title: Estramustine affects bone mineral metabolism in metastatic prostate cancer.
abstract: A patient with metastatic prostate cancer is described where treatment with Adriamycin (doxorubicin) and estramustine produced severe hypophosphatemia (serum phosphate level, 1.2 mg/dl), which was reversible when treatment was discontinued. Previous studies have shown no effect of Adriamycin on serum phosphate levels. A retrospective study of serial serum chemistry values was done in 15 patients treated with estramustine. A significant fall in the serum phosphate level (mean, 0.8 +/- 0.3 mg/dl) was observed during the first 6 weeks of treatment. When compared with similar patients treated with bilateral orchiectomy, estramustine-treated patients had lower levels of serum calcium, fractional excretion of calcium, serum phosphate, and renal tubular threshold for phosphate reabsorption (TmPO4/GFR). Qualitatively similar but quantitatively smaller effects were also seen in a group of patients treated with diethylstilbestrol (DES) in a dose of 1 to 3 mg daily. Estramustine appears to have significant effects on bone mineral metabolism, particularly on renal phosphate handling resulting in significant hypophosphatemia. This is probably due to an estrogenic effect.
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000188:drug therapy* / Q000601:surgery; D001842:Bone and Bones / Q000378:metabolism*; D002118:Calcium / Q000097:blood*; D003404:Creatinine / Q000097:blood; D004054:Diethylstilbestrol / Q000494:pharmacology; D004961:Estramustine / Q000009:adverse effects*; D004967:Estrogens / Q000494:pharmacology; D006801:Humans; D007668:Kidney / Q000378:metabolism; D008297:Male; D009362:Neoplasm Metastasis; D009588:Nitrogen Mustard Compounds / Q000009:adverse effects*; D009919:Orchiectomy; D010710:Phosphates / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000601:surgery
chemical_list: D004967:Estrogens; D009588:Nitrogen Mustard Compounds; D010710:Phosphates; D004961:Estramustine; D004054:Diethylstilbestrol; D003404:Creatinine; D002118:Calcium