Diethylstilbestrol in castration-resistant prostate cancer - Abstract

Diethylstilbestrol (DES) was the first hormone treatment used for prostate cancer and has also shown effectiveness in castration-resistant disease in small studies; however, concerns over thromboembolic toxicity have restricted its use in the past.

Over 200 elderly men with castration-resistant prostate cancer were treated with 1-3 mg of DES, given with 75 mg aspirin and breast bud irradiation. Almost 30% of men showed a significant PSA response and the median time to PSA progression was 4.6 months. Almost 20% of patients with pain had a significant analgesic benefit. The most important toxicity was thromboembolism in 10% of men. Overall the drug has an acceptable toxicity profile and offers a palliative benefit in frail elderly men who may not be fit for chemotherapy.

OBJECTIVE: To assess the efficacy and toxicity of diethylstilbestrol (DES) in the management of castration-resistant prostate cancer (CRPC).

PATIENTS AND METHODS: A total of 231 patients with CRPC received treatment with DES at the Royal Marsden Hospital between August 1992 and August 2000.  The median pre-treatment prostate-specific antigen (PSA) level was 221 ng/mL. DES was used at a dose of 1-3 mg daily, with aspirin 75 mg. The primary endpoint was PSA response rate.

RESULTS: The PSA response rate (using PSA Working Group criteria) was 28.9%. The median time to PSA progression was 4.6 months. Of patients with bone pain, 18% had an improvement in their European Organisation for the Research and Treatment of Cancer pain score. Thromboembolic complications were seen in 9.9% of all patients.

CONCLUSIONS: DES has significant activity in CRPC and can be of palliative benefit.  DES has an acceptable toxicity profile in the management of patients with symptomatic CRPC when used at a dose of 1-3 mg, combined with aspirin and prophylactic breast bud radiotherapy.

Written by:
Wilkins A, Shahidi M, Parker C, Gunapala R, Thomas K, Huddart R, Horwich A, Dearnaley D.   Are you the author?
Academic Urology Unit, Royal Marsden Hospital, Sutton, UK.

Reference: BJU Int. 2012 Oct 30. Epub ahead of print.
doi: 10.1111/j.1464-410X.2012.11546.x

PubMed Abstract
PMID: 23110500

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