Combined Treatment with Buserelin+Cabergoline in Patient with Prostate Cancer and Pituitary Macroprolactinoma

Gervain Mihály, Vörös Erika, Molnár Andor, Karcsú-Kis Gyöngyi, László Ferenc, László A. Ferenc
DOI: 10.4236/jct.2010.14033                

Abstract

Twelve years following hemicolectomy for colon adenocarcinoma, a 75-year-old patient with prostate cancer was treated for 4 weeks with the antiandrogen nilutamide and then with the long-acting GnRH agonist buserelin. The serum testosterone and prostate-specific antigen levels had decreased dramatically after 3 months of treatment. After 2 years of buserelin administration, the hormonal state was examined. Serum estradiol, testosterone, DHEA, DHEAS, FSH and LH levels proved to be suppressed, but the serum PRL concentration was extremely high (3 365 mIU/l). The pituitary MRI revealed a macroadenoma. The patient was treated with the dopamine agonist cabergoline, together with buserelin. After 9 months of this combined treatment, the prostate-specific antigen and testosterone levels were very low; the serum estradiol, DHEA, DHEAS, FSH and LH concentrations remained suppressed. The serum PRL level fell dramatically to 6.95 mIU/l, and a significant reduction in tumor size was observed on MRI. In conclusion: Combined buserelin + cabergoline treatment proved a highly successful procedure to cure this patient with prostate carcinoma and subsequent pituitary macroprolactinoma.

Keywords

Prostate cancer, Prolactinoma, Buserelin; Cabergoline

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	C. Huggins and C. V. Hodges, “Studies on Prostatic Cancer. I. The Effect of Castration on Serum Phosphatases In Metastatic Carcinoma of the Prostate,” Cancer Research, Vol. 1, No. 1941, pp. 293-296.
[2]	C. E. Blackard, D. P. Byar and W. P. Jordan, Jr., “Orchidectomy for Advanced Prostatic Carcinoma. A Reevaluation,” Urology, Vol. 1, No. 6, 1973, pp. 553-560.
[3]	F. Sciarra, G. Sorcini, F. Di Silverio and V. Gagliardi, “Plasma Testosterone and Androstenedione after Orchiectomy in Prostatic Adenocarcinoma,” Clinical Endocrinology (Oxford), Vol. 2, No. 2, 1973, pp. 101-109.
[4]	H. J. de Voogt, P. H. Smith, M. Pavone-Macaluso, M. de Pauw and S. Suciu, “Cardiovascular Side Effects of Diethylstilbestrol, Cyproterone Acetate, Medroxyprogesterone Acetate and Estramustine Phosphate Used for the Treatment of Advanced Prostatic Cancer: Results from European Organization for Research on Treatment of Cancer Trials 30761 And 30762,” The Journal of Urology, Vol. 135, No. 2, 1986, pp. 303-307.
[5]	R. A. Airhart, T. F. Barnett, J. W. Sullivan, R. L. Levine and J. U. Schlegel, “Flutamide Therapy for Carcinoma of the Prostate,” Southern Medical Journal, Vol. 71, No. 7, July 1978, pp. 798-801.
[6]	G. Tolis, N. Faure, M. Koutsilieris, A. Lemay, S. Klioze, A. Yakabow and A. T. Fazekas, “Suppression of Testicular Steroidogenesis by the GnRH Agonistic Analogue Buserelin (HOE-766) in Patients with Prostatic Cancer: Studies in Relation to Dose and Route of Administration,” Journal of Steroid Biochemistry, Vol. 19, No. 1C, 1983, pp. 995-998.
[7]	J. Trachtenberg, “The Treatment of Metastatic Prostatic Cancer with a Potent Luteinizing Hormone Releasing Hormone Analogue,” The Journal of Urology, Vol. 129, No. 6, June 1983, pp. 1149-1152.
[8]	G. Mathe, A. V. Schally, A. M. Comaru-Schally, R. Y. Mauvernay, M. L. Vovan, D. Machover, J. L. Misset, B. Court, P. Bouchard, J. Duchier and et al., “Phase II Trial with D-Trp-6-LH-RH in Prostatic Carcinoma: Comparison with Other Hormonal Agents,” The Prostate, Vol. 9, No. 4, 1986, pp. 327-342.
[9]	H. J. de Voogt, U. Studer, F. H. Schroder, J. G. Klijn, M. de Pauw and R. Sylvester, “Maximum Androgen Blockade Using LHRH Agonist Buserelin in Combination with Short-term (two weeks) or Long-term (continuous) Cyproterone Acetate is Not Superior to Standard Androgen Deprivation in the Treatment of Advanced Prostate Cancer. Final Analysis of EORTC GU Group Trial 30843. European Organization for Research and Treatment of Cancer (EROTC) Genito-Urinary Tract Cancer Cooperative Group,” European Urology, Vol. 3
[10]	H. Parmar, R. H. Phillips, S. L. Lightman, L. Edwards, L. Allen and A. V. Schally, “Randomised Controlled Study of Orchidectomy vs Long-acting D-Trp-6-LHRH Microcapsules in Advanced Prostatic Carcinoma,” Lancet, Vol. 2, No. 8466, 1985, pp. 1201-1205.
[11]	J. Waxman, “Gonadotrophin Releasing Hormone Analogues For Prostatic Cancer: An Overview,” Seminars in Oncology, Vol. 15, No. 4, 1988, pp. 366-370.
[12]	H. Matzkin, I. Kaver, O. Lewyshon, D. Ayalon and Z. Braf, “The Role of Increased Prolactin Levels under Gnrh Analogue Treatment in Advanced Prostatic Carcinoma,” Cancer, Vol. 61, No. 11, 1988, pp. 2187-2191.
[13]	A. B. Grotas and H. M. Nagler, “Presentation of a Functional Pituitary Adenoma as A Significant Decrease in Prostate-Specific Antigen Level in a Patient Followed for Prostate Cancer,” The Canadian Journal of Urology, Vol. 13, No. 6, 2006, pp. 3346-3347.
[14]	F. G. Robertson, J. Harris, M. J. Naylor, S. R. Oakes, J. Kindblom, K. Dillner, H. Wennbo, J. Tornell, P. A. Kelly, J. Green and C. J. Ormandy, “Prostate Development and Carcinogenesis in Prolactin Receptor Knockout Mice,” Endocrinology, Vol. 144, No. 7, 2003, pp. 3196-3205.
[15]	A. Peyre, J. P. Ravault and P. Laporte, “Potentiation Effect Of Endogenous Prolactin on Male Sex Effectors Treated with Testosterone,” Comptes rendus des séances de la Société de biologie et de ses filiales, Vol. 162, No. 8, 1968, pp. 1592-1595.
[16]	F. Labrie, A. Belanger, V. Luu-The, C. Labrie, J. Simard, L. Cusan, J. Gomez and B. Candas, “Gonadotropin-releasing Hormone Agonists in the Treatment of Prostate Cancer,” Endocrine Reviews, Vol. 26, No. 3, 2005, pp. 361-379.
[17]	I. M. Spitz, B. Chertin, A. Fridmans, A. Farkas, A. Belanger, H. Hartman and F. Labrie, “Partial Androgen Suppression Consequent to Increased Secretion of Adrenal Androgens in a Patient with Prostate Cancer Treated with Long-acting GnRH Agonists,” Prostate Cancer and Prostatic Diseases, Vol. 12, No. 1, 2009, pp. 100-103.
[18]	E. Ciccarelli, M. Giusti, C. Miola, F. Potenzoni, D. Sghedoni, F. Camanni and G. Giordano, “Effectiveness and Tolerability of Long Term Treatment with Cabergoline, a New Long-lasting Ergoline Derivative, in Hyperprolactinemic Patients,” The Journal of Clinical Endocrinology and Metabolism, Vol. 69, No. 4, 1989, pp. 725-728.
[19]	E. Delgrange, T. Daems, J. Verhelst, R. Abs and D. Maiter, “Characterization of Resistance to the Prolactin-lowering Effects of Cabergoline in Macroprolactinomas: A Study in 122 Patients,” The European Journal of Endocrinology, Vol. 160, No. 5, 2009, pp. 747-752.
[20]	F. A. Laszlo, C. Varga, A. Papp, I. Pavo and F. Fahrenholz, “Difference between Male and Female Rats in Vasopressor Response to Arginine Vasopressin,” Acta Physiologica Hungarica, Vol. 81, No. 2, 1993, pp. 137-145.
[21]	F. F. Casanueva, M. E. Molitch, J. A. Schlechte, R. Abs, V. Bonert, M. D. Bronstein, T. Brue, P. Cappabianca, A. Colao, R. Fahlbusch, H. Fideleff, M. Hadani, P. Kelly, D. Kleinberg, E. Laws, J. Marek, M. Scanlon, L. G. Sobrinho, J. A. Wass and A. Giustina, “Guidelines of the Pituitary Society for the Diagnosis and Management of Prolactinomas,” Clinical Endocrinology (Oxford), Vol. 65, No. 2, 2006, pp. 265-273.