We report the results of the first use of a steroidal aromatase inhibitor, 4-hydroxyandrostenedione (4-OHA, CGP 32349), in the palliation of patients with advanced, hormone resistant, prostatic cancer. Twelve of 19 patients (63%), who had relapsed following castration and other therapies, gained significant pain relief following weekly intramuscular injections of 4-OHA. Five patients (31%) experienced a transient 'tumour flare', represented by an increase in bone pain soon after commencing treatment. The mechanism of action of 4-OHA in palliating patients with advanced prostatic cancer is obscure at present, but may represent an important new treatment modality which may lead to greater insight into prostatic biology.

Transabdominal ultrasound may have a limited but useful role in the surveillance of bladder cancer. Its advantages over other diagnostic methods are that it is easy to use and that it can be repeated as many times as necessary without harm or discomfort to the patient. As such, it is an extension of the physical examination by the clinician, who should, if politics allow, take up its use more frequently.14 Only by using it routinely and understanding its limitations can urologists hope to use ultrasound as a safe and helpful aid to diagnosis.