A pilot trial of chemohormonal therapy for metastatic prostate carcinoma

Article Abstract:

Prostate cancer is extremely common among older men. In 1991, an estimated 122,000 new cases occurred in the US, and 32,000 men died from this disease. It is estimated that 70 percent of patients with prostate cancer will develop metastatic disease. This spread of prostate cancer to other organs, often bones, may be temporarily controlled, but, as is the case for many cancers, metastatic disease is rarely cured. Prostate cancer is sensitive to stimulation by male hormones, and therapy for metastatic prostate cancer is directed at removing this source of stimulation. This is accomplished by surgically removing the source of male hormones or by chemically interfering with the normal production of male hormones. Temporary tumor control may be achieved in 80 to 85 percent of cases, but overall survival is less than three years after treatment. A pilot study was conducted to evaluate the combination of hormonal treatment with standard chemotherapy. Fifteen patients were treated with leuprolide and flutamide, drugs that block the synthesis of male hormones (androgens) and interfere with their effects. Prior to the standard chemotherapy, the patients were primed with androgens. This priming stimulates the cancer cells which had been suppressed by the antiandrogen treatment; the idea is to catch them with the cytotoxic chemotherapeutic drugs just at they are starting to multiply again. Three patients achieved a complete response, that is, a disappearance of the symptoms of cancer, as a result of this treatment. Eight patients experienced a partial response, which is generally defined as a reduction in apparent tumor mass of at least 50 percent. The remaining four patients experienced stabilization of their cancer. The median time to disease progression among these patients was 31 months, and nine of the 15 patients are still alive after a median follow-up time of 42 months. The results of the present study were excellent and suggest that a larger trial of this combination of hormonal and chemotherapy is in order. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prostate cancer, Hormone therapy

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Small testicles with impaired production of sperm in adult male survivors of childhood malignancies

Article Abstract:

To evaluate the long-term damage to the testes sustained by boys treated for various cancers, a total of 66 patients were examined for testicular size and function. The mean follow-up time since the initial diagnosis of cancer was 14.5 years. Fifty-one men had small testicles, and the smallest were in the 14 patients who had been treated for leukemia. Five had testicles which were abnormally soft. Sperm production was correlated with testicle size; of those providing samples, 12 percent of those with small testicles had signs of sperm production, compared with 83 percent of those with somewhat larger testes, i.e. volume greater than 10 milliliters (ml). In addition, the serum levels of follicle stimulating hormone (FSH) correlated strongly, and inversely, with sperm production. In this study, only two factors correlated with decreased testicle size on multivariate analysis. Having irradiation either to the head or the testes and having therapy which included cyclophosphamide were independently correlated with having small testes. The results suggest that the measurement of testicular size and the evaluation of FSH levels may be a practical approach for predicting testicular damage to boys undergoing chemotherapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Diseases, Testis, Cancer in children, Childhood cancer, Chemotherapy, Cyclophosphamide

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