To investigate the feasibility and antitumoral effect of
ketoconazole in the treatment of disseminated
prostatic cancer, 22 patients with stage D2 disease were treated with 400 mg.
ketoconazole orally every 8 hours. Of the 17 patients evaluable for antitumoral effect an initial
tumor response of 88 per cent was observed (1 complete and 8 partial responses, and 6 with stable disease) with a mean duration of 15.8 months (range 5 to more than 30 months). Treatment-related side effects were encountered in 21 patients and consisted of
asthenia, gastrointestinal complaints, skin reactions and cardiovascular complications. They were judged to be mild in 8 patients, moderate in 5 and severe in 8. Treatment had to be discontinued because of side effects in 7 patients (32 per cent). During treatment with
ketoconazole serum
testosterone levels decreased rapidly and attained nearly castrate levels at the end of week 3. However, after 1 month a steady increase was noted and the
testosterone levels reached low normal ranges after 5 months. No hormonal or biochemical indications of adrenocortical insufficiency were noted. High dose
ketoconazole is effective in the treatment of disseminated
prostatic cancer. Its use is limited by the side effects and the inability to maintain castrate levels of
testosterone.