Hormonal therapy of prostatic cancer

The principle goal of hormonal therapy in the treatment of prostatic cancer, as Huggins suggested in 1941, is the suppression of androgenic stimuli. Consequently, the treatment of advanced prostatic cancer has consisted of orchiectomy, estrogen administration, antiandrogen therapy, adrenalectomy or hypophysectomy, or a combination of some of these. Although the three VACURG studies are subject to several valid criticisms, they provide the best available information to date. In summary, these studies report 1) patients with low stage disease who are treated with estrogen (diethylstilbestrol 5 mg/day) have a higher death rate, mainly cardiovascular, than men not receiving estrogen and 2) in patients with high stage disease, delayed hormonal therapy is as effective as early hormonal therapy. Castration appears to be as effective as treatment with estrogens or a combination of the two and does not evoke the untoward side-effects of estrogen administration. Although subjective improvement has been observed following adrenal or pituitary ablation, the duration of response is usually short, and consequently these procedures are used infrequently now. Experience with the use of antiandrogens is even more limited. Efforts must continue to develop means of predicting hormonal responsiveness. If receptor measurements prove to be an accurate means for predicting the hormonal responsiveness of prostatic cancer, as they have in breast cancer, then our current plan of treatment will need modification. In those men who are unlikely to respond to hormonal therapy, early chemotherapy should be instituted.