Estrogens in the Treatment of Prostate Cancer

Abstract

A 1 mg. dose of diethylstilbestrol remains a medial alternative to bilateral orchiectomy in the treatment of advanced prostate cancer. Doses of 3 mg. diethylstilbestrol or more have a prohibitively high risk of cardiovascular death. Further studies comparing the efficacy, complications and cost of regimens containing oral estrogens or parenteral estrogens with agents that increase efficacy (for example antiandrogens) and decrease toxicity (for example anticoagulants) to results of other regimens, such as combined androgen blockade, should be done to determine if an estrogen-containing regimen could lower the cost of treating advanced prostate cancer.

Low Serum Testosterone and High Serum Estradiol Associate With Lower Extremity Peripheral Arterial Disease in Elderly Men

“…In addition, we recently determined that circulating estradiol independently and positively predicts progression of carotid artery intimamedia thickness in middle-aged men (7). Moreover, although no current evidence suggests that testosterone treatment affects the risk of cardiovascular disease (8), high-dose estrogen treatment of men with prostate cancer associates with increased cardiovascular morbidity and mortality (9).…”

Management of patients with an increasing prostate-specific antigen after radical prostatectomy

“…Traditional hormonal therapy Throughout the past 60 years, the mainstay therapy for advanced metastatic prostate cancer has been androgen ablation by surgical [51] or medical orchiectomy by the use of estrogens (rarely used today because of cardiovascular toxicity [52]), luteinizing hormone-releasing hormone (LH-RH) analogues, or antiandrogens [53]. However, the use of hormonal therapy in men with only rising serum PSA, as a reflection of distant disease recurrence, is controversial.…”

Orchidectomy and Oestrogen Therapy Revisited

“…Among the many formulations of both natural and artificial oestrogens, oral diethylstilboestrol (DES) has been most frequently used, but polyoestradiol phosphate for parenteral use and ethinyl oestradiol for oral administration have also been used, particularly in Scandinavia. Both experimental and clinical evidence suggest that oestrogen therapy may be superior to castration in terms of efficacy, possibly because of a direct effect on the tumour [19, 20, 21]. Suggested effects of oestrogens are increased synthesis of sex hormone binding globulin, decreased levels of adrenal androgens presumably via a change in hepatic function, inhibition of 5-α-reductase, suppression of dedifferentiation, direct effect on Leydig cell function, and a possible cytotoxic effect [20].…”

“…Along with gynaecomastia and loss of sexual function in most treated patients, fluid retention with peripheral oedema in up to 23% of patients and deep venous thrombosis (2–8%) are also included in the known side effects associated with oestrogen therapy (table 2) [20]. However, it was unacceptable cardiovascular toxicity that severely limited the routine use of oral oestrogens.…”