Scand J Urol Nephrol. 2008;42:220-229
Parenteral estrogen therapy with high-dose polyestradiol phosphate (PEP, Estradurin) has anticancer efficacy similar to that of combined androgen deprivation (CAD) in patients with metastatic prostate cancer, researchers report.
PEP does not increase cardiovascular mortality but it carries a significant risk of non-fatal cardiovascular events, “which should be balanced against the skeletal complications in the CAD group,” the authors wrote.
Per Olov Hedlund, MD, of Karolinksa University Hospital in Solna, Sweden, and his colleagues studied 910 patients with metastatic prostate cancer and skeletal metastases. Men were randomized to receive PEP or flutamide in combination with either triptorelin or, on an optional basis, bilateral orchidectomy. Each group had 455 patients, who were recruited in Sweden, Denmark, Finland, Norway, and Iceland.
The researchers observed no difference between treatment arms with respect to biochemical or clinical progression-free survival or in overall or disease-specific survival. They observed no difference in cardiovascular mortality, but a significant increase in non-fatal cardiovascular events in the PEP arm. Eighteen “grave” skeletal events occurred in the CAD group but none occurred in the PEP group.
“It is feasible to use Estradurin in the primary or secondary endocrine treatment of metastasized patients without prominent cardiac risk factors and especially those with osteoporosis,” they concluded.