DETERIORATED ARTERIAL SUPPLY TO THE LOWER-LIMB DURING ORAL ESTROGEN THERAPY OF PATIENTS WITH PROSTATIC-CARCINOMA

Patients with prostatic carcinoma were randomised to treatment with su rgical castration (n = 47) or oral oestrogen therapy (n = 53). The oes trogen-treated patients received oral ethinyl oestradiol daily, 1 mg f or the first 2 weeks followed by 150 mu g. In addition, oestrogen was given intramuscularly as polyoestradiol phosphate monthly 160 mg for 3 months, continued by 80 mg. Before and 1 year after therapy systolic arm and toe blood pressures were measured. Eleven percent of the patie nts in the oestrogen group had a pathological pressure difference betw een the arm and toe before treatment versus 34% in the orchidectomy gr oup. Despite the greater proportion of subclinical atherosclerotic dis ease in the legs of the patients in the orchidectomy group, the patien ts in the oestrogen group only had signs and symptoms of a deteriorati on of the arterial system. Thus, in the oestrogen group the arm-toe bl ood pressure difference increased from 20 +/- 3 to 32 +/- 4 mm Hg (p < 0.001) and the proportion of pathological toe pressures increased fro m 11 to 29% (p = 0.0014). Two of the patients in this group had to be referred for reconstructive surgery due to severe intermittent claudic ation. In addition, 5 more patients in this group suffered arterial is chemic events in the coronary and cerebral vasculatures. In contrast, there were no clinical ischemic events in the orchidectomy group and n o change in the blood pressure difference between the arm and the toe 1 year after orchidectomy. In conclusion, oral oestrogen therapy, in c ontrast to orchidectomy, induces a deterioration of the arterial suppl y to the lower limbs during the Ist year of therapy. These results con stitute a further argument against oral oestrogen therapy in patients with prostatic carcinoma.