Parenteral Estrogen versus Combined Androgen Deprivation in the Treatment of Metastatic Prostatic Cancer - Scandinavian Prostatic Cancer Group (SPCG) Study No. 5

Hedlund, Per Olov; Ala‐Opas, Martti; Brekkan, Einar; Damber, Jan Erik; Damber, Lena; Hagerman, Inger; Haukaas, Svein A.; Henriksson, Peter; Iversen, Peter; Pousette, Åke; Rasmussen, Finn; Salo, J.; Vaage, Sigmund; Varenhorst, Eberhard

doi:10.1080/003655902762467549

Cited by 45 publications

(42 citation statements)

References 20 publications

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“…This finding was confirmed by a brief report of a subsequent evaluation (Hedlund et al, 2007). There was also no evidence of a difference in prostate cancer mortality in the two arms of the Mikkola trial at 2 years (RR ¼ 1.09, 95% CI: 0.40, 2.96; P ¼ 0.86) (Mikkola et al, 1998); subsequent subgroup analysis using a Cox proportional hazards model at 10-year follow-up also showed no difference in diseasespecific mortality in either M0 or M1 patients (M0: RR ¼ 1.14, 95% (Mikkola et al, 2007).…”

Section: Nature Of the Evidencesupporting

confidence: 61%

“…This finding was confirmed by a brief report of a subsequent evaluation (Hedlund et al, 2007). The Mikkola trial showed an increased level of CVS mortality in the PEP arm, although this was of borderline statistical significance (RR ¼ 2.68, 95% CI: 0.98, 7.31; P ¼ 0.05) (Mikkola et al, 1998).…”

Section: Nature Of the Evidencementioning

confidence: 65%

“…There was no evidence of any difference in overall mortality between the treatment groups (RR ¼ 0.99, 95% CI: 0.90, 1.10; P ¼ 0.89) (Figure 2). This finding was confirmed by a brief report of a subsequent evaluation of data at 12-year follow-up, at which point 94% of patients had died (Hedlund et al, 2007). In the Mikkola trial, 76% of M0 and 93% of M1 patients had died at 10-year follow-up (Mikkola et al, 2007).…”

Section: Nature Of the Evidencementioning

confidence: 74%

“…After full assessment, three further reports of two previously included studies were identified in the review of effectiveness and safety (Mikkola et al, 2005(Mikkola et al, , 2007Hedlund et al, 2007). Two of these were full papers (Mikkola et al, 2005(Mikkola et al, , 2007 Figure 1 Study identification, retrieval and inclusion.…”

Section: Nature Of the Evidencementioning

confidence: 99%

“…Two of these were full papers (Mikkola et al, 2005(Mikkola et al, , 2007 Figure 1 Study identification, retrieval and inclusion. (Hedlund et al, 2007). In addition, an ongoing trial was identified that compares transdermal oestrogen administered through patches with an LHRH analogue, but for which no outcome data are available (Abel, ongoing).…”

Section: Nature Of the Evidencementioning

confidence: 99%

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Parenteral oestrogen in the treatment of prostate cancer: a systematic review

et al. 2008

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The objectives of this study were to assess the effectiveness and safety of parenteral oestrogen in the treatment of prostate cancer, and to examine any dose relationship. A systematic review was undertaken. Electronic databases, published paper and internet resources were searched to locate published and unpublished studies with no restriction by language or publication date. Studies included were randomised controlled trials of parenteral oestrogen in patients with prostate cancer; other study designs were also included to examine dose -response. Study selection, appraisal, data extraction and quality assessment were performed by one reviewer and independently checked by another. Twenty trials were included in the review. The trials differed with regard to the included patients, formulation and dose of parenteral oestrogen, comparator used, outcome measures reported and the duration of follow-up. The results provide no evidence to suggest that parenteral oestrogen, in doses sufficient to produce castrate levels of testosterone, is less effective than luteinising hormone-releasing hormone (LHRH) or orchidectomy in controlling prostate cancer, or that it is consistently associated with an increase in cardiovascular mortality. Further well-conducted trials of parenteral oestrogen are required. A pilot randomised controlled trial comparing transdermal oestrogen to LHRH analogues in men with locally advanced or metastatic prostate cancer is underway in the United Kingdom.

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Section: Nature Of the Evidencesupporting

confidence: 61%

Section: Nature Of the Evidencementioning

confidence: 65%

Section: Nature Of the Evidencementioning

confidence: 74%

Section: Nature Of the Evidencementioning

confidence: 99%

Section: Nature Of the Evidencementioning

confidence: 99%

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Parenteral oestrogen in the treatment of prostate cancer: a systematic review

et al. 2008

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Prostate Neoplasm

et al. 2019

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Predictors of early androgen deprivation treatment failure in prostate cancer with bone metastases

Varenhorst

Klaff

Berglund³

et al. 2016

Cancer Medicine

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Approximately 15% of men with hormone naïve metastatic prostate cancer primarily fail to respond to androgen deprivation treatment (ADT). The reason why the response to ADT differs in this subgroup of men with prostate cancer remains unclear. The aim of this study was to describe the characteristics of these men and to thereby define predictors of early ADT failure in prostate cancer patients with bone metastases. The study was based on 915 men from the prospective randomized multicenter trial (no. 5) conducted by the Scandinavian Prostate Cancer Group comparing parenteral estrogen with total androgen blockade. Early ADT failure was defined as death from metastatic prostate cancer within 12 months after the start of ADT. Multivariate logistic regression models were applied to identify clinical predictors of early ADT failure. Ninety‐four (10.3%) men were primarily nonresponders to ADT. Independent predictors of early ADT failure were poor Eastern Cooperative Oncology Group performance status (PS), analgesic consumption, low hemoglobin, and high Soloway score (extent of disease observed on the scan), in where patients with poor PS and/or high analgesic consumption had a threefold risk of early ADT failure. Not significantly factors related to early ADT failure were age, treatment, cardiovascular comorbidity, T category, grade of malignancy, serum estrogen level, and SHBG at enrolment. We analyzed characteristics of a subgroup of patients who primarily failed to respond to ADT. Four independent clinical predictors of early ADT failure could be defined, and men exhibiting these features should be considered for an alternative treatment.

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Parenteral Estrogen versus Combined Androgen Deprivation in the Treatment of Metastatic Prostatic Cancer - Scandinavian Prostatic Cancer Group (SPCG) Study No. 5

Abstract: PEP has an equal anticancer efficacy to CAD and does not increase cardiovascular mortality. Final evaluation of cardiovascular morbidity is awaiting further analysis and follow-up. PEP is considerably cheaper than CAD.

Cited by 45 publications

References 20 publications

Parenteral oestrogen in the treatment of prostate cancer: a systematic review

Parenteral oestrogen in the treatment of prostate cancer: a systematic review

Prostate Neoplasm

Predictors of early androgen deprivation treatment failure in prostate cancer with bone metastases

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