Huggins and hormonal treatment of prostate cancer

Charles Huggins, a Canadian-born surgeon at the University of Chicago, came to prostate cancer through the physiology of the dog. He devised a way to collect a dog's prostatic secretion at frequent intervals for years, and found that removing the testes shrank the gland and stopped secretion, while testosterone restored it. Huggins called the dog the only laboratory species in which prostate tumors occur, and in old dogs he saw that castration or small doses of estrogen made the tumors shrink quickly.

In men he needed a measure of the cancer's activity. Kutscher and Wolbergs had found acid phosphatase concentrated in the human prostate, and Gutman and Gutman had shown that serum acid phosphatase rises in many men with metastatic prostate cancer. With Clarence Hodges, Huggins chose eight men with bone metastases and high serum acid phosphatase, measured the enzyme three times a week, and castrated all of them; some also received estrogens, including stilbestrol, a synthetic compound first made in 1938. Castration and estrogen lowered acid phosphatase. Testosterone raised it: in one man, 25 mg a day for 18 days took it from 11 to 48.75 units. They reported in Cancer Research in 1941 that, judged by serum phosphatases, the disease was inhibited by eliminating androgens.

A second 1941 paper, with R. E. Stevens, reported the first series treated by orchiectomy: 21 men with far-advanced metastases, of whom 4 lived more than 12 years. Huggins later acknowledged many failures but judged that the treatments had lengthened lives and reduced pain. He called the removal of a normal gland to control distant disease physiologic surgery, and described stilbestrol as the first synthetic substance to control a cancer. Huggins traced the first sign that an advanced cancer could be made to regress to G. T. Beatson's removal of the ovaries in two women with breast cancer in 1896.

When Huggins shared the 1966 Nobel Prize in Physiology or Medicine with Peyton Rous, G. Klein of the Nobel committee said that more than half of men with prostate cancer too advanced for surgery had shown objective shrinkage or disappearance of their tumors, often with years free of symptoms. Huggins also introduced hormonal treatment of breast cancer. He died on 12 January 1997.