In the early 1900s, the outlook was grim in general for a patient with prostate cancer, much less one who had failed conventional treatment. But today, alternative therapy is available to patients who have failed traditional treatments: hormone therapy. Now, thanks to all of these new treatments, sufferers can bask in the hope, if not the reality, of a cure.
In 1962, Stanford University's Malcolm Bagshaw showed that high-dose, radioactive gold celluloid radiation could be an effective treatment for men with early (and even advanced) prostate cancers. University of Iowa's Rubin Flocks followed with large-scale implantation of radioactive gold seeds, a therapy that improved with the guidance of ultrasound.
Yet, despite great promise, these treatments are still dimmed by the shadow of too many men dying from malignancies too advanced to be treated, much less cured. Thankfully, since the 1940s hormone therapy has given patients with late stage prostate cancer a glimmer of hope. Because of University of Chicago's Charles B. Huggins, there's a palliative treatment that puts a damper on the disease and can improve quality of life.
Huggins made history by altering the body's hormonal milieu to slow or stop cancer cell growth. He showed that either surgically removing testicles or suppressing their testosterone action with medication could turn off the fuel to hormone-driven malignant cells.
Huggins, with Clarence V. Hodges, initiated their hypothesis on benign enlarged prostates of dogs, eliminating the testicles to shrink the gland and then injecting hormones before measuring regrowth. Their findings not only confirmed testosterone's role in the gland's growth, but also hinted that human prostates could be similarly manipulated.
In the patient research that followed, Huggins, with Hodges, R.E. Stevens Jr. and William W. Scott, confirmed that malignant prostate cells had a similar dependence on hormones. Castration and/or doses of the female hormone estrogen could slow or retard tumor growth.
In studies yielding remarkably good results, more than one-half of advanced prostatic cancer patients saw their tumors reduced or even disappear. By administering non-toxic, naturally-occurring hormones, Huggins had produced a new therapy. His epic discovery earned him a Nobel Prize in 1966. But the true beneficiaries were the gravely ill patients who, with no previous recourse, now had temporary, symptomatic relief.
Huggins also tried to remove the adrenal and pituitary glands to block testosterone formation completely. Both methods peaked briefly in the 1940s but disappeared because of too many complications and too few successes.
Based on its power to counteract testosterone, estrogen therapy emerged quickly after Huggins' successes. But by the early 1970s multi-center studies documented that men on high doses (unlike those undergoing orchiectomy, or testicle removal) had significantly higher non-cancer death rates. Fortunately, by dropping dosages, urologists could retard the tumors without risking the accompanying heart problems.
Today, the synthetic LH-RH (luteinizing hormone releasing hormone) is the medication mainstay for advanced cancer. Since the 1980s, injectable drugs such as leuprolide acetate and goserelin acetate are administered every three--or even 12--months to shut down testosterone production. In the interim, oral androgen-blocking agents, flutamide, boost the overall effect by preventing testosterone from attaching to prostate cells. Together, these medications bring dramatic, even miraculous, improvements to quality of life.
Yet, they aren't a cure. Advanced cancer inevitably returns, causing cancer that had nearly vanished so encouragingly to creep back until improved health becomes fleeting. The cells at fault are other, hormone-resistant, cancer cells, not those responding brilliantly to the therapy.
Some of the most exciting bench-to-bedside research could eliminate advanced prostate cancer. Angiogenesis inhibitors, for instance, hold great promise in starving tumors by cutting off their blood supply, ready-made nutrients for growth. Likewise, gene therapy, which utilizes the body's own DNA like programmed computer chips, could net genetically engineered "vaccines" and doctored viruses that target prostate cancer cells for search-and-destroy missions.
In any case, physicians soon may have therapies that derail the disease long before Huggin's therapy is necessary. With science shedding new light on this old dilemma, their patients may bask in the reality, not just the hope, of a cure.
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