TY - JOUR
T1 - Orchidectomy and oestrogen therapy revisited
AU - Iversen, P
PY - 1998
Y1 - 1998
N2 - Over the past 20 years therapeutic options for prostate cancer have increased. Nevertheless, there may still be a role for long-established treatments such as orchidectomy and oestrogens. Orchidectomy is a simple surgical procedure, and patient survival is comparable with other treatments involving androgen ablation. However, loss of libido and sexual function is an expected outcome and hot flushes occur in about 50% of patients. Osteoporosis, loss of muscle mass, and the psychological impact associated with orchidectomy are of concern, particularly with increasing treatment periods. Nevertheless, orchidectomy is indicated when an immediate reduction of testosterone levels is required, or the patient does not comply with other treatments or objects to the cost of medical therapy. Oestrogen therapy may be superior to castration in terms of efficacy, but orally administered oestrogens are associated with gynaecomastia, loss of sexual function and unacceptable cardiovascular toxicity. Low dose oestrogens in combination with antiandrogens or antithrombotic agents may be better tolerated treatments. The route of administration is a crucial factor in the genesis of cardiovascular toxicity and parenterally administered oestrogens may not entail the same risk. Further research in this area is warranted.
AB - Over the past 20 years therapeutic options for prostate cancer have increased. Nevertheless, there may still be a role for long-established treatments such as orchidectomy and oestrogens. Orchidectomy is a simple surgical procedure, and patient survival is comparable with other treatments involving androgen ablation. However, loss of libido and sexual function is an expected outcome and hot flushes occur in about 50% of patients. Osteoporosis, loss of muscle mass, and the psychological impact associated with orchidectomy are of concern, particularly with increasing treatment periods. Nevertheless, orchidectomy is indicated when an immediate reduction of testosterone levels is required, or the patient does not comply with other treatments or objects to the cost of medical therapy. Oestrogen therapy may be superior to castration in terms of efficacy, but orally administered oestrogens are associated with gynaecomastia, loss of sexual function and unacceptable cardiovascular toxicity. Low dose oestrogens in combination with antiandrogens or antithrombotic agents may be better tolerated treatments. The route of administration is a crucial factor in the genesis of cardiovascular toxicity and parenterally administered oestrogens may not entail the same risk. Further research in this area is warranted.
KW - Androgen Antagonists
KW - Antineoplastic Agents
KW - Cardiovascular Diseases
KW - Combined Modality Therapy
KW - Estrogens
KW - Humans
KW - Male
KW - Orchiectomy
KW - Prostatic Neoplasms
M3 - Journal article
C2 - 9854189
VL - 34 Suppl 3
SP - 7
EP - 11
JO - Open Access Journal of Urology
JF - Open Access Journal of Urology
SN - 0302-2838
ER -