Orchiectomy for advanced prostatic carcinoma A reevaluation

Abstract The efficacy of four treatments, placebo, orchiectomy plus placebo, estrogen (diethylstilbestrol 5.0 mg. daily), and orchiectomy plus estrogen, was evaluated in 1,903 Stage III and IV prostatic cancer patients by comparing (1) survival curves, (2) causes of death, (3) clinical response, (4) development of metastases in Stage III patients, and (5) incidence of treatment change. Survival curves did not differ significantly for the four treatment groups except in Stage III, in which orchiectomy plus estrogen was worse than placebo, or orchiectomy plus placebo. There were significantly more cancer deaths in the two nonestrogen groups in both stages. Otherwise, there were no appreciable differences between the three hormonal treatments. We conclude that estrogen is more effective than orchiectomy in preventing cancer deaths, and the addition of orchiectomy to estrogen does not offer a clear-cut advantage over either treatment alone. Therefore, if treatment becomes necessary because of cancer symptoms, initial treatment with estrogen is preferred.