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June 6, 1977

Disappearance of Osteoblastic Metastases in Prostatic Carcinoma Following Estramustine Therapy

JAMA. 1977;237(23):2471. doi:10.1001/jama.1977.03270500023011

To the Editor.—  Healing of osseous metastases is usually described as a recalcification process and is best seen in osteolytic lesions.1 Osteoblastic lesions are more difficult to evaluate. Eighty percent of the skeletal metastases in prostatic carcinoma are purely osteoblastic in nature2; thus, the evaluation of improvement is difficult. Endocrine therapy may bring about a dramatic clinical improvement associated with return of acid and alkaline phosphatase values to normal, but the roentgenographic appearance of the blastic lesions rarely changes. In an early report, Huggins and co-workers3 claimed that all patients with prostatic carcinoma who underwent orchiectomy had increased osteosclerosis of the skeletal metastases. Others2 have reported an occasional shrinkage of osteoblastic lesions, but complete disappearance of osteoblastic metastases has never, to our knowledge, been previously reported.Two patients treated with estramustine phosphate (Estracyt) who were observed for more than three years exhibited a gradual complete disappearance