DEVELOPMENT OF PROSTATE-CANCER AFTER PITUITARY DYSFUNCTION - A REPORTOF 8 PATIENTS

Objectives. Eight patients with a history of pituitary dysfunction wer e seen in the Department of Radiation Oncology at the Hospital of the University of Pennsylvania for evaluation of their prostate carcinoma. Because prostate cancer is a hormonally responsive cancer, hormonal a bnormalities from pituitary dysfunction may have played a role in its development. In addition, many patients with pituitary dysfunction rec eive exogenous hormonal replacement. The histories of these 8 patients were reviewed to look for any common underlying factor in the develop ment of their prostate cancer. Methods, The radiation oncology charts, hospital charts, and pathology reports were reviewed. The cause and t reatment of the pituitary disorder were reviewed. Hormonal dysfunction , hormonal replacement, and treatment duration were recorded. The inte rval to the development of prostate cancer, stage at diagnosis, prosta te-specific antigen level, Gleason score, treatment, and treatment out come were also investigated. Results, We found a variety of pituitary disorders and treatments. However, all patients received testosterone replacement therapy prior to the development of their prostate cancer (median of 30 months). The time to the development of the cancer range d from 26 to 250 months (median 98). Patients had Stage T2 or T3 tumor s at diagnosis. Patients were treated either with radical prostatectom y or radiation therapy. Six of the 8 patients were alive and doing wel l at their last follow-up examination. Conclusions. Prostate cancer ha s been shown to be androgen responsive. All the patients in this serie s were placed on physiologic testosterone replacement for pituitary dy sfunction. The role of testosterone in the initiation of prostate canc er has been debated. However, at the present time, it seems appropriat e to establish close monitoring for prostate cancer in patients receiv ing androgen therapy for pituitary dysfunction. (C) 1997, Elsevier Sci ence Inc.