前立腺癌の内分泌学的研究

Daily outputs of urinary 17-ketosteroid and its fractionation were determined on sixteen cases of prostatic carcinoma. Changes of 17-KS and its fractionation were investigated in course of several kinds of the antiandrogenic treatments. The results are as follows:<br>(1) Levels of urinary 17-KS in 12 cases of untreated prostatic carcinoma and in 5 cases of prostatic hypertrophy were within normal limits. Increased outputs of 17-KS were observed in some patients with prostatic carcinoma, but they were statistically insignificant. No significant differences were found between normal adults, cases of prostatic carcinoma and cases of prostatic hypertrophy.<br>(2) Following total prostatectomy which was done on 2 cases urinary 17-KS outputs were decreased for the first 2-3 days but the preoperative levels were regained on the 4th day. Thereafter the level was unchanged in one, another the level decreased again. In 17-KS fractionation a case presented no remarkable change, while in another a decrease of fractions IV and V and an increase in fractions VI and VII were marked. The difference in 17-KS of the patients may be due to the individual difference of reaction against operative invasion.<br>(3) In two cases in which prostatectomy had been performed several years ago urinary 17-KS outputs were also within normal limits, but its fractionation revealed that androgen fractions were markedly exceeded by corticoid fractions.<br>(4) Urinary 17-KS levels decreased following castration as a rule. But transient increases up to or more than the preoperative levels were observed during 10th to 25th day after the operation. As regards 17-KS fractionation, fractions IV and markedly decreased after the operation, but there-after the ratios to fractions VI and VII gradually increased. Fraction III did not show any definite tendency.<br>(5) Administrations of estrogenic hormones resulted in reduction of urinary 17-KS outputs, both in fractions IV and V and fractions VI and VII. Changes of fraction III in cases of prostatic carcinoma were inconsistent. But, the same results were observed in cases of prostatic hypertrophy, too.<br>(6) Administration of corticosteroids reduced urinary 17-KS outputs. As regards 17-KS fractionation both fractions IV and V and fractions VI and VII decreased, but fraction III slightly increased.<br>(7) Similar changes were found both in patients in whom anti-androgenic treatments were effective and in patients in whom they were not effective. Therefor, it is suggested that the effectiveness of anti-androgenic treatments does not depend on to the endocrinological disturbance, but to androgen-dependency of the carcinoma cell.<br>(8) X-ray irradiation of the hypothalamo-pituitary region was much effective in untreated patients of prostatic carcinoma, as shown in reduction of the size and hardness of the gland and in decrease of residual urine. Of 3 cases on which other anti-androgenic treatments had been tried it was more or less effective in two. Another patient who was suffering from bladder symptoms due to intravesical invasion of the prostatic carcinoma did not show any symptomatic improvement through the treatment.<br>(9) Results of the determination of urinary 17-KS revealed that in course of the irradiation the hypothalamo-pituitary function was initially stimulated and then suppresive effects became gradually evident.<br>(10) In the initial stage of the course of the irradiation both fractions VI and V and fractions of VI and VII increased, the changes of the former fractions being more marked. In the later course of the irradiation both fractionations reduced, the fractions of IV and V decreasing more markedly. Fraction III did not show any definite tendency in the initial stage, but it presented an increasing tendency in the later cause of the irradiation. These results suggested that the hypothalamo-pituitary gonadal system was more x-ray sensitive than the hypothalamopituitary-andrenocortical system.<br>(11) T