Subcutaneous estradiol pellet implantation in management of advanced prostatic carcinoma

Thirty patients with previously untreated Stage C and D carcinoma of the prostate were treated with subcutaneously implanted estradiol pellets in an effort to determine the efficacy of this mode of therapy in the control of advanced prostatic carcinoma. Serum levels of gonadotropins, testosterone, and estradiol were obtained prior to institution of therapy and at monthly intervals thereafter. Twenty-eight patients were followed for at least one year. Sixteen patients were hormonally castrate at six months following 1-pellet implantation. In these 16 patients the means serum testosterone level was 43.6 ng./dl. with a serum luteinizing hormone (LH) of 13.3 mlU/ml. and a serum estradiol of 19.2 ng./dl. Twenty-two patients were hormonally castrate at twelve months following 1 or more pellet implantations. In this group the mean serum testosterone level was 51.5 ng./dl. with a serum LH of 16.2 mlU/ml. and a serum estradiol of 22 ng./dl. Fifteen patients who were taking narcotics for pain relief either became pain free or had a marked decrease in need for analgesics. Increased weight improvement in over-all well-being was noted in 86 per cent of patients. pellet implantation intervals ranged from four to ten months, with a mean interval of 5.85 months between implantations. Complications attributable to this mode of therapy were no more apparent than with oral estrogens. In addition to better compliance, subcutaneously implanted estrogen pellets appear to provide a safe, reliable, and effective method of tumor control and palliation in advanced carcinoma of the prostate.