Correspondence

Correction

Management of Cancer of the Prostate

N Engl J Med 1995; 332:335-336February 2, 1995

Article

To the Editor:

Dr. Catalona's article on the management of cancer of the prostate (Oct. 13 issue)1 was informative and thorough, except for two omissions concerning the treatment of patients with end-stage disease.

First, patients with extensive, painful bony metastases may benefit from treatment with strontium chloride labeled with strontium-89.2 This radionuclide is easily administered, is usually effective within a few weeks, and has beneficial effects that usually last for several months or more. The main disadvantages are cost and occasional thrombocytopenia. Although external-beam radiation therapy will remain the mainstay of treatment for the majority of patients with bony metastases, strontium-89 is worth considering as an additional agent.

Second, glucocorticoid therapy receives only cursory mention in Catalona's review. Glucocorticoids alone decrease serum androgen concentrations in men who have undergone orchiectomy.3,4 Thus, they have palliative as well as supportive value in this group of patients. In our experience, glucocorticoid therapy may be quite beneficial in patients with advanced disease and should be routinely considered for their treatment.

Patrick Stone, M.A., M.R.C.P.
Clare Phillips, B.Sc., M.R.C.G.P.
Royal Hospitals National Health Service Trust, London E1 1BB, United Kingdom

4 References

1. 1

   Catalona WJ. Management of cancer of the prostate. N Engl J Med 1994;331:996-1004
   Full Text | Web of Science | Medline

2. 2

   Laing AH, Ackery DM, Bayly RJ, et al. Strontium-89 chloride for pain palliation in prostatic skeletal malignancy. Br J Radiol 1991;64:816-822
   CrossRef | Web of Science | Medline

3. 3

   Plowman PN, Perry LA, Chard T. Androgen suppression by hydrocortisone without aminoglutethimide in orchiectomised men with prostatic cancer. Br J Urol 1987;59:255-257
   CrossRef | Medline

4. 4

   Dowsett M, Shearer RJ, Ponder BA, Malone P, Jeffcoate SL. The effects of aminoglutethimide and hydrocortisone, alone and combined, on androgen levels in post-orchiectomy prostatic cancer patients. Br J Cancer 1988;57:190-192
   CrossRef | Web of Science | Medline

Author/Editor Response

Dr. Catalona replies:

To the Editor: My own clinical experience and that of my colleagues has not confirmed the very favorable response rate reported in patients with painful bony metastases treated with strontium-89. About 20 percent of our patients have had a flare response in which the pain became more severe. Only about one third have pain relief lasting for three to six months. Although strontium-89 may augment the beneficial effects of external-beam irradiation, we are withholding judgment until more data become available. The high cost of treatment with strontium-89 is an important issue.

I agree that glucocorticoid therapy is beneficial to some patients, but the responses are usually short-lived.

There were two errors in my article. On page 1001, right-hand column, last paragraph, the second sentence should have read, “In a trial comparing orchiectomy with goserelin plus flutamide, there was a significant (48 week) delay in the objective progression of disease and a significant (7 month) survival advantage among the patients who received combined therapy.⁸⁸” In Table 3, the units for plasma suramin concentrations should have been given as micrograms per milliliter instead of micrograms per liter.

William J. Catalona, M.D.
Washington University School of Medicine, St. Louis, MO 63110

Citing Articles (1)

Citing Articles

1. 1

   C. Nabhan, B. Parsons, E. Z. Touloukian, W. M. Stadler. (2011) Novel approaches and future directions in castration-resistant prostate cancer. Annals of Oncology 22:9, 1948-1957
   CrossRef