A cellent results in the treatment of advanced mammary cancer that can be obtained with ablative procedures. However, since the number of endocrine glands is limited, and since, in spite of extensive ablative procedures, the disease eventually progresses, we should continue to seek other or further means ol favorably altering hormonal balance. Testosterone, the male sex hormone, as has been mentioned by others, actually does induce changes in hormonal balance that are accompanied by objective regression of metastatic lesions in one quarter of all patients so treated.
There is a difference of opinion among various investigators as to what their results represent. However, when the same objective criteria are applied, there is surprisingly good agreement about the favorable effects of the various ablative approaches and of androgen therapy, providing the initial patients are comparable. ?'he latter question is, of course, one of the great difficulties. As most of us know, it is not valid to apply statistical methods to samples of patients when the patients have not been selectcd on a random basis and when some who have lesions with a poor prognosis are omitted from one of the groups. It is equally difficult to compare the value of various procedures when the groups of patients are of dissimilar chronological or physiological age or when various types of lesions are involved. Patient selection niay thus explain some of the differenccs of opinion about the absolute effectiveness oC different procedures.
As a clinician, I must agree with Cade (pp.
777-788) that when we get very substantial subjective iniprovement it is this that is of tre-From the Alton Ochsner \Tediral Foundation and the