Comparable amounts of sex steroids are made outside the gonads in men and women: strong lesson for hormone therapy of prostate and breast cancer.
The objective of this study was comparison of circulating androgens and their metabolites as well as estrogens measured for the first time by a validated mass spectrometry technology in 60-80-year-old men and women of comparable age. Castration in men (n=34) reduces the total androgen pool by only about 60% as indicated by the decrease in the serum levels of the glucuronide metabolites of androgens compared to intact men (n=1302). Such data are in agreement with the 50 to 75% decrease in intraprostatic dihydrotestosterone (DHT) concentration after castration. Most interestingly, the same amounts of androgens and estrogens are found in postmenopausal women (n=369) and castrated men of comparable age. The most significant therapeutic implication of these findings is the absolute need to add a pure (nonsteroidal) antiandrogen to castration in men with prostate cancer in order to block the action of the 25 to 50% DHT left in the prostate after castration. Not adding an antiandrogen to castration in men treated for prostate cancer is equivalent to not prescribing a blocker of estrogens in women suffering from breast cancer because they are postmenopausal and have low circulating estradiol.
Labrie
Fernand
F
Molecular Endocrinology and Oncology Research Center, Laval University Hospital Research Center (CRCHUL) 2705, Laurier Boulevard, Quebec City, Quebec, Canada G1V 4G2. fernand.labrie@crchul.ulaval.ca
Cusan
Leonello
L
Gomez
José Luis
JL
Martel
Céline
C
Bérubé
René
R
Bélanger
Patrick
P
Bélanger
Alain
A
Vandenput
Liesbeth
L
Mellström
Dan
D
Ohlsson
Claes
C
D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000097:blood / Q000188:drug therapy*; D002369:Castration; D005260:Female; D008401:Gas Chromatography-Mass Spectrometry; D012739:Gonadal Steroid Hormones / Q000096:biosynthesis* / Q000097:blood / Q000627:therapeutic use*; D006066:Gonads / Q000378:metabolism*; D020249:Hormone Replacement Therapy; D006801:Humans; D008297:Male; D008954:Models, Biological; D017698:Postmenopause / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000188:drug therapy*; D012727:Sex Characteristics
D012739:Gonadal Steroid Hormones