Castration as prostate cancer treatment?

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Tuesday, August 12, 2014

DO YOU know that a man with prostate cancer between the 1940s and 1950s would have to decide whether to die of cancer or have his testes castrated?

The procedure was called “surgical orchiectomy,” a component of the so-called “androgen deprivation therapy” (ADT). In simple terms, it is as much a castration procedure as that done in young dog. The aim was to remove the source testosterone among men. Testes produce nearly 95 percent of circulating testosterones; ergo, removing them cuts off the supply of the androgens towards the prostate gland.

Prostate cancer is most commonly malignancy affecting men, and the second most common cause of cancer deaths in men worldwide. The United States alone had almost 30,000 deaths (men deaths) every year.


Since the groundbreaking publication in 1941 of the Huggins and Hodges study, the medical community accepted the theory that testosterone has a supportive role in causing prostate cancer growth. The theoretical basis in the use of the ADT came from this theory.

Negative reactions from male patients, however, resulted in its discontinuation. Because it is an invasive procedure, surgical castration had dealt men with significant psychological trauma. I can imagine, by the mention of the medicalisque term surgical orchiectomy, men in that period may have ran away from any surgical clinic like hell.

That setback led to the appearance of the so-called medical ADT, which is practically a chemical ADT. The first pharmacological agent used as ADT for prostate cancer was diethylstilbestrol (DES). It is a synthetic oral estrogen that stops the secretion of follicle stimulating hormone and luteinizing hormone to prevent Leydig cells of testes to produce testosterone.

Since its appearance in the 1950s, DES had been discontinued in the 1980s after studies found adverse effects in the cardiovascular systems, the system that conducts the blood from the peripheral areas to the heart, to the lungs, and then back. In a study conducted by the Veterans Administrative Cooperative Urological Research Group (Vacurg), DES had shown improved outcome in prostate cancer. However, the DES group showed an increase of 36 percent in non-cancer-related deaths, mostly blood system-related. The highest risk turned out to be in the first year of starting therapy.

Had DES been better than castration? Certainly not. Men would have chosen to loss their testes just to stay alive.

Amit Abraham, head of the postgraduate department of psychology at St. John’s College (Agra, Uttar Pradesh, India) wrote: “The punishment for rape should be castration.” Not for getting an over-excited prostate-gland cells.

Published in the Sun.Star Cebu newspaper on August 13, 2014.


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