The role of parenteral polyestradiol phosphate in the treatment of advanced prostatic cancer on the threshold of the new millennium

Orchiectomy and estrogens have been used for over 50 years in the treatment of advanced prostatic cancer. Although orchiectomy is a simple procedure, it may cause psychological stress. Oral estrogen therapy is as effective as orchiectomy in terms of cancer inhibitory effect, but its acceptance as pr imary hormonal treatment is overshadowed by an increased risk of cardiovasc ular complications. Parenteral estrogen, polyestradiol phosphate (PEP), is effective, but also associated with cardiovascular complications, although to a lesser extent. During the last 20 years, well tolerated luteinizing ho rmone releasing hormone (LHRH) analogues have been replacing orchiectomy an d estrogens. Efforts have been made to increase the efficacy of the treatme nt by adding antiandrogens to LHRH analogues and also to orchiectomy (combi ned androgen blockade, CAB). However, the efficacy of LHRH analogues and CA B has not proved to be superior to that of simple orchiectomy and, moreover , they are expensive treatment modalities. Orchiectomy and LHRH analogues a re associated with negative effects on bone mass and may cause osteoporosis , whereas PEP treatment has an opposite effect. Parenteral polyestradiol ph osphate is still a cheap potential treatment for advanced prostatic cancer, but further studies should be conducted to establish its future role, e.g. combining acetylsalicylic acid to prevent cardiovascular complications.