MEDICAL ADRENALECTOMY FOR ADVANCED PROSTATE CANCER

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An effective medical adrenalectomy regimen has been used to suppress adrenal steroid synthesis and estrogen production in the treatment of women with advanced breast cancer. This regimen will be adapted for use in men for the treatment of advanced prostatic carcinoma. The method for medical adrenalectomy uses aminoglutethimide (AG) in combination with hydrocortisone. AG appears to have two separate actions: inhibition of steroid-ogenesis and the blockade of the peripheral aromatization of androgens to form estrogens. The regimen of "medical adrenalectomy" appears to be equal to, if not better than, surgical adrenalectomy for the treatment of advanced breast cancer. The current study will provide the opportunity to evaluate in detail the hormonal consequences and clinical responses to medical adrenalectomy in the treatment of men with disseminated prostatic carcinoma. We anticipate that extensive hormonal studies of a population of men undergoing this major chemical ablative therapy will provide useful information as to completeness of the medical ablative procedure as well as tumor response to this modality of treatment. Preliminary studies from our laboratory indicates that AG reduces androgen and estrogen levels in plasma of orchiectomized men with metastatic cancer of the prostate and provides encouragement that this modality of therapy may prove to be useful.