Some aspects of the effect of cyproterone acetate on levels of other steroid hormones in man

The effects of orchidectomy, estrogens, and cyproterone acetate on plasma testosterone, LH, and FSH concentrations in patients with carcinoma of the prostate

The peripheral plasma concentrations of testosterone, luteinising hormone (LH) and follicle stimulating hormone (FSH) were determined in 46 patients (age 51-86 years) with cytologically confirmed prostatic carcinoma. Treatment consisted of subcapsular orchidectomy (15 cases) or estrogen medication (16 cases) or cyproterone acetate (15 cases). The determinations were made before and 2 weeks and 2 months after treatment was initiated. No correlation was found between the pretreatment levels of testosterone and gonadotrophins and the local extent of the primary tumor or the degree of malignancy. Nor was there any correlation between hormonal level, presence of metastases or patient age. Orchidectomy and estrogen medication both resulted in very low plasma testosterone levels, corresponding to 15% of the pretreatment values. This proportion was 28% in the group treated with cyproterone acetate. Orchidectomy was followed by significant increase in the levels of LH and FSH. Estrogen treatment resulted in suppression of the LH levels to 40% and of FSH to 14% of the pretreatment values. The corresponding decreases in response to cyproterone acetate were 65 and 35%. The results indicate that reduction in gonadotrophin secretion is the primary mechanism in the lowering of testosterone levels produced by treatment with estrogens or cyproterone acetate.

Therapeutic sex drive reduction

Sex drive reducing therapies are employed in those cases of anomalous erotic preferences in which the patient's sexual behaviour is dangerous (certain forms of sadism, or a preference for forcing intercourse or similar interaction) or while not really dangerous, is utterly unacceptable to the community (pedophilia and pedohebephilia) or is an embarrassment to the patient himself (exhibitionism). Three sex drive reducing therapies are in use, all designed for male patients, (1) pharmacological reduction of circulating testosterone, (2) orchidectomy, (3) deletion of certain brain structures by stereotaxic surgery. The main indication for pharmacological sex drive reduction is exhibitionism but here it should be used only temporarily, as a first emergency measure, and after that only intermittently, during periods when the patient can not manage his urges by techniques he should be taught by a behaviour therapist. In cases of unmanageable and dangerous sadism, orchidectomy is the method of choice--and the same would appear to be true for particular cases of pedohebephilia. Brain surgery in this realm is not yet based on sufficient knowledge and should be thoroughly studied on infrahuman primates, before use with humans could be seriously considered.

Treatment of advanced prostatic cancer with parenteral cyproterone acetate: a phase III randomised trial

Forty-two patients with previously untreated T3/4 N1-4 MO/1 prostatic adenocarcinoma were treated with either cyproterone acetate (n = 21; 300 mg intramuscularly per week) or oestradiol undecylate (n = 21; 100 mg intramuscularly per month) after extensive staging which included open skeletal biopsy and pelvic lymphadenectomy in some cases. Subjective and objective parameters as well as signs of drug toxicity were recorded regularly. Evaluation after 6 months showed cyproterone acetate to be more effective in the following respects: (1) the significantly different castration effect as judged by plasma testosterone, (2) the objective voiding pattern and tumour response, with regression of palpable and histologically evaluable local tumour in 16 of 21 patients, and (3) side effects and untoward reactions. Thus cyproterone acetate is suggested as a valuable alternative in the treatment of advanced prostatic cancer.

A morphological study on the effect of cyproterone acetate on human prostatic carcinoma

Sixteen patients with prostatic carcinoma were treated with 200 mg of Cyproterone acetate daily. No other kind of hormonal treatment was given. Transrectal biopsies of the prostate were taken before the treatment was started, and at regular intervals afterwards. The treatment period lasted from 3 to 16 months, with an average of 9 months. A thorough examination of multiple sections from all specimens revealed no convincing signs of cellular involution. The study has demonstrated no specific or significant atrophic changes following Cyproterone acetate therapy. Some possible explanations regarding the effect of Cyproterone acetate on human malignant prostatic tissue are discussed.