Transdermal estrogen in the treatment of hot flushes in men with prostate cancer

Objectives. To assess the effectiveness and tolerability of transdermal est rogen in men with hot flushes after hormonal therapy for prostate cancer. Methods. Twelve men with moderate to severe hot flushes were randomized to receive either low-dose (0.05 mg) or high-dose (0.10 mg) estrogen patches a pplied twice weekly for 4 weeks. After a 4-week washout period in which no treatment was given, each patient received the alternative dose for 4 weeks . Treatment response was assessed by daily logs and questionnaires complete d every 4 weeks that included a visual analog assessment. Serum luteinizing hormone, follicle-stimulating hormone, testosterone, and estradiol levels were also measured every 4 weeks during the study. Results. There was a significant reduction in the overall severity of the h ot flushes seen in patients with both the low and high-dose estrogen patch. A significant reduction in the daily frequency of the hot flushes was seen with the high-dose patch only. Overall, 10 (83%) of 12 men reported either mild, moderate, or major improvement in symptoms with either the low or hi gh-dose patch. Mild, painless breast swelling or nipple tenderness was note d in 2 (17%) and 5 (42%) of 12 men treated with the low and high-dose estro gen patch, respectively. FSH levels decreased significantly with both the l ow and high-dose patch. Estradiol levels increased from 12.1 to 16.4 pg/mL and 26.9 pg/mL with the low and high-dose patch, respectively. There was no significant change in serum testosterone or luteinizing hormone levels. Conclusions. Transdermal estrogen appears to be a promising, well-tolerated therapy for men with hot flushes after endocrine treatment for prostate ca ncer. Further study in larger groups of patients is necessary to assess the relative effectiveness and morbidity of this treatment. (C) 2000, Elsevier Science Inc.