ESTROGENS IN THE TREATMENT OF PROSTATE-CANCER

Purpose: The history, mechanisms of action, efficacy and complications of estrogen therapy for prostate cancer are reviewed, and the current and future roles of estrogens in the treatment of prostate cancer are addressed. Materials and Methods: An extensive review of the literatu re was done. Results: Estrogens are effective in the treatment of adva nced prostate cancer. High dose oral estrogens are associated with an increased risk of cardiovascular death. A dose of 1 mg. diethylstilbes trol daily is not associated with an increased risk of cardiovascular death. Estrogens are associated with other toxicities. Parenteral estr ogens may not have the risk of cardiovascular death that is ascribed t o oral estrogens. Estrogens have not been adequately compared to the c ombined androgen blockade regimen. Conclusions: A 1 mg. dose of diethy lstilbestrol remains a medical alternative to bilateral orchiectomy in the treatment of advanced prostate cancer. Doses of 3 mg. diethylstil bestrol or more have a prohibitively high risk of cardiovascular death . Further studies comparing the efficacy, complications and cost of re gimens containing oral estrogens or parenteral estrogens with agents t hat increase efficacy (for example antiandrogens) and decrease toxicit y (for example anticoagulants) to results of other regimens, such as c ombined androgen blockade, should be done to determine if an estrogen- containing regimen could lower the cost of treating advanced prostate cancer.