Hormonal therapy androgens

The rationale for hormonal therapy is based on the effect of androgens on the growth and differentiation of the normal prostate (Fig. 65-1). 

The role of combined hormonal therapy, also referred to as maximal androgen deprivation or total androgen blockade, continues to be evaluated. 

Oral androgens as may be used in hormone therapy for the management of metastatic breast cancer are effective in about 30% of women regardless of age, but virilizing doses of the hormone are usually required. The oral androgens carry the additional risk of toxic hepatitis. 

Diethylstilbestrol continues to be recommended in some centers as one of the agents of last resort when prostate cancer proves refractory to steroid hormones or androgen deprivation therapy has done all it can (1). In a Japanese study in which 16 patients were given a daily intravenous injection of diethylstilbestrol diphosphate 250 mg for 28 days, the short-term response was favorable and the drug was well tolerated (2). 

Most steroid-sensitive cancers express specific cell surface receptors. Prednisone-sensitive lymphomas, estrogen-sensitive breast cancers, and prostatic cancers express specific receptors for corticosteroids, estrogens, and androgens, respectively. It is now possible to assay tumor specimens for steroid receptor content and to identify which individual patients are likely to benefit from hormonal therapy. Measurement of the estrogen receptor (ER) and progesterone receptor (PR) proteins in breast cancer tissue is now standard clinical practice. ER or PR positivity predicts response to hormonal therapy, whereas patients whose tumors are ER-negative generally fail to respond to such treatment. 

P18. Prins, G. S., Sklarew, R. J., and Perschuck, L. P., Image analysis of androgen receptor immunostaining in prostate cancer accurately predicts response to hormonal therapy. J. Urol. 159, 641-649 (1998). 

Hormone therapy. The objective is to reduce androgen production or effect by using,... 

A flare phenomenon is a well-documented effect of hormonal therapies and/or hormone-responsive tumors. A prostate-specific antigen flare occurred in four of 28 patients who received liposomal doxorubicin (Caelyx) for symptomatic androgen-independent prostate cancer (40). 

Hormonal therapy is useful in treating acne in women with elevated or normal serum androgens. It may also be warranted for female patients with severe seborrhea, clinically apparent androgenic alopecia, seb-orrhea/acne/hirsntism/alopecia syndrome, late-onset acne, and with proven ovarian or adrenal hyperandrogenism. ... 

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