Treatment prostatic carcinoma

Use synthetic nonapeptidc agonist analog of gonadorelin (LH-RH), gonad stimulating principle for treatment ol hormone sensitive prostatic carcinoma and endometriosis... 

ATC G03H L02BB02 Use non-steroidal antiandrogen (for treatment of prostatic carcinoma)... 

Measurement of serum acid phosphatase activities as an aid in the diagnosis and treatment of advanced prostatic carcinoma is based on the observation by Gutman and Gutman that the activity is elevated by skeletal metastases ( ). Many workers have... 

In the bicalutamide prostate cancer programme, the adjuvant treatment of patients with advanced prostate carcinoma (T1-T4 NO/NX, MO) with bicalutamide (150 mg, once a day) was evaluated. 4052 patients were randomised to bicalutamide with best standard care (either radiation, prostatectomy or watchful waiting ), whereas 4061 patients received a placebo with best standard care. An initial reduction of prostate cancer recurrence, which was observed in an interim analysis, later was not confirmed [219]. As the survival time in the bicalutamide treatment group was decreased, the study was terminated ahead of time. 

Bicalutamide, flutamide and nilutamide are nonsteroidal antiandrogens that are used for the treatment of prostatic carcinoma. They act as competitive antagonists at the androgen receptor. Hutamide also inhibits the formation of dihydrotestosterone from testosterone. 

Fosfestrol is indicated in the treatment of carcinoma of the prostate. It is a synthetic non-steroidal estrogen which is dephosphorylated to stilboestrol. Polyestradiol phosphate is an oestrogen with sustained activity that is exclusively used for prostate cancer. It is stored in tissues and slowly dephosphorylated to estrogen. 

At high doses, ketoconazole causes a clinically significant reduction in testosterone synthesis and blocks the adrenal response to corticotropin. Gynecomastia, impotence, reduced sperm counts, and dimiiushed libido can occur in men, and prolonged drug use can result in irregular menses in women. These hormonal effects have led to the use of ketoconazole as a potential adjunctive treatment for prostatic carcinoma. 

Doxorubicin is one of the most effective agents used in the treatment of carcinomas of the breast, ovary, endometrium, bladder, and thyroid and in oat cell cancer of the lung. It is included in several combination regimens for diffuse lymphomas and Hodgkin s disease. Doxorubicin can be used as an alternative to daunorubicin in acute leukemias and is useful in Ewing s sarcoma, osteogenic sarcoma, soft-tissue sarcomas, and neuroblastoma. Some activity has been reported in non-oat cell lung cancer, multiple myeloma, and adenocarcinomas of the stomach, prostate, and testis. 

Unlabeled Uses Appetite stimulant, treatment of hormone-dependent or advanced prostate carcinoma, treatment of uterine bleeding... 

Another therapeutic role for estrogens is in the treatment of cancer. In androgen-dependent prostate carcinoma, estrogens are used therapeutically to suppress androgen formation and thus tumor growth. Estrogens are also used to treat inoperable breast cancer in men and postmenopausal women. However, antiestrogens, such as tamoxifen, have fewer side effects and are usually preferred (see section 5.8.4). 

Antiandrogens such as cyproterone acetate (5.54) or the nonsteroidal flutamide (5.55, a substituted anilide) are competitive antagonists on the cytosol receptor. They do not prevent DHT formation rather, they inhibit the nuclear retention of DHT in the prostate. They cause feminization in male fetuses and decrease libido in males. Cyproterone is also an active progestogen. In men, antiandrogens are used commonly in the treatment of prostatic cancer and uncommonly to inhibit sex drive in hypersexuality in women, antiandrogens are used to treat virilization. Bicalutamide (5.56) and nilutamide (5.57) are potent, orally active antiandrogens that may be used in the treatment of metastatic prostate carcinoma. 

Metabolism occurs primarily in the liver. It is used as palliative treatment of disseminated mammary or prostatic carcinoma. 

T raditionally, milk thistle fruits have been used for disorders of the liver, spleen, and gall bladder, such as jaundice and gall bladder colic. Milk thistle has also been used for nursing mothers for stimulating milk production, as a bitter tonic, for hemorrhoids, for dyspeptic complaints, and as a demulcent in catarrh and pleurisy. It is stated to possess hepatoprotective, antioxidant, and choleretic properties (128). Current interest is focused on the hepatoprotective activity of milk thistle and its use for the treatment of liver, spleen, and gall bladder disorders (129). Recently it has been shown that silibinin reduced prostate-specific antigen levels in prostate carcinoma cells lines, indicating a possible role of silibinin in human prostate cancer (130,131). 

Several tests with silicon containing compounds as therapeutics in human medicine have already been crowned with success. In France certain organosilicon preparations, DNR and RDN (compare Chap. 5.5), are used in the treatment of cardiovascular diseases, cancer and virus infections. In the Soviet Union extensive clinical tests with ointments of l-(chloromethyl)- and 1-ethoxysilatrane as possible drugs for treatment of different typs of alopecia were successful (compare Chap. 5.1). Further clinical studies showed that l-(chloromethyl)silatrane is also very promising in treatment of wounds and bums. In a Swedish hospital patients with poorly differentiated prostatic carcinoma were treated with 2,6-c/s-diphenyl-hexamethyl-cyclo-tetrasiloxane (Cisobitan ) the clinical study also yielded promising results (compare Chap. 5.3). 

Harley HA, Mason R, Phillips PJ. Profound hypocalcaemia associated with oestrogen treatment of carcinoma of the prostate. Med J Aust 1983 2(l) 41-2. 

Fosfestrol is an unusual agent used in Japan for the treatment of prostatic carcinoma but not accepted by experts in Europe. Described as an estrogen, in European studies it had a high incidence of complications, including fluid retention (16%), myocardial infarction (10%), and thromboembolism (6.3%). A case of adrenocortical insufficiency has now been documented in Japan, involving a 59-year-old man who had taken the drug for 10 years (3). 

Men taking estrogens generally do so in the course of palliative treatment for malignancies (prostatic carcinoma), for which high doses have sometimes been used. Estrogen therapy in men with prostate cancer may be superior to castration in terms of efficacy, but orally administered... 

Pope JE, Joneja M, Hong P. Anti-androgen treatment of prostatic carcinoma may be a risk factor for development of rheumatoid arthritis. J Rheumatol 2002 29(ll) 2459-62. 

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