Tuesday, January 20, 2015

Historical Contribution: 1962, Hypophysectomy for Prostate Cancer, Scott & Schirmer.


1962
Scott WW, Schirmer HKA. Hypophysectomy for Disseminated Prostatic Cancer. Cancer and Hormones. 1962. 175-203.


 

WW Scott
Believing that the metastatic progression of prostate cancer was related to exogenous testosterone after castration,[What makes the Prostate Grow, WW Scott] Scott and other embarked on experimentation with hypophysectomy (removal of the pituitary) in the treatment of advanced prostate cancer with mixed results – the first patient died 11 days after surgery, but two of the next five patients had a tangible response to surgery. Between 1948 (the 1st hypophysectomy) and 1961, 17 patients underwent hypophysectomy for the treatment of their prostate cancer.

In a detailed description of the 17 cases, Scott and Schirmer arrived at the following conclusions. While the intention of hypophysectomy was palliative (i.e. not intended to extend life), it could not be demonstrated to improve survival outcomes of these patients. Instead Scott and Schimer recognized that grade, timing of metastases and castration had the largest influence on survival times. While hypophysectomy could improve the subjective (symptoms) and objective (lab values) progression of many of these patients, they recognized that

"these comparisons are probably meaningless… they point out our lack of reliable criteria on which to base an evaluation as well as the fact that the degree of palliation depends to a great extent on when in the course of the disease any hormonal therapy is instituted."

Nevetheless, Scott and Schirmer were able to demonstrate effects of serum acid phosphatase, ketosteroids, and osseous lesions on x-ray – demonstrating some effect of hypophysectomy on these patients. They concluded that patients with (1) a previous favorable response to castration therapy and (2) evidence of persistent androgen production may benefit from this surgery.

 

To read the entire manuscript: follow the link above, visit the Centennial Website or click here.

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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