Prostatic Cancer

There was a kind of grim good news for half the human race last week: a doctor stated flatly that he does not think castration is the inevitable prescription for prostatic cancer.

Wrote Dr. Herman Louis Kretschmer of Chicago's Presbyterian Hospital in the Journal of the American Medical Association: "There seems to be a prevailing notion that ... all that is necessary to effect a cure is to perform an orchiectomy [castration]. It is extremely unfortunate. . . . Results are . . . anything but desirable."

Men, Lions and Dogs. Enlargement of the prostate gland occurs in most men over 50 and about half of them have some prostate trouble. An estimated 17 to 20% of men past 50 develop prostatic cancer. This also happens to dogs and lions. The dangerous gland, situated at the lower part of the bladder next to the exit, rarely gives much warning (common first symptom: difficulty in urinating) until the cancer is beyond surgery.

A lucky few can have gland and cancer completely removed. But all that can be done for most patients is to try to make them comfortable and prolong their lives by 1) operations, X-ray or radium treatments; 2) morphine and other pain-killing drugs.

Fashions in Surgery. Castration as a method for checking prostatic cancer is once more in fashion. It was abandoned in the '90s because it did not cure, revived in the '30s because many doctors believe the temporary relief it offers is worth while. The operation is often supplemented by continuing doses of female sex hormones. Many patients refuse the treatment.

Dr. Kretschmer's blunt boo gains force from his experience with eleven castrated patients who had some prostatic tissue cut out besides: "Three of the patients are dead [after] five, eight and eleven months; one patient is bedridden, requiring frequent doses of morphine; three patients have pain; one patient had painful urination and attacks of hematuria [bloody urine]; only three say they are improved after eleven, seven and three months respectively." (Procastration doctors say that Dr. Kretschmer is wrong to discount the initial improvement in his patients, even if it is short-lived.)

Sex Treatment. One hopeful alternative to castration is injections of female sex hormones (plus an operation on the prostate, if necessary). Like castration, female hormones seem to slow down the growth of cancer cells. Drs. Charles Cornell Herger and Hans Richard Sauer recently reported in the American Journal of Surgery that 30% of their patients getting stilbestrol (a female sex hormone) "responded with regression or softening of the prostate."

The castration argument is not over. Many doctors are castration zealots. Others, like Dr. Kretschmer, are dead set against it. Drs. Herger and Sauer take the middle ground: they do not invariably castrate all prostatic-cancer patients, but recommend castration 1) for patients who do not respond to female sex hormones, 2) to prolong and ease the lives of men whose cancers have become widespread.

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