Tratamiento con dietilestilbestrol en pacientes refractarios a la castración por análogos LH- RH / Treatment with diethylstilbestrol in patients who had failed to androgen deprivation by lhrh agonists

Introducción: El objeto de este trabajo clínico es estudiar la eficacia de la administración de Dietilestilbestrol (DES) oral en pacientes con cáncer de próstata avanzado y que han presentado refractariedad al tratamiento con análogos LH-RH y además evaluar los efectos colaterales atribuibles a su uso. Material y métodos: Entre Noviembre de 2010 y Mayo de 2012 se ingresaron en forma consecutiva al estudio 15 pacientes con cáncer prostático avanzado, refractarios a manejo con análogos LH-RH. Edad promedio de los pacientes 69,4 años .Rango 57-80. Se registró el tipo de tratamiento realizado, detallando el manejo hormonal previo al que fueron sometidos. Se consideró refractariedad a los análogos, la detección de 2 alzas consecutivas del APE durante la administración de éstos. Se indicó a los pacientes 1mg. de DES al día. La evaluación del tratamiento se hizo cada 30 días con determinación de APE y registro de efectos colaterales. Resultados: De los 15 pacientes, 8 (53,3 por ciento) disminuyeron su APE inicial, 6 de ellos (40 por ciento) lo hicieron en más de un 50 por ciento de su valor y 2 (13,3 por ciento) disminuyeron el APE pero en menos de un 50 por ciento. 7 pacientes (46,6 por ciento) no disminuyeron su valor de APE y fueron considerados como fracasos. Como efectos colaterales del tratamiento tuvimos 13 pacientes (86,6 por ciento) que presentaron hipersensibilidad de los pezones, pero solo 2 requirieron tratamiento sintomático. 4 pacientes (26,6 por ciento) desarrollaron ginecomastia leve a moderada y no tuvimos ninguna complicación cardiovascular en los 15 pacientes estudiados. Conclusión: Consideramos de acuerdo a nuestros resultados que el DES oral es efectivo como tratamiento en los pacientes que han fallado o son refractarios a la deprivación androgénica por análogos LH-RH, con una baja morbilidad, buena aceptación de los pacientes y de muy bajo costo.

Introduction: The object of this clinical trial is to study the effectiveness of the administration of Diethylstilbestrol (DES) oral in patients with advanced cancer of prostate and that has presented resistance to the treatment with analogs LH-RH and in addition to evaluate the collateral effects attributable to its use. Material and methods: Between November of 2010 and May of 2012 15 patients with advanced prostate cancer, refractory to handling with analogs LH-RH entered themselves in consecutive form the study. Age average of the patients 69, 4 years, Rank 57-80. The type of made treatment was registered, detailing previous the hormonal handling which they were put under. Resistance to the analogs, the detection of 2 consecutive rises of the PSA was considered during the administration of this one. 1 mg. was indicated to the patients of DES to the day. The evaluation of the treatment was made every 30 days with determination of PSA and registry of collateral effects. Results: Of the 15 patients, 8 (53,3 percent) diminished their initial PSA, 5 of them (40 percent)did in more of a 50 percent of their value and 2 (13,3 percent) diminished the PSA but in less of a 50 percent. 7 patients (46,6 percent) did not diminished their value of PSA and were considered like failures. As collateral effects of the treatment we had 13 patients (86,6 percent) who presented hypersensitivity of the nipples, but single 2 required symptomatic treatment, 4 patients (26,6 percent) developed ginecomastia weighs moderate and we did not have any cardiovascular complication in the 15 studied patients. Conclusion: We considered according to our results that the oral DES is effective like treatment in the patients who have failed or ar refractory to the androgenic deprivation by analogs LH-RH, with a low morbidity, good acceptance of the patients and very low cost.

Successful treatment of unilateral cryptorchid boys risking infertility with LH-RH analogue

INTRODUCTION: Infertility is the primary concern for boys with uni- or bilateral undescended testes. An early and seemingly successful orchiopexy does not improve fertility in a substantial number of cryptorchid males. We confirmed that LH-RH analogue (LH-RHa) treatment induces an increase in and maturation of the germ cells; however, it was uncertain if treatment would improve the chance of fertility later in life. MATERIALS AND METHODS: Thirty unilateral cryptorchid boys, with an average age of 3 years at the time of surgery, were included in the study. Testicular biopsy showed that they had impaired testicular maturation and were therefore at high risk for infertility. Fifteen of the 30 unilateral cryptorchid boys were treated with 10 µg LH-RHa (Buserelin) nasal spray, administered on alternate days for a period of 6 months, following orchiopexy. The control group consisted of 15 cryptorchid boys who had been treated by Schoemakers type of orchiopexy, alone. After puberty, the ejaculates of both groups were analyzed. RESULTS: All males in the untreated group were severely oligospermic, with 20 percent being azoospermic. In contrast, 86 percent of the treated ex-cryptorchid males had a sperm concentration within the normal range; this was significantly different from the sperm concentration found in the untreated group (p = 0.000008). CONCLUSION: For the first time, we demonstrate that infertility in cryptorchidism can be successfully corrected when suitably treated with a LH-RHa. Sperm parameters normalized following therapy in the majority of cryptorchid males who, untreated, would have remained infertile. This innovative hormonal treatment will have a profound effect on the current recommended surgical treatment of boys with undescended testes.

Incidence Rate of Injection-Site Granulomas Resulting from the Administration of Luteinizing Hormone-Releasing Hormone Analogues for the Treatment of Prostatic Cancer

PURPOSE: Granulomas resulting from the administration of luteinizing hormone-releasing hormone analogues (LH-RH analogues) are thought to be very rare. We report on our clinical experience with injection-site granulomas that result from the administration of LH-RH analogues, and we evaluate the incidence rate of these granulomas. MATERIALS AND METHODS: We used the clinical records of 118 patients who were administered LH-RH analogues in 2005. We describe the clinical data of patients who experienced injection-site granulomas and evaluated the incidence rate. RESULTS: Five patients demonstrated injection-site granulomas due to LH-RH analogue administration. The incidence rate was 4.2% (5 of 118 patients). Most of the granulomas occurred after the first or second administration of 11.25mg of leuprorelin acetate. CONCLUSION: The occurrence of granulomas resulting from the administration of LH-RH analogues was thought to be very rare. Our study, however, revealed a higher incidence rate than expected, especially for leuprorelin acetate.

The Patient`s Choice of Hormonal Treatment for Metastatic Prostate Cancer / 대한비뇨기과학회지

PURPOSES: We performed a study to estimate the attitude of patients toward orchiectomy, and the factors impacting to choose treatment in real situation. MATERIALS AND METHODS: One thousand one hundred and eighteen patients were asked questionnaires at their first visit of outpatient clinic. Among them 775 patients completed the questionnaires which are composed with three items asking the degree of acceptance for orchiectomy, the acceptable cost to save the testes. The responses were analysed according to ages, educational levels, occupations and final diagnosis. In 38 patients diagnosed with prostate cancer, we analysed the factors impacting on their decision when they faced to choose a method of antiandrogen therapy. RESULTS: Among 775 patients who make the definite decisions for orchiectomy, 212 patients(27.4%) accepted the orchiectomy, 452 patients(58.3%) denied orchiectomy, 111 patients(14.3%) want to avoid orchiectomy as much as possible. The younger patients are, the more they want to save their testes. The accepting orchiectomy of patient is not impacted by occupation or educational levels. Among 45 patients who were finally diagnosed as metastatic prostate cancer, 13 patients changed thier choices that they selected at first visit. The most common causes to choose orchiectomy was economic conditions and to choose LH-RH analogue was fear to surgery. CONCLUSIONS: Around three forth of men over 50 years old have negative attitude for orchiectomy. But this can be changed easily by the factors such as economic status, fear to surgery and doctor`s advise. If the higher the house income is, the more LH-RH analogue will be used.

Intranasal LH-RH treatment of cryptorchidism / 대한비뇨기과학회지

The effect of intranasal luteinizing hormone-releasing hormone (LH-RH) on cryptorchidism was investigated in 15 prepubertal boys with 26 undescended testes. Eleven patients were bilateral cryptorchidism. Boys with retractile testes, ectopic testes or palpable hernia, as well as boys who had chromosomal abnormalities were excluded from admission to the study. Synthetic LH-RH (Cryptocurs) was applied as nasal spray at a dose of 1.2mg daily over a period of 4 weeks. Testicular position and mobility were assessed independently by two investigator before and after 4 and I6 weeks of therapy. Testicular descent into the scrotum occurred in 5(19%) and partial descent in 10 testes (38%). Descended testes were bilateral cryptorchidism and located below the inguinal area in all cases. Follow-up examination 4 months after therapy showed no relapse. No side effects were observed. Overviewing the literature and regarding our own results, we believe that LH-RH has a place in the treatment of cryptorchidism. In the treatment of the more caudally positioned and bilateral undescended testes, it can be beneficial, because of the potential merits of avoiding an operation and the small number of minor side effects.

HISTOLOGICAL STUDY ON THE EFFECT OF A HIGH DOSAGE OF LH-RH-A IN ENDOME-TRIUM ON PSEUDOPREGNANT RATS / 解剖学报

The decidua of pseudopregnant rats and of those effected by high dosage of luteinizing hormone-releasing hormone analogue (LH-RH-A) were studied histologically.After inducement of pseudopregnancy, 29 Wistar virgin rats were divided into experimental and control groups. The experimental group was injected with 200?g. of LH-RH-A subcutaneously daily for four days, while to the control group, physiological saline was injected instead. Both experimental and control animals were killed on the 9th, 11th and 13th day of pseudopregnancy.The uteri were fixed with appropriate fixatives and paraffin sections were processed with HE, phloxine-tartrazine, Foots and aldehyde fuchsin staihing methods.On the 9th day decidua of the control rats are well developed with many endometrial granulated cells, while in the decidua of the experimental group, the decidual cells become pyknotic, and the granulated cells are barely seen. The results suggest that a high dosage of LH-RH-A advances the necrosis of decidua of the pseudopregnant rats.