Hypophysectomy for prostate cancer – a revival of old knowledge?

The growth of prostate cancer is controlled by several hormones and growth factors. In cases of metastasized prostate cancer the anti-gonadotropic therapy is currently used as state-of-the-art treatment. Orchidectomy and hypophysectomy are no longer in use. Here, we discuss the palliative use of hypophysectomy. A 63 year old male with progressing metastasized prostate cancer despite leuproreline- and taxotere therapy presented with cavernous sinus syndrome. Despite significant pain therapy severe bone pain was present, due to the tumor invasion of the bone marrow the patient was anemic. The last PSA level was measured at 1300 ug/l, a cMRI showed a pituitary macroadenoma as well as a metastatic infiltration of the skull base including the cavernous sinus. Prolactin levels were mildly elevated, testosterone below detection limit, IGF-1 was in the upper age-related limits, the patient received prednisone. Because of the elevated Prolactin and the high-normal IGF-1 level we offered additionally to transnasal adenomectomy a hypophysectomy, which was performed after appropriate preparation of the patient.

Histologically, a hormone-inactive pituitary adenoma with infiltration of prostate cancer cells was confirmed. Postoperatively, PSA dropped to 850 ug/l, the bone pain resumed, and the cavernous sinus syndrome improved. However, the patient died 4 months later of tumor progression. It is well known, that lactotropic and somatotropic factors influence the growth of prostate tissue as well as carcinomas. Therefore, in cancer progression despite LHRH-analogue and chemotherapy treatment additional options are desperately needed. Hypophysectomy may be considered in special cases. The significant question is, whether dopamine agonist therapy and/or somatostatin analogue therapy may show a „new“ way of treatment in these otherwise hopeless patients.