Transdermal Estradiol Therapy for Advanced Prostate Cancer—Forward to the Past?
- 1 May 2003
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Urology
- Vol. 169 (5), 1735-1737
- https://doi.org/10.1097/01.ju.0000061024.75334.40
Abstract
Current hormonal therapies for prostate cancer are associated with significant morbidities, including symptoms of andropause and osteoporosis. Oral estrogens prevented many of these problems but were abandoned due to cardiovascular toxicity attributed to hepatic effect. In contrast, parenteral estrogens prevent first pass hepatic metabolism and substantially reduce cardiovascular risk, and long-term transdermal estradiol therapy is believed to be cardioprotective. We report preliminary results of a pilot study using transdermal estradiol therapy to treat men with advanced prostate cancer. A total of 20 patients with advanced prostate cancer were enrolled in a before and after study that examined the impact of estradiol patches on hormones, disease, thrombophilia, vascular flow, osteoporosis and quality of life. Median followup is 15 months. Estradiol levels greater than 1,000 pmol./l. were achieved using 2 patches and higher levels were obtained by increasing the number of patches. All patients achieved castrate levels of testosterone within 3 weeks and had biochemical evidence of disease regression. One patient died of disease at 14 months and 1 cardiovascular complication occurred. Thrombophilic activation was avoided and vascular flow improved. Bone mineral density was significantly increased. Mild or moderate gynecomastia occurred in 80% of patients but no patient had hot flushes. All other functional and symptomatic quality of life domains improved. Transdermal estradiol therapy produced an effective tumor response. Cardiovascular toxicity was substantially reduced compared with that expected of oral estrogen, and other morbidity (gynecomastia) was negligible. Transdermal estradiol therapy prevented andropause symptoms, improved quality of life scores and increased bone density. Transdermal estradiol costs a tenth of current therapy cost, with the potential for considerable economic savings over conventional hormone therapies.Keywords
This publication has 14 references indexed in Scilit:
- Cancer Statistics, 2001CA: A Cancer Journal for Clinicians, 2001
- Parenteral estrogen versus total androgen ablation in the treatment of advanced prostate carcinoma: effects on overall survival and cardiovascular mortalityUrology, 2000
- The first clinical synthesis conference on hormone replacement therapy: new perspectives for HRT?Maturitas, 1999
- Randomized Trial of Estrogen Plus Progestin for Secondary Prevention of Coronary Heart Disease in Postmenopausal WomenJAMA, 1998
- Parenteral polyoestradiol phosphate vs orchidectomy in the treatment of advanced prostatic cancer. Efficacy and cardiovascular complications: a 2‐year follow‐up report of a national, prospective prostatic cancer studyBritish Journal of Urology, 1998
- Mortality and morbidity in transsexual subjects treated with cross‐sex hormonesClinical Endocrinology, 1997
- Cardiovascular and all‐cause mortality in prostatic cancer patients treated with estrogens or orchiectomy as compared to the standard populationThe Prostate, 1991
- Effect of Parenteral Oestrogen on the Coagulation System in Patients with Prostatic CarcinomaBritish Journal of Urology, 1990
- Estrogen therapy and liver function—metabolic effects of oral and parenteral administrationThe Prostate, 1989
- A comparison of androgen status in patients with prostatic cancer treated with oral and/or parenteral estrogens or by orchidectomyThe Prostate, 1989