Hormonal therapy in prostatic carcinoma

A significant number of patients with newly diagnosed prostatic cancer will be found to have metastatic disease at time of presentation. Since the work of Huggins and Hodges in the early 1940s, endocrine manipulation and androgen deprivation have become the accepted methods of treating this group of patients. Approximately 70 per cent to 80 per cent of patients demonstrate positive clinical response. Many experience a decrease in the size of the primary tumor, a decrease in the levels of serum acid phosphatase, relief of bone pain, a decrease in bladder outlet obstruction, an increase in appetite, and a generalized improvement in their overall sense of well-being. Adequate hormonal therapy usually consists of estrogen administration of bilateral orchiectomy, but other modalities include administration of antiandrogens, progestational agents, androgen-synthesis inhibitors, and, recently, gonadotropin-releasing hormone analogues. This latter group may have increasing applications, particularly if the evidence indicating reduced side effects continues to be substantiated. The probability of producing a positive clinical response is increased when hormonal therapy is introduced at the time of diagnosis, at which point the tumor is still likely to be androgen dependent.