Metastatic parathyroid carcinoma (mPCa): natural history and treatment of a case.

We report the case of a 46-year-old male patient who, after disease-free intervals of five, four and one and a half years following resection of an 'atypical' parathyroid adenoma in 1982, relapsed with clinical and laboratory recurrence of primary hyperparathyroidism (PHP). Noninvasive, traditional and modern imaging methods localized small distinct metastatic foci in both lungs without evidence of primary thyroid, neck or mediastinal tumor. Three successive bilateral lung nodule excisions resulted in a long PHP remission, while a three month treatment with normal saline infusions, diuretics, calcitonine and pamidronate infusions, following the last recurrence, resulted in moderate improvement of hypercalcemia and hypercalciuria with no effect on both PTH secretion or on the size of new metastatic lung foci. Recurrent mPCa with or without secretion of biologically active PTH is optimally treatable with successive surgical resections of the metastases and intermittent medical treatment to achieve PTH secreting tumor mass reduction and a beneficial metabolic effect.

Octreotide in the management of hormone-refractory prostate cancer.

Patients with advanced or metastatic prostate cancer (PC), a partially hormone-resistant disease, will require some form of hormonal manipulations or some new therapeutic modalities. Octreotide, as somatostatin (SST) analogs, has been found to inhibit the growth of experimental PCs via several mechanisms, as indirect antihormonal and direct antimitogenic actions, mainly due to inhibition of SST receptor subtypes (SSTR-1-5). Sporadic clinical trials with octreotide (alone or with a complete antiandrogen blockade) treatment of patients with advanced stage D2 PC demonstrated promising results. Unfortunately, at present these clinical trials have some disadvantages and leave some uncertainty with regard to the trial design, the SSTR subtype determination and tumor localization with SSTR scintigraphy before the start of a selective SST analog, and finally the randomization in groups according to hormone resistance, dosage regimen and route of administration.