The hormonal sensitivity of prostate cancer has been exploited clinically since Huggins and Hodges established the suppressive effects of castration on prostate cancer. Despite over sixty years of research into alternate modalities, androgen deprivation therapy (ADT) has become the mainstay treatment for locally advanced and metastatic prostate cancer. Suppression of testosterone production, the primary goal of hormonal therapy, can be achieved by a multitude of treatments. The ideal timing, duration and composition of ADT remains undefined. At the present time, first-line therapy consists of orchiectomy, luteinizing hormone-releasing hormone (LHRH) analogues or complete androgen blockade (CAB). However, new combinations and treatment settings show promise for improving outcomes and decreasing toxicity. This article provides an overview of the hormonal therapies currently used in advanced prostate cancer.
Androgen Antagonists ; Castration ; Gonadotropin-Releasing Hormone ; Orchiectomy ; Prostatic Neoplasms ; Testosterone

PURPOSE: We aimed to evaluate the therapeutic effect of maximal androgen blockade (MAB) compared with that of medical or surgical castration alone in the treatment of the metastatic prostate cancer. MATERIALS AND METHODS: We reviewed the progressive status and the survival of the patients with stage D Prostate cancer who had received hormonal therapies at our institution. Classified by treatment arms, the patients were divided into two groups. Group I was composed of 82 patients who had undergone either bilateral orchiectomy or GnRH agonist (goserelin acetate) injection alone, and Group II, of 65 patients who had undergone MAB with antiandrogen (flutamide) in addition to bilateral orchiectomy or gosereline acetate injection. We investigated the overall survival, time to objective progression, progression-free survival, and side effects. RESULTS: The 5 year survival rates of Group I and II were 31.2 % and 32.5%, respec tively and median survival after the treatment was 34.2 months and 38.0 months respectively, which showed no significant differences between the two groups (p=0.21). The time to objective progression was 22.0 months in Group I and 24.0 months in Group II (p=0.52). Furthermore, each of median progression-free survival was 23.0 months and 24.0 months, respectively (p=0.79). In the minimal disease group, MAB appeared to increase the overall survival rate by 9.7%, progression-free survival rate by 7.3% and the time to objective progression by 10 months, respectively compared with the monotherapy. CONCLUSIONS: In the hormonal therapy for the patients with stage D prostate cancer, there were no significant differences in overall survival, median progression-free sur vival, and time to objective progression between monotherapy and MAB. This indicates that MAB does not have any advantages.
Arm ; Castration ; Disease-Free Survival ; Gonadotropin-Releasing Hormone ; Goserelin ; Humans ; Orchiectomy ; Prostate* ; Prostatic Neoplasms* ; Survival Rate

PURPOSE: The limited information regarding preservation of erectile function following castration is based on self-reports by castrated patients. Therefore, we evaluated the erectile status in 38 patients with advanced prostatic cancer. MATERIALS AND METHODS: Castrations were achieved by bilateral orchiectomy, estrogen therapy of both. Patients answered the questionnaires regarding the medical status and erectile function before and after castration, and the blood levels of testosterone were assessed. Especially in seven patients, penile circumference and erection quality were monitored during the visual sexual stimulation. RESULTS: 11 patients(58%) out of 19 potent men achieved functional erection after castration. Mean serum testosterone level was 0.31 +/-0.19ng/ml in men who were potent after castration and 0.06+/- 0.04ng/m1 in those not potent(p<0.05). No statistically significant differences were noted in age, interval after castration, method of castration, degree of gynecomastia, stage of prostatic cancer and doing radiation therapy between the men who did and did not achieve erection(p>0.05). CONCLUSIONS: Following castration, sexual potency and libido decreased markedly in most cases, but 58% retained some degree of normal sexual potency. And, statistically significant difference was noted only in serum testosterone level between the men who did and did not achieve erection.
Castration* ; Estrogens ; Gynecomastia ; Humans ; Libido ; Male ; Orchiectomy ; Prostatic Neoplasms ; Surveys and Questionnaires ; Testosterone

PURPOSE: In patients suffering from prostate cancer, endocrine treatment is commonly applied to either locally advanced or metastatic prostate cancer. But, there are many side effects with endocrine treatment in spite of its good response. We studied the effect of castration using absolute alcohol injection into the testis of Sprague-Dawley rats. MATERIALS AND METHODS: We checked and compared the serum testosterone level after surgical castration and the injection of a serial amount of alsolute alcohol into the testis of sixty Sprague-Dawley rats. The histologic findings of the testes and prostates in those injected with absolute alcohol were also evaluated. RESULTS: The testosterone level of normal control was 2.29 +/-0.47ng/ microliterand that of the bilateral orchiectomy group was 0.03 +/-0.02ng/ml. The testosterone level of the groups that were injected with absolute alcohol more than 25% of testicular weight were the same as the testosterone level of castrated rats. The histologic findings of the testes and prostates in those injected with absolute alcohol more than 25% of testicular weight were diffusely atrophied. CONCLUSIONS: We suggest that chemical orchiectomy using absolute alcohol as a new endocrine treatment is another modality in advanced prostatic cancer patients who need an orchiectomy.
Animals ; Castration ; Ethanol* ; Humans ; Orchiectomy* ; Prostate ; Prostatic Neoplasms ; Rats* ; Rats, Sprague-Dawley ; Testis* ; Testosterone

Prostate cancer generally relapses into castration resistant prostate cancer (CRPC) after androgen deprivation therapy, which may be associated with androgen metabolism, particularly de novo androgen synthesis apart from the amplification and mutation of androgen receptor and the activation of its signaling pathways. This article focuses on the advances in the studies of the changes in androgen metabolism and de novo androgen synthesis in CRPC as well as their possible mechanisms and clinical significance.
Androgen Antagonists ; pharmacology ; Androgens ; biosynthesis ; metabolism ; Humans ; Male ; Orchiectomy ; Prostate ; metabolism ; Prostatic Neoplasms, Castration-Resistant ; metabolism

OBJECTIVETo introduce the framework of evidence-based practice with a case of castration-resistant prostate cancer (CRPC) as an example.

METHODSA clinical question was formulated according the clinical scenario. A systematic search was conducted for the published literature in the databases of PubMed, EMBASE, Cochrane Library, Clinical Trial Registries, and Web of Knowledge up to Dec 2014. The identified literature was reviewed for quality appraisal before the evidence was applied to clinical practice.

RESULTSThe treatment was effective and the patient achieved disease remission.

CONCLUSIONEvidence-based practice should be integrated with clinical scenario, current evidence, and patients' willingness, and follow a systematic framework.

We tried to find out any differences between initial characteristics of androgen receptors and of relapse after castration in 6 stage D2 prostatic cancer (mean age, 68.7+/-4.6) (Gleason score 5, 8, 9 ; 1,3, 2 patients respectively), with immunohistochemical expression using the mouse monoclonal antibody against human androgen receptor. The prostate specimens were obtained by either transrectal needle biopsy or transurethral resection at the time of initial diagnosis and of relapse following castration. The age matched 6 benign prostatic hyperplasia (BPH) specimens were used as control. 200 cancer cells were chosen and staining intensity of each nuclei was graded (O-absent, +1-weak, +2-moderate, +3-strong) from randomly selected and photographed from 10 different fields of each specimen. The means of staining intensity of nuclei from BPH and prostatic cancer before treatment were 1.93+/-0.03 and 1.59+/-0.03 respectively (p<0.05). At the time of relapse after bilateral orchiectomy (mean, 24.5+/-5.0 months), the mean staining intensity of nuclei of all cancer patients (1.38+/-0.03) was significantly different from that of before treatment (p<0.05). But in individual comparison, we could find the decrement in only 2 patients. The intervals of relapse from castration of these two patients (29 and 32 months) were longer than the mean of 6 patients. In conclusion, androgen receptors are still expressed significantly after castration in prostatic cancer. In some patients (2/6), castration down regulates the expression of androgen receptors and the down regulation closely correlated with the relapse time."
Animals ; Biopsy, Needle ; Castration* ; Diagnosis ; Down-Regulation ; Humans ; Immunohistochemistry ; Mice ; Orchiectomy ; Prostate* ; Prostatic Hyperplasia ; Prostatic Neoplasms* ; Receptors, Androgen* ; Recurrence

Most prostate cancer cases ultimately relapse after a period of initial response to castration therapy and progress to intractable castration-resistant prostate cancer (CRPC). Hardly any therapeutic options currently used can improve the 2- to 3-year survival of the patient. Recently, some new drugs for the treatment of CRPC through various action mechanisms have been approved, and others are in the advanced stage of clinical trial. This review provides an overview of these new therapeutic agents.
Antineoplastic Agents ; therapeutic use ; Humans ; Male ; Neoplasm Recurrence, Local ; Orchiectomy ; Prostatic Neoplasms ; surgery ; Prostatic Neoplasms, Castration-Resistant ; drug therapy ; mortality

No abstract available.
Animals ; Castration* ; Finasteride* ; Prostate* ; Rats*

No abstract available.
Castration ; Granuloma ; Granuloma, Foreign-Body