CA: A Cancer Journal for Clinicians, Vol 28, 182-190, Copyright
© 1978 by American Cancer Society
The Effects of Orchiectomy on Primary and Metastatic Carcinoma of the Breast
Norman Treves M.D.1,
Jules C. Abels M.D.1,
Helen Q. Woodard Ph.D.1, and
Joseph H. Farrow M.D.1
1 The Breast Department, the Clinical Metabolic Laboratories and the Chemistry Department, Memorial Hospital, New York.
In summarizing this group we may comment briefly on Case 2, the primary operable patient who became inoperable about seven months after radical mastectomy. He was treated with progynon after orchiectomy was refused and osseous metastasis had appeared. He had an associated cirrhosis of the liver. When the pain from the metastatic deposits in bone became unbearable he agreed to castration. The operation was performed under local anesthesia without incident, but the patient died suddenly three days after orchiectomy. Obviously the effects of castration could not be studied in this case.
In Case 5, the patient, a young man of 39 years admitted to the clinic with widespread disease of the skeletal system and intense pain, submitted to bilateral orchiectomy, surviving for four months. In the postcastration period there was no relief of pain and no evidence of reparative change in the skeletal metastases. It may be that his comparative youth, contrasted with the four older males in this group who have had favorable clinical responses, may be the reason for the unsatisfactory result. Cancer of the breast in the young, female or male, is always a formidable [See Table in Source Pdf.] [See Table in Source Pdf.] therapeutic problem. It may likewise be significant that his alkaline phosphatase was the highest preoperative value of any of the patients in this group—8.1 units. He also had the highest initial postoperative value of alkaline phosphatase—13.7 units. At no time did this reading approach the normal value and the last phosphatase determination showed a reading of 38.8 units. The procedure in this instance must be considered a clinical failure. Of the group of six castrates, he is the outstanding failure.
In Case 1, a 72-year-old male with widespread metastases to bone, was castrated on February 9, 1942. He had prompt relief from pain and has been comfortable since that time. Skeletal metastases have shown marked reparative change; all the pathological fractures in bone having healed with a firm callus which subsequently ossified. His general condition is good; he is in an excellent state of nutrition; the blood chemistry has returned to normal. One of the most striking results in this case has been the continued regression in the primary cancer of the left breast. The ulcerating tumor has now been completely replaced by a cicatrix. However, at the present time there is some question of reactivation especially in the skull. Twenty-eight months have elapsed since castration.
In Case 3, the patient submitted to castration on May 8, 1943, and was relieved promptly of the pain caused by metastases to the lower dorsal and lumbar vertebrae. While his blood chemistry never showed an abnormally high rise, his preoperative alkaline phosphatase of 6.6 units now is 2.6 units. X-ray films show evidence of bone regeneration. There has been a gain in weight. No evidence of local recurrence is noted nor are there new areas of metastasis and the pain has been completely relieved—a very gratifying clinical result 13 months after bilateral orchiectomy.
The third case with a favorable result has now gone one year after castration. He was the only primary operable patient in the group and his breast cancer was treated only by local excision and bilateral orchiectomy.
This unusual approach to the control of mammary carcinoma in the male has resulted in the following observations: (1) A radical axillary dissection 10 months after local excision and castration revealed no evidence of metastasis to the axillary nodes. (2) There has been no recurrence at the site of the local excision and the patient has not developed distant metastatic areas to date. However, one cannot be certain that local excision alone might have controlled the tumor process.
In Case 6, patient was castrated in January 1944, following the discovery of definite pulmonary metastases on his initial visit to the clinic. Five months after operation there has been a noticeable decrease in the extent and character of the pulmonary metastases. A single area of bone destruction in the crest of the right ilium has shown no further progression. The primary tumor in the breast has shown moderate healing and regression, but the axillary metastases have as yet shown no signs of alteration. There have been no significant changes in the blood chemistry. The patient has maintained his weight and is in good general condition.
It would appear, therefore, that of the metabolic phases measured, none changed significantly in the 12 to 18 days after orchiectomy in the patients studied. Changes known to be induced by testosterone or 
-estradiol apparently do not occur simultaneously with clinical symptomatic improvement in patients subjected to orchiectomy.
