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As high grade PIN is commonly associated with concomitant cancer, current literature recommends re-biopsy of patients with high grade PIN. This paper describes the prevalence of high grade prostatic intra-epithelial neoplasia (PIN) from three independent clinical settings, reported by a single pathologist (MCP). High grade PIN was diagnosed in biopsies from 131 of the 1205 (11%) of patients in whom cancer was suspected in hospital practice, 42 of the 202 (20%) asymptomatic men screened for prostate cancer and 29 of the 118 (25%) patients presenting with prostatism in a case finding study. Re-biopsy on this scale has major clinical and cost implications. However, from a literature review, there is evidence to suggest that the risk of concomitant cancer with high grade PIN may be stratified according to serum PSA. This opinion should be tested prospectively.

(1995). Some aspects of the biology and endocrinology of prostate cancer. Scandinavian Journal of Clinical and Laboratory Investigation: Vol. 55, No. sup221, pp. 23-31.

The histological and transrectal ultrasound (TRUS) appearances at corresponding sites of the periphery of the prostate gland have been compared in 30 benign and 27 malignant glands taken at autopsy. In the benign series, the histological capsule was frequently absent and correlated poorly with the consistent TRUS findings of a regular, well-defined 'ultrasonic capsule'. It is concluded that 'the capsule' should be replaced as a tumour-staging landmark by a more realistic terminology. Carcinoma may be described as intra- or extra-prostatic, or confined or unconfined with respect to the gland. In the malignant glands, there was no correlation between morphologically unconfined cancers and irregular or absent ultrasound 'capsule' when corresponding areas were compared. This disparity must contribute to an underestimation of tumour extent with TRUS.

Transforming growth factor alpha (TGF alpha) expression was analyzed immunocytochemically on formalin-fixed wax-embedded sections obtained from 24 benign prostatic hyperplasia (BPH) specimens and 76 prostatic carcinoma tissues, 3 human prostatic tumor xenografts, normal kidney, and salivary gland. Low amounts of TGF alpha immunopositivity were encountered in the epithelium of BPH glandular tissues, whereas in the prostatic adenocarcinoma samples, a greater heterogeneity and intensity of TGF alpha immunostaining was observed. The most intense staining was exhibited by the least differentiated tumors, although a few of these were weakly stained. Statistical analysis of the relationship of histopathological grade of tumor with TGF alpha expression in the carcinomas showed a significant correlation of these parameters, 0.01 > P > 0.001. The expression of the proliferation markers Ki-67 and PCNA was also analyzed in the carcinoma specimens, and the relationship of these to TGF alpha expression indicated that there was no significant correlation in this series of tumors between increased growth activity and TGF alpha expression (p approximately 0.25 with both markers). The prostatic carcinoma xenografts TEN12 and TEN15 contained low levels of immunoreactive TGF alpha, which was uniformly distributed, whilst heterogeneous immunostaining was observed in the uroepithelial xenograft TEN16. In the normal human kidney, TGF alpha was concentrated in the epithelium of the distal convoluted tubules (DCT) and the collecting tubules (CT), and lower amounts were identified in the proximal convoluted tubules (PCT). As in the prostatic carcinomas, the immunostaining was eliminated by prior absorption of the antibody with pure TGF alpha and not with human or mouse EGF. No crossreactivity of the TGF alpha antibody with salivary EGF was demonstrated. This study concludes that, in prostate carcinoma, the least differentiated tumors more often expressed greater amounts immunoreactive TGF alpha; however, no relationship between TGF alpha expression and cellular proliferation markers was found.

Bone scintigraphy is the most sensitive imaging technique for the initial detection of bone metastases and is widely used in the staging of prostatic cancer. This study was performed to assess whether the development of further bone metastases can be detected by serial measurements of the serum glycoprotein prostate-specific antigen (PSA) as an alternative to follow-up scintigraphy. The bone scintigrams and PSA levels of 101 patients with metastatic prostate cancer entered into two therapeutic trials have been reviewed. Serial results of both investigations were available in 59 cases. In three cases new bone deposits were observed without a corresponding rise in PSA. In two other cases the scintigrams were considered to be suspicious of progression with no change in PSA levels; however, further follow-up indicated that these changes were not due to metastases. In 13 cases PSA levels were rising in advance of new deposits on the scintigrams. In the remaining 41 cases the PSA levels and scintigraphic findings paralleled each other. We conclude that serial estimation of PSA levels is a simpler marker for disease progression than bone scintigraphy in metastatic prostatic cancer, but that neither technique in isolation gives complete accuracy.

Summary— Seminal vesicle cysts may arise from inflammation or obstruction of the seminal vesicle or from embryological remnants such as the mullerian duct. Surgical removal has been proposed as the treatment of choice. A 19-year-old boy presented with abdominal pain and constipation. Investigations revealed a 14-cm multiloculated cyst arising from the right seminal vesicle and a small stone lodged at the orifice of the ipsilateral ejaculatory duct. Following endoscopic removal of the stone the mass decreased in size considerably and 2 months later transrectal ultrasound and magnetic resonance imaging showed normal seminal vesicles and no evidence of the cyst. This case strongly supports an obstructive aetiology for this cyst and we would suggest that, in similar cases, full assessment of the ejaculatory apparatus should be carried out to exclude an obstructive cause before embarking on major surgery.

Proliferating cell nuclear antigen (PCNA) expression was determined immunohistochemically, using a monoclonal antibody PC10, in 102 prostatic carcinoma samples and in prostate tissue from 21 patients with benign prostatic hyperplasis (BPH). The percentage of cells with stained nuclei ranged from 1% to 58% in the carcinoma specimens and 0% to 10% in the BPH specimens. A semiquantitative scoring system was devised for the degree of PCNA positivity observed in the tumors. Statistical analysis of the PCNA score in relation to the histological grade of the tumors gave a significant positive or negative correlation between these parameters P less than 0.001. No significant correlation between PCNA score was, however, seen with metastatic status, T category (TMN classification) of the primary tumor, or the patient's age at diagnosis. In 65 prostatic cancer patients of known survival, those individuals whose tumors had a PCNA score of +/- (less than 10% of nuclei stained) were compared with those patients whose tumors were either 1+, 2+, or 3+ (greater than 10% of nuclei stained). Life table analysis of the two groups indicated that the patients with the lower PCNA score survived significantly longer than those with the higher PCNA scores, P less than 0.04. Comparison of the Ki-67 expression in frozen sections with the PCNA expression in wax-embedded tissue of 86 prostatic carcinomas was also undertaken. A significant correlation between these two parameters was found, P less than 0.001, although the growth fraction estimated by Ki-67 expression was generally lower than that given by the PCNA scoring system.

Serum IGF-1 determination in relation to prostate cancer screening: possible differential diagnosis in relation to PSA assays

Three major developments have occurred in recent years which have increased our understanding of prostatic disease: a major reassessment of the anatomy of the prostate, the development of the serum assay for prostate-specific antigen, and developments in prostatic imaging. The prostate gland has traditionally been regarded as an organ with a relatively simple anatomical structure, based on a system of lobes, as proposed by Lowsley (1912). Lowsleyapos;s concept was, however, based on observations of fetal prostate glands and this system cannot now be accepted. A zonal system of anatomy of the prostate was initially proposed by McNeil in 1969 and was fully described in 1981. This concept has been supported by work by Blacklock and Boushill (1977). In McNeil's system the prostate is considered as three glandular zones, transition, central and peripheral, and one non-glandular region, the anterior fibromuscular stroma. The urethra and ejaculatory ducts pass through these zones (Fig. 1). It is important to app...

A consecutive series of 143 ultrasound guided biopsies of the prostate have been analysed. In 84 patients, in whom carcinoma was suspected by both digital examination and ultrasound, 49 cancers were confirmed histologically. In 29 patients in whom digital examination suggested cancer but ultrasound was normal, 2 cancers were confirmed. In 20 patients with a normal digital examination but a suspicious ultrasound appearance, no cancers were proven.

The prostate gland is being biopsied increasingly frequently, especially as a result of the visualisation of suspect areas on transrectal ultrasonography, using a variety of different needle types. We report only the third case of tumour seedling in the tract following a transperineal biopsy of a prostatic cancer with a 'Tru-Cut' needle. The literature is reviewed with regard to the characteristics and the incidence of seedling and the importance of including the perineum in any treatment option is emphasized.

Granulomatous prostatitis is an unusual, but well-recognized entity frequently mistaken for carcinoma on both digital rectal examination and transrectal ultrasound. The ultrasonographic findings of 11 patients with histologically-proven granulomatous prostatitis are reviewed.

Objective To determine the completeness of transurethral resection of the prostate (TURP). Patients and methods The prostate volume of 432 patients was measured by transrectal ultrasonography (TRUS) before they underwent a TURP performed by one of three consultant urological surgeons. The prostate tissue collected at resection was weighed, multiplied by 1.2 to compensate for ‘shrinkage’, and the amount of tissue removed expressed as a percentage of the pre-operative prostate volume determined by TRUS (resection ratio). The patients were categorized into groups based on pre-operative prostate size. Results The mean weight of prostate tissue resected was 25.6 g. Resection ratios increased with prostate size, with the largest occurring in prostates of 71–110 g. The surgeon did not resect more than 50% of the gland volume in any group. Conclusion This study counters the theory that a complete resection of the prostate is routinely achieved. The endoscopic appearances probably imply a complete resection of the adenoma but a considerable volume of the gland remains. This has important implications for the detection of prostate carcinoma at TURP and for the staging of the disease.

The prostate gland has attracted a remarkable increase in interest in the past few years. The two most common diseases of this gland, benign prostatic hyperplasia and carcinoma of the prostate, have been brought into greater prominence by new diagnostic methods, public interest, and a wider choice of surgical and non-surgical treatments. Uncertainty about the significance of these changes has occurred because of the rapidity of change, the profusion of statements, opinions and promotions, and the relatively little guidance available from the profession. Ten urologists and two general practitioners have reviewed the relevant evidence about these two prostate diseases and the newer diagnostic methods; their conclusions are summarised here. Management options and guidance on clinical practice are also discussed. Because of a number of unresolved diagnostic and management issues, detailed requirements for practice guidelines have not been specified.

Neurological dysfunction from base of skull metastasis of prostate cancer is rare. In this case, dysphagia was the presenting symptom and relief occurred after orchidectomy. Improvement of neurological symptoms usually occurs only after local radiotherapy.

A great deal of information has been gathered together during the past 50 years about the pathology of prostate cancer, its endocrinology, cell biology and particularly its clinical features and behaviour. Despite this, there is uncertainty about its causes and natural history, and as there is still considerable debate about methods of treatment it is probably not surprising that mortality from the disease remains much as it was 30 to 40 years ago. It would appear, therefore, that there has been limited forward progress in the clinical management of this disease so what should we be examining in the last decade of the twentieth century, to find some answers, particularly to reduce mortality?

Prostatic cancer in the year 2000 will be at the forefront of medical problems affecting the male population of the world. There is now a considerable amount of evidence to indicate that cancer of the prostate gland is, or is quickly becoming, the most commonly diagnosed cancer in men in the western world. The incidence rate appears to be consistently rising and, interestingly, the mortality rate for the black population of the United States of America is double that of the white people. It is becoming very evident that prostatic disease, both benign prostatic hyperplasia (BPH) as well as cancer, has become a serious health-care problem, particularly when considered in relation to the ever increasing proportion of the population in the more developed countries that is over the age of 65 years.

A clinical diagnosis of prostatitis is often made by the urologist but is often not confirmed by objective laboratory or radiological evidence. Prostatitis is not one disease but occurs in several distinct forms or syndromes, and the common types of prostatitis may be divided into acute (ABP) and chronic bacterial prostatitis (CBP), non-bacterial prostatitis (NBP) and prostatodynia. This classification is based on obtaining evidence of bacterial infection localised to the prostate, and inflammatory cells in the expressed prostatic secretions (EPS). Bacterial prostatitis is associated with bacteriuria. In cases of CBP the persistent presence of the pathogenic organism leads to recurrent bacteriuria, whilst in patients with NBP or prostatodynia bacteriuria rarely (if ever) occurs. Patients with CBP and NBP have excess fat-containing macrophages and leukocytes in their prostatic secretions whilst patients with prostatodynia have prostatic secretions without such evidence of inflammation.

Serum prostatic specific antigen (PSA) and ultrasound-determined prostatic volume (UPV) were measured in 50 patients with histologically proven benign prostatic hyperplasia (BPH) and in 40 patients with histologically proven prostatic cancer of whom 17 had evidence of distant metastases (M1) and 23 did not (M0). A good correlation between log PSA and UPV was demonstrated in the BPH group and rearrangement of the linear regression equation allowed calculation of a single variable--the log PSA corrected to a standard prostate volume for any given individual. A volume-corrected PSA correctly identified all patients with M1 disease and greatly improved but did not eliminate overlap of M0 disease with BPH. Reduction of serum PSA to a single volume-corrected variable will allow the introduction of practical and optimum protocols for the management of patients with prostatic enlargement.

Estimation of the growth fraction of 153 prostatic carcinoma specimens employing Ki-67 immunostaining was undertaken and its relationship to various clinical parameters investigated. In prostate specimens, the percentage of tumour nuclei expressing Ki-67 antigen was measured and assigned a Ki-67 score. It was observed that high Ki-67 scores were associated with the poorly differentiated tumours, the correlation of this proliferation marker with histological grade was found to be significant (P less than 0.001). No relationship was observed between the Ki-67 score of the primary tumour with either the patient's age or with the primary tumor stage (T category). The metastatic status of the patient at diagnosis and the Ki-67 score of the tumour were correlated (P less than 0.05), higher Ki-67 scores being associated with M1 disease. Life-table analysis of 86 patients who subsequently received androgen withdrawal therapy, was undertaken with reference to the various Ki-67 scores of their primary tumors. A statistically significant difference in survival times was observed in patients whose Ki-67 values were less than 1% (P less than 0.0001) when compared to those patients whose tumours expressed 1% and over Ki-67 positivity, the former having longer survival times. When patients were subdivided according to their metastatic status and similar life-table analyses were carried out, no statistical difference was found between survival times and Ki-67 scores in M0 staged patients. In the M1 population of patients, however, those patients whose tumours were negative for Ki-67 expression had significantly longer survival times than those patients whose tumours exhibited positive Ki-67 staining (P less than 0.01). Comparing M1 staged patients whose prostate tumor cells exhibited less than 1% Ki-67 positive nuclei with M1 staged patients whose prostate tumour cells contained 1% and higher Ki-67 stained nuclei, a significantly longer survival time was found in the former group of patients (P approximately 0.0001).

Most interest in transrectal ultrasound (US) of the prostate has concentrated on its role in the diagnosis and management of prostatic cancer. The increasingly detailed investigation of male patients with infertility has recently led to interest in the use of US in investigating the structure and function of the ejaculatory ducts and seminal vesicles. The anatomy and pathology of the ejaculatory ducts and seminal vesicles as demonstrated by transrectal US are discussed and illustrated.

Summary— The development of microradiography of the prostate gland has provided a new approach to investigating the origin and structure of benign hyperplasia. It has demonstrated that benign prostatic hyperplasia is usually microadenomatous in structure, although reticular types do occur. It originates at the lateral boundary of the periurethral muscle in the position of the transitional zone. In contrast, stromal nodules are homogeneous and amorphous in structure and develop at the site of the short straight urethral ducts within the periurethral muscle.

The transrectal ultrasound findings in 52 patients with haemospermia were reviewed. Scan abnormalities were demonstrated in 43 patients (83%). These included benign prostatic hyperplasia (24 patients), seminal vesicle abnormalities (10 patients), prostatic calcification (32 patients) and two patients with prostatitis. No patient was proven to have prostatic malignancy. Transrectal ultrasonography can suggest a cause of haemospermia in the majority of patients without resort to invasive investigations, and can exclude underlying prostatic malignancy. It is recommended as the first radiological investigation in patients presenting with haemospermia.

The side effects and patient acceptability of 230 ultrasound guided prostatic needle biopsies performed by the transrectal route in an out-patient setting were reviewed retrospectively. Most of the side effects were transient and mild; one patient required hospitalization for urinary retention. Patient acceptability was good; over 70% of patients reported no significant pain from the biopsy procedure.

The histopathological, microradiographic and ultrasonographic features of corresponding areas of 100 cadaveric prostates were examined and correlated statistically to investigate their relationship. Benign glands are seen to be related to reticular structure and mid-range echoes. Benign prostatic hyperplasia is related to microadenomatous structure and mid-range echoes, whilst cancer is related to amorphous structure and low echoes. A small number of cancers have irregular calcification present and these tumours are related to high echoes. The structure of the prostate gland is therefore related to its pathology and explains its ultrasound echogenicity.

One hundred and thirty-seven patients underwent optical urethrotomy and have been followed up over a period of 3 years. The overall improvement rate was 66%. The results were unrelated to the length of history, the number of previous dilatations or the site of the lesion. However, traumatic strictures did significantly less well than the others. Although the procedure can be repeated, the chance of failure following the third or subsequent urethrotomy was much greater than after the first or second procedure. Urethrotomy for post-prostatectomy membranous strictures was followed by incontinence in 31% of patients. Otherwise the procedure was safe and should be the first choice of treatment for most patients with urethral strictures.

Summary— One hundred cadaver prostates were examined by per-rectal ultrasound and the findings correlated with the microradiographic and histopathological features of whole sections taken at the levels of scanning. The normal gland consists of both periurethral muscle and glands. The periurethral muscle has little structure on microradiography and is therefore hypoechoic (low amplitude echoes) on ultrasound scanning. The gland itself, both central and peripheral zones, has a lattice appearance on microradiography (reticular structure) and therefore produces mid-range amplitude echoes on ultrasound. Benign hypertrophy develops at the edge of the periurethral muscle and is microadenomatous in structure. This produces mid-range amplitude echoes which are coarser than in the normal gland. Associated calcification has a characteristic distribution around the adenomas. Cancer produces an amorphous structure resulting in loss of ultrasonic echoes (hypoechoic). In a few cancers irregular calcification is present, resulting in high echoes in the ultrasound scan (hyperechoic) which are not in the typical benign distribution. The internal structure of the prostate was therefore demonstrated in its histopathological states by the technique of microradiography and seen to relate to its representation by ultrasound.

The immunocytochemical detection of endogenous human GH and the binding of exogenously applied human GH in tumour tissue from patients with benign prostatic hyperplasia or prostatic carcinoma is reported. Monoclonal human GH antibody binding was exclusively to the connective tissue in both benign and carcinomatous specimens. Specificity control experiments indicated that the antibody could be absorbed with human GH but not with human prolactin. Preincubating the sections with human GH considerably altered the immunocytochemical staining, reducing the reaction product within the connective tissue in a concentration-dependent manner and revealing a binding site for GH within the cytoplasm of epithelial cells. J. Endocr. (1984) 103, 311–315

Twenty two patients with advanced carcinoma of the prostate have been treated for up to 3 months with the slow-release (depot) formulation of the luteinizing hormone-releasing hormone (LHRH) agonist ICI 118630. Patients were randomized to receive one of three different doses of ICI 118630 of 0·9, 1.8 or 3.6 mg. The depot preparation was injected subcutaneously every 4 weeks. At the highest dose, the concentration of testosterone in serum was significantly reduced to castrate values after 2–3 weeks of therapy. The smaller doses of ICI 118630 (1.8 or 0.9 mg every 4 weeks) similarly reduced serum testosterone concentrations although, at the lowest dose, testosterone values were not suppressed in all patients during the first month. Hormonal changes were accompanied by subjective clinical improvement in symptomatic patients and there were no significant side effects. The data clearly demonstrate the considerable therapeutic potential of ICI 118630 in the depot formulation for the treatment of advanced carcinoma of the prostate.

Summary— The clinical and endocrine response to a depot preparation of the LH-RH analogue ICI 118630 (Zoladex) was assessed in 55 untreated patients with advanced prostatic cancer. Whereas gonadal androgen suppression was achieved in all patients, subjective and objective clinical response occurred in only 69%, indicated by a relief of bone pain, a decrease in the size of the primary tumour and lymph node metastases and improvement in bone scan appearances. A third of these patients, however, subsequently showed progression of their disease. Serious side effects were not encountered in this study. The depot formulation is a simple, safe and convenient method of administering Zoladex and offers an alternative treatment for metastatic prostatic cancer.

Objectives: Transurethral resection of prostate (TURP) is the gold standard treatment for symptomatic prostatic bladder outlet obstruction. Haemorrhage during and after TURP can lead to significant morbidity and mortality. The purpose of this study was to assess the influence of anaesthesia, operating time, weight of resected prostatic tissue and its histology on blood loss during and after TURP and to revisit the available body of evidence in the literature of urology. Materials and methods: This is a prospective study of a cohort of 100 consecutive patients who had undergone TURP over a period of one year, where the data was collected on a performa specifically designed for the study, which included the type of anaesthesia administered, resection time, amount of blood lost during and after TURP, weight of the resected prostatic tissue and histology. Results: Sixty seven patients underwent TURP under spinal anaesthesia (SA) and 33 under general anaesthesia (GA). The median intraoperative (SA: 89.95 (5-936); GA: 105.40 (5-517) mls), postoperative (SA: 72.37 (15-387); GA: 136.43 (11-969) mls) and total (SA: 162.32 (29-1200); GA: 241.83 (21-1251) mls) blood losses were not significantly different between the two groups (95% C.I. -9.90 to 19.22, p= 0.46). The total operating time (SA: 29.70 (10-55); GA: 29.80 (10-65) minutes) and weight of resected prostate (SA: 21.90 (3-45); GA: 18.00 (4-60) gms) were similar between the two groups. There was a trend towards increased blood loss when BPH was associated with prostatitis (N=8). Of these, 3 patients required blood transfusion as compared to 1 patient in rest of the group, although this was not statistically significant (95% C.I - 67.2 to 1120.4, p = 0.87). Conclusions: The intraoperative, postoperative and total blood losses related to TURP were not influenced by the type of anaesthesia, resection time, weight of the resected prostate and the histology. Key Words: Transurethral resection of prostate, blood loss, anaesthesia, prostatitis, carcinoma, aspirin doi: 10.3126/kumj.v6i3.1707 Kathmandu University Medical Journal (2008), Vol. 6, No. 3, Issue 23, 329-334

The per-rectal ultrasound scans and digital assessments of 193 patients with prostatic nodules were analysed retrospectively. There were 88 histologically proven cancers and per-rectal ultrasound demonstrated extracapsular spread of tumour in 36 of these patients. In the diagnosis of prostatic cancer, ultrasound had a sensitivity of 97.6% and a specificity of 93.8% whereas digital examination had a sensitivity of 96.5% and a specificity of 53.3%.

Summary— A technique for examining cadaver prostates by per-rectal ultrasonography has been developed. The ultrasonic plane was defined and corresponding sections taken for microradiographic and histopathological examination. The technique has enabled a comparison to be made of the structural changes that occur in the prostate in disease states and the corresponding ultrasonic features.

Summary— Sixty men (7 normal, 53 with prostatic disease) underwent transrectal ultrasonic scanning of their prostates in order to assess the technique and evaluate its reliability in the detection and staging of prostatic cancer. The prostatic capsule was clearly seen in 58 men; non-integrity of the capsule occurred only in those with proven cancer (17 cases). An ultrasound diagnosis of cancer was made for 32 of 33 men with proven disease and it was shown that ultrasound demonstrated anterior perforations of the capsule in 6 out of 18 men with tumours that had been judged by rectal palpation to have been confined to the prostate. It is concluded that transrectal ultrasound is a promising technique of imaging the prostate, particularly in relation to selection of patients for biopsy and for checking staging of cancer carried out by digital assessment of the prostate.

Prostatic cancer is one of the most common causes of death from malignant disease in men. It is unfortunate, however, that this particular form of cancer and benign hyperplasia of the prostate gland are generally considered mere appurtenances of advancing years and relatively little research has been directed to the study of the biological factors that may be concerned with the aetiology of the condition. Furthermore, prostatic cancer is often clinically recognised only when the disease has become systemic and has extended beyond the prostate, yet there is little information on potential risk factors relating to the disease, and limited data on the practical value of various ‘tumour markers’ for the early detection of the condition.

Plasma testosterone, androstenedione, oestradiol-17β, follicle stimulating hormone (FSH) and luteinizing hormone (LH) were not significantly different in patients with prostatic cancer, with benign prostatic hyperplasia or in patients without prostatic disease. Plasma prolactin concentrations were significantly lower in the patients with benign disease than those with prostatic carcinoma. Endocrine therapy in the form of stilboestrol administration significantly decreased plasma levels of testosterone, oestradiol-17β, FSH and LH within 7 days of the treatment. After 7 days therapy prolactin levels increased significantly in all patients studied. Changes in growth hormone concentrations were more varied in response to stilboestrol, being elevated in several patients and remaining unchanged in others. Treatment of a few prostatic carcinoma patients who were receiving stilboestrol therapy with CB154, an inhibitor of prolactin secretion, brought an immediate decrease in prolactin levels which was sustained. Plasma testosterone, androstenedione and growth hormone were unchanged in these patients but a significant decrease in plasma oestradiol-17β was noted in two patients during CB154 administration.