The clinical significance of steroid hormone measurements in the management of patients with prostatic cancer

Abstract

In a study involving 174 patients with proven carcinoma of the prostate the significance of steroid measurements in circulating blood, prostatic tissues and urine in relation to clinical management of patients was evaluated and the following findings were obtained: 1. Despite certain differences in the serum level of individual androgens between normal and malignant patients, single measurements of androgens does not provide a reliable index for differentiating the normal subjects from patients with carcinoma of the prostate. However, the ratio of testosterone (T) to either 5α-dihydrotestosterone (DHT) or 5α-androstane-3α, 17β-diol (diol) can provide a better discriminant. 2. Assessment of changes in serum T and DHT following endocrine therapy of 158 patients with carcinoma of the prostate showed that with the exception of radiotherapy a highly significant suppression of these androgens were found following orchidectomy, treatment with diethylstilboestrol (DES), estramustinephosphate (Estracyt) and cyproterone acetate. The latter compound produced the least suppression of T compared to the other endocrine modalities. Estracyt produced similar degrees of suppression of DHT as Cyproterone acetate, but less than either orchidectomy or DES. 3. The measurement of steroids in prostatic tissues provides a more reliable index for separating malignant from benign hypertrophied tissues. Androstenedione, oestradiol-17β and T were found to be significantly higher in malignant prostates, whilst DHT was higher in benign hypertrophied tissues. 4. Urinary measurements of unconjugated steroids proved to be the least effective means in assessing the endocrine status in patients with malignant prostates.