Treatment of Advanced Carcinoma of the Prostate with Estramustine Phosphate

Abstract

Estramustine phosphate has been useful in the treatment of advanced carcinoma of the prostate. Objective remissions were obtained with this therapy in 6 of 17 patients (35 per cent). The results presented herein indicate that the clinical response is to a certain extent caused by an estrogen effect, which was clearly demonstrable in a previously untreated patient. A specific cytostatic effect of estramustine phosphate, which is not yet clearly explained, may be responsible for remissions in some patients who have become resistant to conventional hormonal treatment.

Cytotoxic chemotherapy in the contemporary management of metastatic castration‐resistant prostate cancer (mCRPC)

“…Estramustine was one of the first effective chemotherapeutics shown to improve biochemical response in mCRPC, but also has anti‐androgen effects due to the oestradiol component. However, gastrointestinal and thromboembolic toxicities have resulted in estramustine being rarely administered . Older agents, such as platinums, cyclophosphamide and 5‐fluorouracil, demonstrate marginal single‐agent activity using suboptimal response criteria in an unselected group of men with prostate cancer and have not been further developed partly due to lack of commercial incentives .…”

The Treatment of Oestrogen-Escaped Carcionoma of the Prostate with Estramustine Phosphate

“…It has been suggested that the steroid fraction acts as a carrier to hormone-dependent tumour tissue where the alkylating agent is released and exerts a direct action (Muntzing et al, 1974). Earlier reports showed an encouraging response in advanced disease (Alfthan and Rusk, 1969;Jonsson and Hogberg, 1971) and subsequent reports have continued to show a useful clinical response (Fossa and Miller, 1976;Mittleman, Shukla and Murphy, 1976;Nagel and Kolln, 1977).…”

Reduction of Serum Prostate-Specific Antigen during Endocrine or Cytotoxic Treatment of Hormone-Resistant Cancer of the Prostate

“…Also estramustine phosphate represents a high-dose estrogen treatment and acts probably also as a cytostatic agent. The drug has been shown to relieve pain and to improve the general condition in prostate cancer patients who progress on ongoing primary hormone manipula tions [21,22], According to the present study with admittedly few patients within each group, secondary hormone treatment with 1 of the above 3 hormonal agents reduces elevated PSA levels by > 50% in 20-30% of the patients with hor mone-resistant prostate cancer. These biochemical re sponses objectively indicate that at least some of the tumor cells are still sensitive for endocrine manipulation.…”