A CASE FOR SYNCHRONOUS REDUCTION OF TESTICULAR ANDROGEN, ADRENAL ANDROGEN AND PROLACTIN FOR THE TREATMENT OF ADVANCED-CARCINOMA OF THE PROSTATE

The present study was undertaken mainly to investigate whether prolact in manipulation combined with maximal androgen blockage improves the e ffectiveness of treatment in advanced prostatic cancer. The efficacy o f oral hydrocortisone as an alternative to commercial anti-androgens i n reducing the adrenal androgens, and of bromocriptine in reducing the prolactin level were also examined. A consecutive series of 30 patien ts with untreated and advanced prostatic cancer were entered into a th ree-arm prospective randomised trial. 10 patients received subcapsular orchiectomy alone (arm 1), another 10 had subcapsular orchiectomy plu s flutamide (arm 2), and the remaining 10 had subcapsular orchiectomy plus oral hydrocortisone and bromocriptine (arm 3). Clinical and bioch emical parameters, including trans-rectal ultrasound-determine prostat ic volumes, hormonal profiles and radionuclide bone scan were evaluate d at regular intervals. At 12 months, serum testosterone was reduced b y more than 90% in all arms, however, maximum suppression of androsten edione, prolactin, and reduction of prostatic volumes were only observ ed in arm 3; this was reflected by the significant improvement in clin ical response in arm 3 compared with other arms. This study suggests t hat a combined maximal suppression of androgens and prolactin offers a significant improvement in response over conventional treatments with out prolactin suppression in the treatment of advanced prostatic cance r. Importantly, a better clinical outcome in arm 3 was still apparent at the end of 36 months.