PARENTERAL POLYESTRADIOL PHOSPHATE VS ORCHIECTOMY IN THE TREATMENT OFADVANCED PROSTATIC-CANCER - EFFICACY AND CARDIOVASCULAR COMPLICATIONS- A 2-YEAR FOLLOW-UP REPORT OF A NATIONAL, PROSPECTIVE PROSTATIC-CANCER STUDY

Objective To evaluate the clinical efficacy and cardiovascular complic ations of orchidectomy or polyoestradiol phosphate (PEP) in the treatm ent of advanced prostatic cancer. Patients and methods In a prospectiv e, randomized study 444 patients (mean age 73 years, range 45-91) with T3-4 MO or T1-4 M1 prostatic cancer were treated either by orchidecto my (group 1, n = 217) or parenteral PEP (group 2, n = 227; 240 mg/mont h), The patients were examined at 3 and 6 months after start of the th erapy and thereafter every 6 months; they were also assessed whenever they had symptoms indicating progression, Possible cardiovascular comp lications included myocardial infarction, cerebrovascular accident, pu lmonary embolism and deep vein thrombosis. Results After a follow-up o f 2 years there was no statistically significant difference between th e groups in progression-free time; 65 of 217 (30%) patients in group 1 showed evidence of progression, including seven (3%) who died from pr ostate cancer. In group 2, 64 of 227 (28%) patients showed progression and eight (3.5%) died from prostatic cancer. There were 10 (5%) cardi ovascular complications in patients in group 1, including five (2%) ca rdiovascular deaths; in group 2 there were 24 (11%) and 14 (6%), respe ctively. During the first year of treatment there were three (1.4%) ca rdiovascular complications in group 1 and 14 (6%) in group 2 (P < 0.05 ), and during the second year, seven (4%) and 10 (6%), respectively, C onclusion Parenteral PEP (240 mg/month) seems to be as efficient as or chidectomy in inhibiting disease in patients with advanced prostatic c ancer (T3-4 MO and T1-4 Mi). There were more cardiovascular complicati ons in patients treated with PEP than after orchidectomy; the differen ce was statistically significant during the first year of treatment.