We have reviewed 500 consecutive prostatectomies with a follow-up period of between 5 and 8 years; 184 surviving patients were sent a questionnaire and patients with residual urinary symptoms were interviewed, examined and a flow rate was performed. The operative mortality rate was 0.5%. Patients who presented with retention of urine had a high mortality rate in the first 3 years after the operation. Thirty-six per cent of surviving patients with chronic retention and 24% of those who underwent elective prostatectomy had residual urinary symptoms at the time of the study. Of patients who were sexually active pre-operatively, 34% felt that the operation was responsible for a deterioration in their sex lives. The incidence of retrograde ejaculation was 93%. It was concluded that prostatectomy is a safe operation with good patient acceptability. Patients with symptoms of prostatism require careful evaluation before prostatectomy and sexually active patients should be warned of the risks of impotence and decreased satisfaction due to retrograde ejaculation.
Summary Thirty-five patients with advanced malignant disease have been treated as outpatients with increasing doses (0.1 -00 mcg) of interleukin 2 (IL2) by once daily self-administered subcutaneous (s.c.) injection, 5 days weekly for 8 weeks followed by a 4 week observation period. Systemic side effects were not experienced by patients at the 3 lower doses. Three patients required dose reduciton from 100 mcg daily because of intolerance (fever, rash, lethargy, nausea and vomiting) and one patient was discontinued because of dyspnoea. We observed immunological effects at the 100 mcg dose (but not at the lower doses). These consisted of (a) a modest sustained lymphocytosis, (b) eosinophilia in six (out of nine) patients and (c) a significant rise in IL2-stimulated peripheral blood lymphocyte activated killer (LAK) cell activity in six (out of nine) patients to a mean of 2.0 times pretreatment levels (P<0.01). Two (out of nine) patients with renal cell carcinoma treated with 100 mcg daily had partial responses of duration 4 and 9 months respectively and a further three had disease stabilisation for at least 3 months. Low dose long-term s.c. IL2 is clinically and immunologically active, and in comparison to other IL2 regimens it has minor toxicity and is easy to administer. These characteristics make low dose s.c. IL2 suitable for study in the adjuvant setting.
Summary
Experience of 26 patients with carcinoma of the prostate treated by adrenal suppression with aminoglutethimide is reviewed. 60% of hormone resistant tumours showed some response.
A fall in plasma testosterone beyond that achieved by oestrogens was not observed.
A high incidence of side‐effects was noted.
A limited role for aminoglutethimide in the management of prostatic carcinoma is suggested.
Our thanks are due to the Consultant Surgeons, St Peter's Hospitals who referred their cases to us for investigation. We acknowledge with thanks the help of Dr I. F. Sommerville and Mr M. D. Mansfield, Department of Clinical Endocrinology, Chelsea Hospital for Women, who performed testosterone assays. Aminoglutethimide was supplied by Ciba Laboratories Ltd, Horsham, Sussex. This work was supported by a grant from the St Peter's Research Trust.
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