Jordan W P, Blackard C E, Byar D P
South Med J. 1977 Dec;70(12):1411-3.
The results of a large randomized prospective clinical trial conducted by the Veterans Administration Co-operative Urological Research Group (VACURG) in 1968 are updated and reevaluated. In this study, placebo, diethylstilbestrol (DES, 5 mg/day), orchiectomy plus placebo, and orchiectomy plus DES were compared in patients whose conditions were initially diagnosed as stage III and IV carcinoma of the prostate. Results showed that orchiectomy alone or in combination with estrogen did not improve overall survival rates in stage III and IV carcinoma of the prostate. In the two treatment groups receiving estrogen, however, there were fewer deaths due to cancer of the prostate, but this effect tended to be offset by an increased number of deaths due to cardiovascular causes. Deaths from other causes showed no particular pattern with respect to treatment. These studies showed that estrogen is more effective than orchiectomy in preventing deaths from cancer and that the addition of orchiectomy to estrogen does not offer any clear-cut advantage over estrogen therapy alone. If cancer symptoms necessitate treatment, initial therapy with estrogen is preferred. Orchiectomy should be reserved for those circumstances in which a patient is not reliable, cannot tolerate estrogens, or has severe cardiovascular disease.
退伍军人管理局合作泌尿学研究组（VACURG）1968年开展的一项大型随机前瞻性临床试验结果得到更新和重新评估。在这项研究中，对最初诊断为前列腺癌III期和IV期的患者比较了安慰剂、己烯雌酚（DES，5毫克/天）、睾丸切除术加安慰剂以及睾丸切除术加DES的疗效。结果显示，单纯睾丸切除术或与雌激素联合使用并不能提高前列腺癌III期和IV期患者的总体生存率。然而，在接受雌激素治疗的两个治疗组中，前列腺癌导致的死亡人数较少，但这种效果往往被心血管疾病导致的死亡人数增加所抵消。其他原因导致的死亡在治疗方面没有表现出特定模式。这些研究表明，雌激素在预防癌症死亡方面比睾丸切除术更有效，并且在雌激素治疗基础上加用睾丸切除术相对于单纯雌激素治疗并没有明显优势。如果癌症症状需要治疗，首选雌激素进行初始治疗。睾丸切除术应保留用于患者不可靠、无法耐受雌激素或患有严重心血管疾病的情况。
