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Stilboestrol plus adrenal suppression as salvage treatment for patients failing treatment with luteinizing hormone‐releasing hormone analogues and orchidectomy
Author(s) -
Farrugia D.,
Ansell W.,
Singh M.,
Philp T.,
Chinegwundoh F.,
Oliver R.T.D.
Publication year - 2000
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1046/j.1464-410x.2000.00673.x
Subject(s) - medicine , luteinizing hormone , urology , prostate cancer , hormone , refractory (planetary science) , androgen , hydrocortisone , prostate , surgery , gastroenterology , cancer , physics , astrobiology
Objective To investigate the efficacy of low‐dose stilboestrol (SB) with hydrocortisone in patients with advanced prostate cancer refractory to androgen 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 before starting SB. Patients received SB (1 mg/day) combined with hydrocortisone (40 mg/day). In an attempt to reduce the incidence of thrombo‐embolic events, aspirin (75 mg/day) was also added. Results Stilboestrol was the second‐line treatment in 19 patients and the third 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 still alive and 14 still on treatment. Of 29 symptomatic patients, 24 had symptomatic improvement and five had no clear benefit; the median duration of benefit was 6 (2–21) months. The PSA level decreased by 0–50% in six patients, by 50–90% in 13 and by > 90% in eight, while there was symptomatic improvement in these three categories in five, 11 and seven patients, respectively. The median times to PSA nadir and progression were 4 and 6 months, respectively. Some thrombo‐embolic events and fluid retention occurred but overall the treatment was well tolerated. Conclusion Low‐dose SB with hydrocortisone is effective in refractory prostate cancer, although there is some toxicity. Randomized studies against hydrocortisone or SB alone are needed to establish the cost/benefit ratio of this combination.