Orchidectomy and oestrogens as secondary forms of treatment for metastatic prostatic cancer

When in a patient with metastatic prostatic cancer progression of tumour growth occurs during first-line endocrine therapy the prognosis appears to be poor. In the literature there are only a few reports about the efficacy of second-line treatment with castration or oestrogens indicating a mean response rate of 15-20%. The most effective sequence of endocrine therapy has not been determined. Therefore we have evaluated the data of 932 patients treated for prostatic cancer between 1970-1980 in our hospital. Of these 932 patients 516 (55%) had metastatic disease. In 275 patients (53% of the patients with metastatic disease) the metastases were already detected at time of diagnosis of the primary tumour. Adjuvant therapy appeared to cause a delay in the occurrence of overt metastases but (nearly) not an improvement of overall survival for patients who developed metastases. We found no relationship between survival from the time of presentation of metastases and age. The median survival after occurrence of metastases was 18 months with a 5-year survival of 10%. From start of second-line therapy the median survival appeared to be only 6 months with a death rate of 3 times as high as from start of first-line therapy. Looking into our data one could be tempted to express that 1) the combination of castration plus oestrogens as a first-line therapy seems to have a somewhat better effect on survival than other forms of endocrine therapy; 2) that as a second-line therapy castration appeared a suitable form of treatment after oestrogens, antiandrogens after castration and oestrogens when antiandrogens were used in the first line.