ENDOCRINOLOGICAL STUDY OF PROSTATIC CARCINOMA

EFFECTS OF ANTI-ANDROGENIC TREATMENT ON URINARY ESTROGEN EXCRETION

Abstract

Since the report of Huggins and Hodges in 1941 anti-androgenic treatment was widely recommended for the treatment of prostatic carcinoma and from clinical and endocrinological point of view, numerous reports have been published, but only a few report concerning urinary estrogens in course of anti-androgenic treatment.
The auther presents the changes of urinary estrogen excretion of patients with prostatic carcinoma in course of several kinds of anti-androgenic treatment.
Estrogen outputs in urine were determined in 21 patients, of which 4 were performed with castration, 7 were administered with synthetic estrogens (Hexestrol of Stilbestrol diphosphate), 4 were administered with corticosteroids and 6 were performed with hypothalamo-pituitary x-ray irradiation.
Urinary estrogens (estrone, estradiol-17β and estriol) determined by modified method of Aida (1959).
In cases of hypothalamo-pituitary irradiation of x-ray was irradiated on the fields of bilateral temporal areas, total surface doses ranging from 2500 to 6000r. In 5 cases surface dosis of 250r at a time was irradiated on a field of each side alternately every other day, and in the remaining. one 150r was irradiated at a time every day alternately on each side.
The results are as follows:
1) Urinary estrogens showed transient increase within 10 days after castration, the rate of increase being 48.1%. One month after the intervention the values decreased to about 70% of preoperative level.
2) Following administration of synthetic estrogens (Hexestrol or Stilbestrol diphosphate) daily outputs of urinary estrogens showed indifinite of decreasing tendency.
3) Administration of corticosteroids did not resulted in definite changes of urinary estrogen, excretion.
4) There observed two peaks of urinary estrogen excretion in course of hypothalamo-pituitary x-ray irradiation, which were encountered when total surface doses amounted 250 to 900r and 3000 to 4000r. The rates of increase were 48.3% and 54.1%, respectively. Between the two peaks of increment urinary estrogens remained in the level as much as pre-irradiation. After the course of irradiation, urinary estrogen excretion decreased to 90% of pre-irradiation level. There was no difference of urinary estrogen excretion between patients with metastasis and without metastasis. In 3 of 6 patients clinical responses of the carcinoma to the irradiation were verified as reduction in size and in hardness of the prostate gland, decreased amount of residual urine and cellular atrophy and fibrosis in biopsy specimens. Presence of two peaks of urinary estrogens suggests that there may be some controlling mechanism in estrogen excretion other than hypothalamopituitary system.