Therapy Insight: parenteral estrogen treatment for prostate cancer—a new dawn for an old therapy

  title={Therapy Insight: parenteral estrogen treatment for prostate cancer—a new dawn for an old therapy},
  author={Jeremy L. Ockrim and El-Nasir Lalani and Paul D. Abel},
  journal={Nature Clinical Practice Oncology},
Oral estrogens were the treatment of choice for carcinoma of the prostate for over four decades, but were abandoned because of an excess of cardiovascular and thromboembolic toxicity. It is now recognized that most of this toxicity is related to the first pass portal circulation, which upregulates the hepatic metabolism of hormones, lipids and coagulation proteins. Most of this toxicity can be avoided by parenteral (intramuscular or transdermal) estrogen administration, which avoids hepatic… 

Estradiol for the mitigation of adverse effects of androgen deprivation therapy.

Current evidence supports a primary role for estradiol in vasomotor stability, skeletal maturation and maintenance, and prevention of fat accumulation, and the potential for cardiovascular risk and pro-carcinogenic effects on PCa via estrogen receptor signalling must be considered.

An Update on Triptorelin: Current Thinking on Androgen Deprivation Therapy for Prostate Cancer

Despite the inevitable progression to castration-resistant prostate cancer (CRPC) in most patients receiving ADT, monitoring of testosterone levels needs to improve in routine practice and physicians should not overlook the benefits of continued ADT in their patients when introducing one of the various new treatment options for CRPC.

Role of Estramustine Phosphate and Other Estrogens for Castration-Resistant Prostate Cancer

The introduction of several expensive drugs, as abiraterone acetate and enzalutamide, and expansion of indication of these new drugs for prostate cancer patients resulted in dramatic increase in

Estrogen and prostate cancer: An eclipsed truth in an androgen‐dominated scenario

  • G. Carruba
  • Biology, Medicine
    Journal of cellular biochemistry
  • 2007
Evidence is provided to support the assumption that long term administration of androgens and estrogens results in an estrogenic milieu in rat prostates and in the ensuing development of dysplasia and cancer, and to suggest that estrogens are critical players in human prostate cancer.

Short-term effects of transdermal estradiol in men undergoing androgen deprivation therapy for prostate cancer: a randomized placebo-controlled trial.

In men with castrate levels of E2 and TS, daily transdermal E2 reduced hot flushes and bone resorption and increased median serum E2 concentrations into the reference range reported for healthy men, but with substantial variability.

Role of Hormonal Manipulation in Prostate Cancer Management

The present review summarises the chronological evolution of agents used for hormonal manipulation in the management of PCa, highlighting the pros and cons of each and sheds light on the potential future advances in this area.

Secondary hormonal manipulation.

This work discusses the emerging concept of secondary hormonal manipulation on the basis of the current literature and demonstrates prospective alternative treatment modalities for localized prostate cancer.

Estrogens and prostate cancer

A critical literature review of the current basic science and clinical evidence for the interaction between estrogens and CaP shows that estrogens represent a under-recognized contributor in CaP development and progression.



Transdermal estradiol therapy for advanced prostate cancer--forward to the past?

Transdermal estradiol therapy prevented andropause symptoms, improved quality of life scores and increased bone density, with the potential for considerable economic savings over conventional hormone therapies.

Estrogens in the treatment of prostate cancer.

Parenteral Estrogen versus Combined Androgen Deprivation in the Treatment of Metastatic Prostatic Cancer - Scandinavian Prostatic Cancer Group (SPCG) Study No. 5

High-dose polyestradiol phosphate (PEP) has an equal anticancer efficacy to CAD and does not increase cardiovascular mortality, and is considerably cheaper than CAD.

Are Non-Steroidal Anti-Androgens Appropriate as Monotherapy in Advanced Prostate Cancer?

Preliminary findings indicate that flutamide may be as effective as orchidectomy in terms of prolonging progression-free survival in selected patients and bicalutamide is well tolerated as monotherapy and appears to be aseffective as castration in patients with locally advanced non-metastatic disease.

A comparison of androgen status in patients with prostatic cancer treated with oral and/or parenteral estrogens or by orchidectomy

Both estrogen treatment regimens were as effective as orchidectomy in reducing circulating levels of T and A‐4 and the more pronounced effects of oral estrogens on circulating adrenal androgens may reflect an altered liver metabolism associated with this route of administration.

Estrogen therapy and liver function—metabolic effects of oral and parenteral administration

Oral estrogen therapy for prostatic cancer is clinically effective but also accompanied by severe cardiovascular side effects, and the impact of exogenous estrogens on the liver is dependent on the route of administration and the type and dose of estrogen.

Estrogen treatment for cancer of the prostate. Early results with 3 doses of diethylstilbestrol and placebo

The 1.0-mg dose has been as effective as the 5.0‐mg dose in controlling the prostate cancer, but it does not seem to be associated with the excess risk of cardiovascular death.

Parenteral estrogen versus combined androgen deprivation in the treatment of metastatic prostatic cancer: Part 2. Final evaluation of the Scandinavian Prostatic Cancer Group (SPCG) Study No. 5

PEP has an anticancer efficacy equal to CAD and does not increase cardiovascular mortality in metastasized patients, but carries a significant risk of non-fatal cardiovascular events, which should be balanced against the skeletal complications in the CAD group.

Transdermal estradiol therapy for prostate cancer reduces thrombophilic activation and protects against thromboembolism.

It is suggested that transdermal estradiol reduces thrombophilic activation in men with advanced prostate cancer, and protects against the risk of thromboembolism.