前立腺癌及び同肥大症に就ての内分泌学的研究

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The pituitary-adrenocortical function, urinary 17-Ketosteroids and their fractionated patterns. in 23 cases of prostatic carcinoma and 22 cases of prostatic hypertrophy were investigated and the following conclusions were obtained. 1. The values of 17-Ketosteroids in the urine of patients with carcinoma or hypertrophy of the prostate were in the range of values obtained from normal men of the same age level. Neither was there any significant difference in the values between before and after antiandrogenic therapy of the patients with prostatic carcinoma, and those between before and after prostatectomy of the patients with prostatic hypertrophy. Although assaying the values of urinary 17-Ketosteroids of the patients with prostatic carcinoma does not necessarily afford a powerful clue in the diagnosis and the judgement of effectiveness of treatment and that prognosis of the patients, the values seemed to indicate, with considerable accuracy, the possibility of relapse or recurrence of prostatic carcinoma in those cases where the values continued to maintain a high level, or elevated again following restoration to the normal level even after the radical operation or antiandrogenic therapy. 2. No significant difference was observed between the values of urinary 17-Ketosteroids of the patients with prostatic carcinoma, those with prostatic hypertrophy and those of normal men. This fact should partly be attributed to wide individual difference of the fractionated patterns of 17-Ketosteroids. In those patients whose prostatic carcinoma improved with antiandrogenlc therapy, the fraction of androgen and glucocorticoids metabolites was markedly reduced and that of dehydroisoandrosterone (Fraction III) showed a tendency to rise elevation. No significant effect was, however, observed after the prostatectomy of prostatic hypertrophy. 3. Relapse or recurrence of prostatic carcinoma after the radical operation or following antiandrogenic therapy of the tumor caused an enhancement of the values of urinary 17-Ketosteroids and of those of the fraction of androgen and glucocorticoid metabolites. 4. In respect to the pituitary-adrenocortical function, examined by Thorn's test, of the patients with prostatic carcinoma, there was observed a reduction of this function in about a half of the patients and no marked improvement followed antiandrogenic therapy. Thorn's test of the patients with prostatic hypertrophy showed the function to be in a normal range. In patients, whether with carcinoma or with hypertrophy of the prostate, the result of whose Thorn's test was normal, an increase of urinary 17-Ketosteroids was encountered followingthe administration of ACTH. In those the result of whose test was abnormal, the administration of ACTH was not followed by an increase of 17-Ketosteroids, but rather was even followed by a reduction in many cases. A close relationship was recognized between the increase of the fraction glucocorticoids metabolites in the urinary 17-Ketosteroids following the injection of ACTH and the pituitary-adrenocortical function (a decrease of eosinophile leucocytes according to Thorn's test). 5. Antiandrogenic therapy often proved markedly effective against prostatic carcinoma judging from both clinical and pathological findings of the tumor. The therapy, however, sometimes could not be expected to have such a good effect in the case where the tumor consisted of extremely undifferentiated cells. The administration of corticosteroids and carcinostatic drugs sometimes showed a good result in the patients with prostatic carcinoma which was too advanced to be extirpated by a radical operation, but in respect to the fractionated pattern of 17-Ketosteroids, the treatment showed us significant change. 6. Assay of the fractionation of urinary 17-Ketosteroids in the antiandrogenic therapy of prostatic carcinoma affords a powerful clue in the judgement of effectiveness of antiandrogenic therapy, of possible recurrence of the tumor, of selection of hormone preparation and of prognosis of the disease.
社団法人日本泌尿器科学会の論文

前立腺癌及び同肥大症に就ての内分泌学的研究

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