Tuesday, August 26, 2014

Historical Contribution: 1944, Frame & Jewett, 17-Ketosteroids in Prostate Cancer


The excretion of 17-ketosteroids in carcinoma of the prostate E. G. Frame and H. J. Jewett Journal of Urology 1944  52: 330-333.

At the writing of this manuscript, it was known that patients undergoing androgen ablation through bilateral orchiectomy for prostate cancer experienced an oncologic benefit.  As testosterone is secreted by the testes, and then excreted in the urine as 17-ketosteroids, a number of researchers observed that 17-ketosteroid levels fall initially after orchiectomy and then rise within a few months.  This coincides with subjective patients symptoms initially improving and then worsening with time.

Frame and Jewett hypothesized that prostate cancer itself, may impact testosterone/17-ketosteroid levels and sought to determine the influence of prostate cancer on 17-ketosteroid excretion.

Sixteen patients with prostate cancer were compared to 8 patients without the disease.  The data is presented below.  Important observations include:

  • 17-ketosteroid excretion decreases with age (levels are lower in men >62 years in this study)
  • There is no difference between men: 
    • with prostate cancer and controls.
    • before and after orchiectomy (all men underwent orchiectomy >10 months prior to analysis).
  • A slightly higher Beta-Fraction of 17-ketosteroid in the prostate cancer group is not clinically or statistically significant.
Frame and Jewett allude to the fact that the testis are not the only source of 17-ketosteroid (androgens) and that the adrenal may provide an extragonadal source of androgens in the post-orchiectomy patient.  As they observe that 17-ketosteroids decrease in the aged population, they conclude that either:
  1. there is a decreasing contribution of androgen from the testes as men age, OR
  2. removal of the testes results in increased adrenal production of androgen (17-ketosteroid).
Click on the link above, visit the Centennial Website or click here to read the original manuscript.

HISTORICAL CONTRIBUTIONS highlight the greatest academic manuscripts from the Brady Urological Institute over the past 100 years.  As the Brady Urological Institute approaches its centennial, we will present a HISTORICAL CONTRIBUTION from each of the past 100 years.  In the most recent experience, the most highly cited article from each year is selected; older manuscripts were selected based on their perceived impact on the field.  We hope you enjoy! 

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