Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Serum testosterone and prostate-specific antigen (PSA) levels were measured in 3 patients with Stage D2 prostate cancer before and after discontinuation of the long-acting LHRH agonist, goserelin acetate (Zoladex). The patients had received goserelin acetate for ten, sixteen, and thirty months prior to discontinuing the drug because of progressive metastatic disease. In all 3 patients, PSA and testosterone levels increased after goserelin acetate was discontinued. In 2 patients the testosterone level reached normal levels. A bilateral orchiectomy was performed one hundred sixty, one hundred, and seven days, respectively, after the drug was discontinued. In all 3 cases PSA and testosterone levels were reduced following castration, although PSA levels again began to increase within two weeks of orchiectomy in 2 of the 3 patients. These findings suggest that suppression of testosterone by LHRH agonists is not permanent and if tumor progression occurs, maintaining hormone suppression may still be beneficial.
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PMID:Response to orchiectomy following Zoladex therapy for metastatic prostate carcinoma. 170 66

Treatment of carcinoma of the prostate with hormones can be carried out as partial or complete androgen deprivation. As primary therapy it may be administered palliatively in advanced carcinomas (almost always metastatic), as adjuvant treatment following radical prostatectomy, as "salvage" treatment in post-irradiation recurrent disease, or secondarily after unsuccessful primary treatment. In the case of primary treatment, androgen deprivation is more effective than chemotherapy (NPCP Protocol 1300). LHRH analogues (of the gosereline acetate type) are equally as effective as orchiectomy (standard therapy), but cause a flare-up of the patient's symptoms within the first two weeks, and are therefore given in combination with an antiandrogen. The use of a pure antiandrogen (of the flutamide type) is equally as effective as the standard therapy, but in contrast to the latter, impotence does not occur. Complete androgen deprivation (LHRH analogues plus pure antiandrogens) is more effective in the case of low-volume metastases--in terms of time-to-progression--than standard therapy.
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PMID:[Conservative therapy of prostate cancer]. 172 88

Based on a retrospective series of 7 cases, the authors study the particular features of prostatic cancer before the age of 50 years. These 7 patients all had an advanced tumour with, in 4 cases, documented metastases. A single patient had a well differentiated tumour, while the others had a moderately or poorly differentiated or undifferentiated tumour. All patients died rapidly, except one who is currently receiving treatment with an LHRH agonist, with a follow-up of 25 months. On the basis of this study, the authors distinguish between prostatic cancers clinically detectable before the age of 50 years, and those which remain occult, leading to a histological discussion between a benign disease and true early cancer. In the light of these findings, systematic screening for prostatic cancer before the age of 50 years does not appear to be justified.
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PMID:[Prostatic cancer before the age of 50--report of 7 cases]. 172 44

Breast cancer in the male is an uncommon disease, occurring less than 1% as often as in females. Because of its rarity, this disease has not been as extensively studied as its female counterpart. Male breast cancer is evaluated and managed in a fashion very similar to that for female breast cancer. Primary management in early stage disease is usually a modified radical mastectomy. First line hormonal therapy for metastatic disease, in our institution, is tamoxifen for patients with positive estrogen receptors. Second line therapy consists of progestins or antiandrogens/LHRH analogs. No firm recommendations can be made concerning adjuvant systemic therapy. However, it is likely that studies from female patients are adaptable. Unfortunately, carcinoma of the male breast is such an infrequently encountered tumor that unfamiliarity with the disease can lead to delays in diagnosis and treatment. An increased awareness of the disease may be expected to result in earlier detection and institution of therapy at a stage when cure may be possible.
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PMID:Male breast cancer. 177 19

Between November 1983 and February 1986, 358 patients with previously untreated metastatic prostatic carcinoma entered a multicentre, randomised trial in the United Kingdom and the Republic of Ireland, in which the LHRH analogue Zoladex (ICI Pharmaceuticals PLC), administered subcutaneously every 28 days, was compared with orchiectomy. Both treatments were equally effective in lowering serum testosterone concentrations to within the surgically castrate range and this was accompanied by equivalent subjective and objective response rates and times to treatment failure. At a median follow-up of 2 years there was no difference in overall survival, confirming that Zoladex is an effective medical alternative to orchiectomy in patients with metastatic disease.
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PMID:Comparison of LHRH analogue (Zoladex) with orchiectomy in patients with metastatic prostatic carcinoma. 153 12

Serial determinations of serum oestradiol (E2), follicle-stimulating hormone (FSH) and luteinising hormone (LH) were done to assess the effect of chemotherapy, with or without a gonadotropin-releasing hormone analogue, buserelin, on ovarian function in 147 premenopausal women treated for breast cancer. Cyclophosphamide, doxorubicin and 5-fluorouracil (CAF) plus buserelin was given to 81 women with metastatic disease, and 66 women were randomised to adjuvant cyclophosphamide, methotrexate and 5-fluorouracil (CMF) with buserelin or CMF alone. Baseline mean E2 of patients treated with cytostatics plus buserelin fell from premenopausal levels and remained low while patients were on study. E2 levels remained at premenopausal values in patients treated with CMF alone. Downregulation of FSH and LH occurred with cytostatics plus depot buserelin, but fluctuated with the nasal administration; on CMF alone, FSH and LH levels increased. Buserelin plus cytostatics more effectively caused ovarian ablation than cytostatic treatment alone. Depot buserelin was more effective than nasal buserelin.
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PMID:Effect of chemotherapy with or without buserelin on serum hormone levels in premenopausal women with breast cancer. 183 87

In a randomized, double-blind trial for metastatic prostate cancer (Stage D2), 603 men received leuprolide, a gonadotropin-releasing hormone analog that inhibits the release of gonadotropins, coupled with either placebo or flutamide, a nonsteroidal antiandrogen that inhibits the binding of androgens to the cell nucleus. The 303 men receiving androgen blockade with leuprolide and flutamide demonstrated a longer progression-free survival (16.9 vs. 13.9 months, P = 0.039) and an increased median length of survival (35.0 vs. 27.9 months, P = 0.035). In the subgroup of men with minimal disease and good performance status, the advantages of maximal androgen blockade were more pronounced. It is concluded that combined androgen blockade with leuprolide and flutamide was more effective than leuprolide alone for patients with metastatic cancer of the prostate. The therapeutic benefits, although greatest in patients with minimum disease, need to be evaluated in a prospective, randomized fashion in trials specifically designed for men with minimal disease and good performance status. Exploratory analyses using the black race as an explanatory variable were also performed. Black race is associated with shorter survival times and is also associated with other prognostic factors, including recent weight loss, anemia, elevated phosphatase levels, and pain. These findings suggest the need for future studies of the relationship of black race and response to prostate cancer therapy.
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PMID:Leuprolide with and without flutamide in advanced prostate cancer. 211 17

The paper reviews the studies published between 1982 and 1989 on the subject of the use of LHRH analogs in gynecological oncology. Following the analysis of hormonal changes induced by analogue therapy in premenopausal women with advanced stage breast cancer, the clinical results obtained through the clinical treatment of this neoplasia are reported. Results to date are encouraging and analogue therapy still represents an alternative to surgical sterilisation. The clinical findings in postmenopausal women are less encouraging. In both pre- and postmenopause groups, findings were correlated to the receptorial status and site of metastases. The possibility of associating analogues to other hormone replacement therapies, or to chemotherapy is then discussed. Lastly, preliminary data concerning the use of analogue therapy in advanced-stage ovary cancer are analysed. The current indications for therapy and problems still to be resolved concerning the use of LHRH analogue therapy in the context of gynecological oncology are summarised by way of conclusion.
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PMID:[LHRH-analogues: clinical results in ovarian and breast cancer]. 219 55

Endocrine therapy is a major treatment modality for the systemic management of breast cancer. In comparison with alternatives such as chemotherapy, hormone manipulations have the advantage of lower toxicity but suffer from the disadvantages of producing responses in only 30-40% of patients with metastatic disease and seldom being curative. Nevertheless in recent years there have been significant advances in the endocrine treatment of breast cancer which have stemmed from a better understanding of the sources from which breast tumours may be supplied with hormones, the mechanism by which hormones regulate tumour proliferation and the more accurate identification of hormone sensitive tumours. As a result agents such as antioestrogens, aromatase inhibitors. LHRH agonists have largely superseded surgical and radiological ablation of endocrine organs. The major reduction in morbidity associated with these medical regimes means that they are much more acceptable to patients and may be used as adjuvants to local treatment of the breast in patients with "earlier" stages of the disease. At the same time patients can now be offered rational treatment selected on the basis of tumour biology rather than on more empirical criteria. The aims of this review are to provide details of the research which has led to this progress in endocrine treatment of breast cancer and to put into perspective the prospects for further advances.
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PMID:Endocrine treatment for breast cancers: biological rationale and current progress. 227 30

Prostate cancer is the most common malignancy in men over 70. Chronic course of the disease and multiple therapeutic options allow a customized management of the patient's individual problems. Prognostic factors are stage, size of primary tumors, serum acid phosphatase levels, number of metastases, ureteral obstruction and patient's age. In localized disease, surgery and radiation therapy are equally effective for patients with a life expectancy less than or equal to 10 years. Surgery may be superior to radiation if longer survival is expected. In locally advanced disease radiation therapy is preferred to surgery, due to a lower rate of complications. Management of metastatic disease requires offsetting androgen effects by castration or by antiandrogens. Orchiectomy, the safest way to produce castration, is unacceptable to 50% of patients. LHRH analogs are safer than estrogens, but more expensive; the risk of tumor flare up controindicates these compounds in life-threatening situations. The use of ketoconazole is limited by long-term toxicity, but may be life-saving in life-threatening situations, due to a rapid onset of action. Antiandrogens are as effective as castration, but are not commercially available in the USA. Alternative treatments include Estracyt, intermittent estrogentherapy, progesterone derivative and aminogluthetimide. Radical prostatectomy and radiation therapy to the prostate cause erectile impotence with persistence of orgasmic sensations. These patients are ideal candidates for erection-restoring interventions, such as intrapenile injections or penile implants.
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PMID:Prostate cancer: a model of cancer in the elderly. 266 Jul 61


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