Summary The mean total serum oestradiol level was found to be significantly increased in 8 male patients with carcinoma of the breast when compared with 8 healthy reference subjects matched for race, sex and age. The calculated mean free oestradiol index was also higher in these patients. There were no significant differences, however, between the levels of LH, FSH, prolactin, DHEA-S, testosterone and SHGB in the 2 groups. The patients showed a significantly increased LH response to GnRH while there was no difference in the FSH response. Only 1/7 patients had a tumour devoid of steroid hormone receptors. It may be that an increased level of circulating oestradiol-17,B is an important factor in the aetiology of hormone-dependent male breast cancer.
Follow-up studies on 466 patients over a 5-year period showed Whites to have an overall significantly longer disease-free interval and survival than Blacks and Asians. No racial differences in prognosis were seen in patients with Stage II disease (p greater than 0.2) but in Stage III, White patients had significantly longer disease-free periods than Blacks or Asians; the same was not true of survival. Whites had a 67% incidence of cytoplasmic estrogen receptor (CER) positive tumors compared with only 49% in Blacks and 41% in Asians. When tumors were assayed for CER, nuclear estrogen receptor (NER), and cytoplasmic progesterone receptor (CPR), there were no racial differences in the proportions of tumors containing all 3 receptors, but significant variations were found in neoplasms with no receptors and in those with apparently defective receptors. In White patients receptor status had no influence on prognosis (p greater than 0.3). Black patients whose tumors contained both CER and NER had a significantly better time to recurrence than those whose tumors lacked these receptors, while in Asian women the presence of CER alone, or CER together with NER, or CER, NER, and CPR, was indicative of a significantly longer disease-free period.
Fig. 1. A, Diagnostic MRI and, B, 1 year after treatment shows almost complete involution of an orbital metastasis of a prostatic adenocarcinoma. Case reports Cases 1 and 2A 76-year-old man (patient A) and an 83-year-old man (patient B) were examined in 1993 by the ophthalmologist because of diplopia due to progressive unilateral exophthalmus. CT and MRI in both instances showed locally destructive tumours in the right (patient A) and left (patient B) orbital bony and soft tissues. Biopsies revealed adenocarcinomas, which were positive for PSA and PAP on immunohistochemistry. Both patients had high levels of PSA in the serum, 211 ng/mL in patient A and 131.6 ng/mL in patient B. The serum alkaline phosphatase values were normal, although bone scintigraphy showed multiple 'hot spots'. In both cases, a DRE indicated grossly extra-prostatic disease of TNM-stage T4; moreover, TRUS showed multiple hypoechoic lesions, extracapsular disease and seminal vesicle invasion. The TRUS-guided prostate needle biopsies in both patients revealed poorly differentiated adenocarcinomas. Patient A was treated with bilateral subcapsular orchidectomy. One month later the orbital tumour was clearly regressing and the serum PSA level had decreased to 15.4 ng/mL, with a testosterone level of 0.8 nmol/L. A follow-up MRI scan at one year showed almost complete involution of the orbital metastatic process (Fig. 1) and all the visual variables improved to near normality. However, follow-up bone scintigraphy revealed new 'hot spots' in the lumbar vertebral region, while the patient remained in good condition with no pain and an active daily life. The serum PSA level stabilized, with a final value of 14.0 ng/mL. The total follow-up after diagnosis has been 25 months.Patient B was treated with local radiation of the orbital metastasis and chemical castration using the LHRHanalogue goserelin (Zoladex) in 3.6 mg monthly subcutaneous depots after initial pretreatment with cyproterone acetate (Androcur) 100 mg three times daily for 4 weeks. Several weeks after initiation, the serum PSA level was 62.7 ng/mL and the serum testosterone was 0.6 nmol/L. The impaired visual variables showed no improvement.© 1997 British Journal of Urology 288
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