TREATING ADVANCED PROSTATE CANCER: IF ADRENAL ANDROGENS REALLY WERE THE KEY TO FIGHTING PROSTATE CANCER…
If adrenal androgens really were the key to fighting prostate cancer, flutamide should produce a dramatic improvement in men who were castrated, took estrogen or an LHRH agonist and then had a relapse. This just isn’t the case. Sadly, what happens for these men is that beginning total androgen blockade has very little effect—again, suggesting that this approach is not the answer.
Finally, other studies have demonstrated that adrenal androgens have little effect on the prostate. In one investigation at Johns Hopkins, researchers studied four men who had their pituitary glands removed before they reached puberty—which means that not only did their bodies fail to make LH, they failed to make a hormone that stimulates the adrenal gland, so it was virtually shut down; in other words, they had total androgen blockade. They also studied three men who had a genetic disorder called Kallmann’s syndrome (in which the hypothalamus doesn’t make LHRH, and therefore, the pituitary glands don’t make LH or FSH), and one unfortunate man who had been castrated at age seven, when a dog bit off his testicles. The average age of these men was about 65. Using age-matched “control” (normal) patients for comparison, the investigators showed no disparity in prostate size’in men with both testosterone and the adrenal hormones out of commission and in men with only testosterone missing. (In all of these men, the prostate was tiny. In all, there were no Leydig cells, the tiny testosterone-making factories in the testicles.) In other words, total androgen blockade made no difference.
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