Stilboestrol plus adrenal suppression as salvage treatment for patients failing treatment with luteinizing hormone‐releasing hormone analogues and orchidectomy

Abstract

Objective To investigate the ef®cacy of low-dose stilboestrol (SB) with hydrocortisone in patients with advanced prostate cancer refractory to androgen suppression. Patients and methods Thirty-four consecutive patients (median age 70 years, range 51±83) with metastatic disease who progressed on hormone therapy, as shown by recurrent/worsening symptoms and an increase in prostate-speci®c antigen (PSA) level, were recruited and discontinued hormonal treatment before starting SB. Patients received SB (1 mg/day) combined with hydrocortisone (40 mg/day). In an attempt to reduce the incidence of thrombo-embolic events, aspirin (75 mg/day) was also added. Results Stilboestrol was the second-line treatment in 19 patients and the third or fourth in 15. The median (range) duration of treatment with SB was 5 (0.5±21) months and the median follow-up 7.5 months, with 18 patients still alive and 14 still on treatment. Of 29 symptomatic patients, 24 had symptomatic improvement and ®ve had no clear bene®t; the median duration of bene®t was 6 (2±21) months. The PSA level decreased by 0±50% in six patients, by 50±90% in 13 and by >90% in eight, while there was symptomatic improvement in these three categories in ®ve, 11 and seven patients, respectively. The median times to PSA nadir and progression were 4 and 6 months, respectively. Some thrombo-embolic events and¯uid retention occurred but overall the treatment was well tolerated. Conclusion Low-dose SB with hydrocortisone is effective in refractory prostate cancer, although there is some toxicity. Randomized studies against hydrocortisone or SB alone are needed to establish the cost/bene®t ratio of this combination.

A phase II study investigating the re-induction of endocrine sensitivity following chemotherapy in androgen-independent prostate cancer

“…Responses have been seen to steroids and estrogens (Farrugia et al, 2000;Nishimura et al, 2000), and chemotherapy has shown a survival advantage for these patients (Petrylak et al, 2004;Tannock et al, 2004). Until recently, it has been a universal practice to continue androgen deprivation during chemotherapy, despite previous progression on this treatment.…”

Is there a role for chemotherapy in prostate cancer?

“…More recently, there is evidence that some patients with 'hormone-resistant' disease (i.e. after primary androgen ablation and addition and withdrawal of a peripheral antiandrogen) may have transient responses to estrogens such as diethylstilbestrol (Farrugia et al, 2000;Orlando et al, 2000). The mechanism is unknown, but this effect might also account for responses to the agent PC-SPES, which contains phytoestrogens, that have been reported for patients with 'hormone-resistant' disease (Small et al, 2000a).…”

Prostate cancer: palliative care and pain relief

“…Corticosteroids may be the treatment of choice in less ambulatory patients who have a short life expectancy, although they also have an accepted role in antitumour treatment effects. [26][27][28] Most patients will be started on 4 mg dexamethasone daily, even though there are no established evidence-based guidelines for doses of corticosteroids. 29 Other symptoms include nausea and constipation, both of which can be effectively treated by a variety of antiemetics and laxatives, respectively.…”