Therapy With Orchiectomy or Estrogens or Both

Abstract

Since its introduction in 1941 by Huggins and Hodges,²androgen-control therapy has been found effective initially in about 70% to 80% of cases of advanced prostatic cancer. Just why the remainder do not respond is unclear. The typical remission is characterized by prompt relief of bone pain and lessening of urinary-tract symptoms. Objective changes include dramatic regression in the primary prostatic growth and return of elevated serum acid phosphatase (SAP) levels to normal. Changes in bone metastases (usually osteoblastic) occur commonly, but are difficult to evaluate radiologically. The metastases may disappear entirely and be replaced by new bone. Osteolytic metastases are not seen as infrequently as in breast cancer; with healing, these also are replaced by new bone. Enlargement of inguinal, femoral, and intra-abdominal lymph nodes usually decreases perceptibly, sometimes completely. Changes in serum alkaline phosphatase levels are not consistent. In many cases, the serum alkaline phosphatase level rises