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Transdermal oestrogen therapy as a second-line hormonal intervention in prostate cancer: a bad experience
Sandhir Kandola1, Nicola Anyamene, Heather Payne
1Oncology Department, University College Hospital, London, UK.
Objective:
To compare transdermal oestrogen with oral diethylstilbestrol (DES) as a second- or third-line hormonal therapy in the treatment of prostate cancer.
Patients And Methods:
In all, 32 assessable patients who, having already had a relapse on at least one line of hormonal therapy, received transdermal oestrogen therapy as an alternative to oral DES, when DES became unavailable.
Results:
Whereas DES had controlled the prostate-specific antigen (PSA) level for a median of 29 weeks in a group of 15 patients in remission, all but one had an increase in PSA level (median 86% increase above the starting PSA level) within a median of 8 weeks after introducing transdermal therapy. This increase was reversed in seven of the 12 patients who recommenced DES therapy.
Conclusion:
Although the use of transdermal oestrogen is currently attracting enthusiasm as a first-line treatment for prostate cancer, these results show that for second- or third-line therapy further cautious research with careful monitoring is necessary.
Insights
Transdermal estrogen showed limited efficacy in advanced prostate cancer, failing to control PSA levels. Reintroducing oral diethylstilbestrol (DES) reversed PSA increases, suggesting caution with transdermal use in later treatment lines.
Area of Science:
- Oncology
- Endocrinology
Background:
- Prostate cancer treatment often involves hormonal therapy.
- Diethylstilbestrol (DES) has been a standard oral estrogen therapy.
- Transdermal estrogen is being explored as an alternative treatment option.
Purpose of the Study:
- To compare transdermal estrogen with oral diethylstilbestrol (DES) for advanced prostate cancer.
- To evaluate transdermal estrogen as a second- or third-line hormonal therapy.
Main Methods:
- 32 patients with relapsed prostate cancer were assessed.
- Transdermal estrogen therapy was administered when oral DES became unavailable.
- Prostate-specific antigen (PSA) levels were monitored.
Main Results:
- Transdermal estrogen failed to control PSA levels in most patients, unlike previous oral DES treatment.
- A median 86% increase in PSA was observed within 8 weeks of transdermal therapy.
- Resuming DES therapy reversed PSA increases in 7 of 12 patients.
Conclusions:
- Transdermal estrogen demonstrated limited effectiveness as a second- or third-line therapy for prostate cancer.
- Cautious research and careful monitoring are necessary for transdermal estrogen in advanced cases.
- Oral DES remains a viable option for controlling PSA in relapsed prostate cancer.
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