Abstract
For many years the rival merits of prophylactic vs therapeutic castration have been enthusiastically endorsed (mainly on empirical grounds) by those clinicians concerned with the total treatment of breast cancer.(‘*14 In premenopausal patients with operable breast cancer, is it wise to perform prophylactic castration as an adjunct to surgery or is it wiser to reserve this procedure for the palliative treatment of recurrent or metastatic disease? This is, indeed, the doctor’s dilemma! As long as the practice of medicine remained a “science of uncertainty and an art of probability” doctors were destined to be impaled upon the horns of this dilemma. However, today, fortunately, we are on the threshold of a new and exciting era in science-a new generation of radiometric testing called endocrine receptor assays. The results of these steroid hormone receptor assays can be a very specific and selective cytoplasmic binder for tumor tissue. When these results are combined with sophisticated nuclear scans and data gleaned from biochemical tumor markers this information may provide us with new and valuable guidelines for the resolution of this clinical dilemma, namely which patients will be most likely to respond favorably to castration, endocrine ablation or hormone therapy. Additional tests of hormone dependence currently under study may be even more valuable in the future.
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