The Diagnosis of Oestrogen Escape and the Role of Secondary Orchiectomy in Prostatic Cancer

Abstract

The criteria for the diagnosis of progression of prostatic cancer after primary treatment by androgen suppression (oestrogen escape) were studied in 30 patients. Objective criteria are essential for this diagnosis and in this study the bone scan was the most useful criterion. Twenty-one of these patients had a secondary orchiectomy: one patient showed a partial objective response and 3 had a subjective response. It is concluded that an orchiectomy following failed primary oestrogen therapy is an ineffective procedure and therefore unjustifiable and that alternative treatments must continue to be evaluated.

Evaluation of Ki‐67 Monoclonal Antibody as Prognostic Indicator for Prostatic Carcinoma

“…The clinical outcome of patients followed up for over 12 months was classified as disease progression or non-progression, based on guidelines described by Chisholm and Beynon (1982). Patients experiencing tumour progression despite androgen deprivation were considered to have developed "hormonal escape" (Stone et al, 1980).…”

The patient, disease status, and treatment options for prostate cancer: Stages D1 and D2

“…These levels decreased later on supplemental estrogen therapy, correlating with a good clinical response after initial relapse. Whether secondary orchiectomy can induce clinical remission following failure on primary estrogen therapy remains controversial, and, at best, occurs in no more than 10% of patients [12].…”

Hormonal Aspects of Prostatic Cancer: A Review

“…In a study of 21 patients who had failed primary endocrine treatment using cyproterone acetate or diethylstilboestrol, subcapsular orchidectomy was performed. Only one patient improved objectively though 3 showed a subjective response (Stone et al 1980). In a study of 29 men similarly pretreated, 5 were~shown to have had an objective response to orchidectomy (Biorn et al 1979).…”

“…This hypothetical explanation of relapse is naive, for in relapse prostatic cancer is frequently sensitive to secondary hormonal manipulation. Relapse from primary endocrine control occurs within a variable period, with a mean duration of response of approximately 2 years (Stone et al 1980). The hormonal mechanism for escape remains unknown.…”