[Hormone therapy of prostatic cancer (author's transl)]

64% of all patients with newly diagnosed prostatic carcinoma present with metastases. Hormone application with or without orchiectomy appears to be the adequate form of primary treatment. The most common therapeutic modality is estrogen administration, which has, however distinct disadvantages: The patient is protected up to 5 years only, there is a 27% cardiovascular mortality, it induces a prolactin surge, and is immunosuppressive. Phase III-studies of the EORTC and VACURG have demonstrated that medroxyprogesterone acetate and cyproterone acetate parallel the effectiveness of estrogens. In a phase II-trial adjunctive bromocriptine was found to be necessary to suppress estrogen or antiandrogen induced hyperprolactinemia. The following concept is derived: In disseminated untreated prostatic cancer estrogens or antiandrogens in combination with bromocriptine or high dose injectable gestagens are effective means of primary treatment. Distinct clinical parameters determine the "hormone of first choice". Orchiectomy is reserved for patients with ureteral compression or progressing disease.