Document DMwqB5byxYM9Rp7pJjrDrd4zO

H FM - 003529 TABLE 3 CAUSE OF DEATH BY PRIMARY TREATMENT" Cause of Death 7 Orchiectomy Estrogen + Orchiectomy Prostatic carcinoma Other neoplasms ' Cardiovascular diseases Other, mainly respiratory diseases 47.4% 32.8% 13.2% 6.6% 64.7% 6.0% s. 22.9%A 6.4% * Excluding patients who are alive or have died.from unknown cause*. ANot statistically significant. may lead to a valid endocrinologic con-' elusion. In our own experience, this does not justify a change in clinical judgment and is a research project only. The follow ing viewpoints for conventional hormonal palliation with advanced, untreated pros tatic carcinoma are restated: Withhold therapy until the patient's symptoms or general condition warrant treatment. Generally, use castration alonealthough many physicians also? administer stilbestrol either with or without castra tion. a When stilbestrol is administered follow ing symptomatic or clinical relapse after castration, limit the dose to one mg. daily. There is some suggestion, how ever, that three mg./day may. provide better androgen suppression in certain patients. a High-dose estrogen therapy (natural or synthetic source) is not recommended except for selected use in short-term, acute situations. Hypophysectomy and adrenalectomy have been discussed previously.1 The ef fectiveness of these two procedures has been established and need not be repeated at this time. Occasional long-term results from this form of extensive hormonal therapy have been described. '`However, following new forms of chemotherapy for patients-relapsing after conventional hor- "Hormones should be considered j essentially palliative and should 7 not be confused with primary treatment." monal therapy, it has been found that chemotherapy is generally superior.IT Non-steroidal anti-androgens and other agents that have suppressive effects upon the adrenals have'undergone some clinical study, u. isThey do not, however, appear to afford a practical or useful alternative; for palliation at this time. Metastatic pro? static cancer that has relapsed following conventional hormonal. therapy cati be t) 0 1 494? CA-A CANCER JOURNAL FOR CUNICIANS 4 managed usefully according to the results results have been documented.20-22 It is of the National Prostatic Cancer Project, important to emphasize that the criteria The National Prostatic Cancer Project and. evaluation of the response parameparticipants (see box on page XX) have ters selected by this particular national demonstrated that a variety of forms of group have beat found reproducible and chemotherapy in such patients who have tisefhl in the hands of others.23 Moreover, had previous radiotherapy or who have they too, even in dealing with widespread not been treated with radiotherapy, can metastatic disease in patients who have be effective in controlled randomized clin- relapsed after all forms of conventional ical T values. Although these agents are therapy, have found a relationship betoxic, under a carefully controlled pro twe^pprimary tumor histologic gradegnd gram they can be used successfully. Their hml MetS/Wlio trt fshemAtkAvamr 24Tkt im' VOL. 28, NO. 2 MARCH/APRIL 1978 wr!0 1 C94!