ADDITIONAL TREATMENT FOR pT3 PROSTATE CANCER: NOW, LATER OR NEVER

Authors


Sir,

I read this article [1] with interest. The Veterans Administration Cooperative Urology Research Group (VACURG) reports of 1968 (I), 1978 (II), 1986 (III) concluded that: (i) diethylstilbestrol (DES) 1 mg/day was safe and effective; (ii) DES 1 mg was more effective than orchidectomy; and (iii) DES 1 mg plus orchidectomy was no better than DES 1 mg alone, as measured by bone scan, acid phosphatase and death. In all of these studies (>40 000 men over 30 years) hormone therapy was initiated immediately on diagnosis [2].

Scherr et al.[3,4] showed that DES 1 mg prevents the osteoporosis of androgen deprivation. Scherr and Pitts [4] reviewed the nonsteroidal effects of DES, e.g. those against osteoporosis, angiogenesis, mitosis, tubulin, decrease in cognitive function, atherosclerosis, hot flashes and asthenia. Pitts [5] reviewed previous reports and showed that immediate androgen deprivation without oestrogen deprivation using DES 1 mg was the only form of therapy to slow progression and prolong life of any prostate cancer therapy (surgery, radiation, orchidectomy or other chemotherapy).

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