Hormonal Therapy in Metastatic Prostatic Cancer

Abstract

The concept of hormonal therapy for prostatic cancer was introduced in 1941 by Huggins and Hodges with the prospect of curing even the most advanced of cases. They reasoned that since normal prostatic epithelium is androgen dependent, prostatic cancer should be similarly dependent. They and others then demonstrated that human prostatic cancer could be made to regress by the administration of pharmacologic doses of estrogens or by castration (Huggins et al. 1941; Spirnak and Resnick 1983). However, after a decade of enthusiastic and optimistic use of these forms of androgen ablation in all stages of prostatic cancer, it became apparent that hormonal therapy was not to be the panacea initially envisaged. Clinical studies conducted from 1942 to 1983 failed to define clearly the indications for this treatment except to demonstrate that hormonal therapy could not cure prostatic cancer. Studies by Vest and Frazier (1946), Nesbit and Plumb (1946), and Nesbit and Baum (1950) all suggested that hormonal therapy prolonged survival of patients with metastatic disease. However, the Veterans Administration Cooperative Urological Research Group (VACURG) (1967) failed to demonstrate any survival benefit of early hormonal therapy in advanced disease. Lepor et al. (1982) compared the survival of patients with metastatic disease treated immediately prior to the introduction of hormonal therapy with that in patients treated immediately after.