LH-RH-endocrine manipulation in cancer of the prostate

The treatment of advanced stage D, cancer of the prostate is palliative, and based mainly on endocrine manipulations: orchiectomy or estrogen administration. Both attempt to achieve objective and subjective patient response by reducing either the amount or the action of circulating testosterone levels. This review discusses the history and rationale of these endocrine treatments. Two long term clinical studies completed during the 1950's and 1960's have shown the beneficial effects of estrogen use on patient survival. Despite several design errors, these studies indicated favorable results obtained by the combined use of orchiectomy and estrogens in producing long-term remissions. Recently, advances made in the use of hormone-receptor analysis have been applied to the selection of patients who may benefit from various forms of endocrine treatment. The application of these techniques stems from the encouraging results obtained with the use of receptor analysis in the management of advanced carcinomas of the breast, also a hormone-responsive tumor. Preliminary reports are encouraging as patient selection may be accomplished more rationally, while sparing potential non-responders the side-effects of long-term estrogen administration. The role of the recently available luteinizing hormone releasing hormone (LHRH) analogues as diagnostic and therapeutic tools in the treatment of advanced prostatic carcinoma is also discussed.