Stilboestrol plus adrenal suppression as salvage treatment for patients failing treatment with luteinizing hormone-releasing hormone analogues and orchidectomy

Objective To investigate the efficacy of low-dose stilboestrol (SB) with hy drocortisone in patients with advanced prostate cancer refractory to androg en suppression. Patients and methods Thirty-four consecutive patients (median age 70 years, range 51-83) with metastatic disease who progressed on hormone therapy, as shown by recurrent/worsening symptoms and an increase in prostate-specific antigen (PSA) level, were recruited and discontinued hormonal treatment be fore starting SB. Patients received SB (1 mg/day) combined with hydrocortis one (40 mg/day). In an attempt to reduce the incidence of thrombo-embolic e vents, aspirin (75 mg/day) was also added. Results Stilboestrol was the second-line treatment in 19 patients and the t hird or fourth in 15. The median (range) duration of treatment with SB was 5 (0.5-21) months and the median follow-up 7.5 months, with 18 patients sti ll alive and 14 still on treatment. Of 29 symptomatic patients, 24 had symp tomatic improvement and five had no clear benefit; the median duration of b enefit was 6 (2-21) months. The PSA level decreased by 0-50% in six patient s, by 50-90% in 13 and by >90% in eight, while there was symptomatic improv ement in these three categories in five, 11 and seven patients, respectivel y. The median times to PSA nadir and progression were 4 and 6 months, respe ctively. Some thrombo-embolic events and fluid retention occurred but overa ll the treatment was well tolerated. Conclusion Low-dose SB with hydrocortisone is effective in refractory prost ate cancer, although there is some toxicity. Randomized studies against hyd rocortisone or SB alone are needed to establish the cost/benefit ratio of t his combination.