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 hydrocortisone in patients with advanced prostate cancer refractory to androgen suppression.


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.


CONCLUSIONS
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.
Farrugia
D
D
Urological Oncology, The Royal Hospitals Trust, and Whipps Cross Hospital, London, UK.
Ansell
W
W
Singh
M
M
Philp
T
T
Chinegwundoh
F
F
Oliver
R T
RT
D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use; D004054:Diethylstilbestrol / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives / Q000037:antagonists & inhibitors; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009919:Orchiectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000188:drug therapy*; D016879:Salvage Therapy / Q000379:methods; D017211:Treatment Failure
D018931:Antineoplastic Agents, Hormonal; D007987:Gonadotropin-Releasing Hormone; D004054:Diethylstilbestrol; D001241:Aspirin; D006854:Hydrocortisone