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Estrogens in the Treatment of Advanced Prostate Cancer

Last Revised November 25, 1995
[Developments since 1995 may alter this information]

Introduction | DES in treatment of advanced prostate cancer | The use of other estrogens


Introduction

The administration of estrogens (female hormones) to a man has a series of complex effects on that man's hormonal system. One is an effect on the hypothalamus which reduces release of luteinizing hormone releasing hormone (LHRH), with a consequent suppression of production of luteinizing hormone (LH). Suppression of LH production has the resulting effect of suppressing production of testosterone. An appropriate dose of estrogens can reduce a man's testosterone to castrate levels; in other words, it will have the same effect as a surgical orchiectomy. Although a whole series of different estrogens can be used to induce this effect, the compound most commonly used in diethylstilbestrol (DES).

DES in treatment of advanced prostate cancer

Worldwide, DES is still one of the most commonly used agents for the hormonal treatment of advanced prostate cancer for one reason if no other -- it is very low in price. The critical disadvantage of this pharmaceutical is that it has been associated with a relatively high risk for cardiovascular side effects at higher dosages. These severe side effects can include death due to induction of cardiovascular problems, including heart attacks, strokes, and pulmonary embolisms. Specialists in the treatment of prostate cancer would now be very careful to avoid the use of DES in patients who were already at any risk of heart or circulatory disorders. As a consequence, DES is now clearly contraindicated for patients with any signs of cardiovascular disorder. However, even in the US, a small number of physicians continue to treat carefully selected patients who have advanced prostate cancer but no signs of cardiovascular disease with 1, 2, or 3 mg of DES per day.

Doses of less than 1 mg/d DES do not appear to have any appreciable effect on testosterone levels and are now considered to be ineffective. For some patients, but not others, doses of 1 mg/d can lower testosterone levels to castrate levels. It is for this reason that different patients may require doses of DES that are higher than 1 mg.

Apart from the cardiovascular risks, the other common side effects of DES include loss of libido, impotence, gynecomastia, fluid retention, and hot flashes.

The use of other estrogens

Because of the cardiovascular side effects of DES, there have been many attempts over the years to find other estrogens which would have a similar impact on testosterone levels but without the risks associated with DES therapy. Unfortunately, these attempts have all proven unsuccessful so far.


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The content in this section of the Phoenix 5 site was originally developed by CoMed Communications (a Vox Medica company) as part of The Prostate Cancer InfoLink. It is reproduced here with the permission of Vox Medica.

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