title: Comparison of ketoconazole and estramustine for treating patients with castration-resistant prostate cancer.
abstract: OBJECTIVE
  We investigated the efficacy of ketoconazole and estramustine before chemotherapy for treating patients with progressive castration-resistant prostate cancer (CRPC) after anti-androgen withdrawal syndrome.
  
  
  METHODS
  Eighty-four patients who were diagnosed with CRPC and were treated between 2005 and 2009 were included. Thirty-nine patients were treated with 600 mg of ketoconazole and 10 mg of prednisolone per day (group I), and 45 patients were treated with 560 mg of estramustine per day (group II). The prostate-specific antigen (PSA) response, progression-free survival, and side effects were compared.
  
  
  RESULTS
  The median age of the patients, PSA level, and follow-up period were 72 years, 48.5 ng/ml, and 4 months (range, 1 to 29 months), respectively. The overall PSA response rate was 35.7%, and the PSA response rates were 33.3% for group I and 37.8% for group II (p=0.672). The median progression-free survival times were 8 months (95% confidence interval [CI] 5.9-10.1) overall, 5 months (95% CI 1.6-8.3) in group I, and 8 months (95% CI 5.9-10.0) in group II (p=0.282). The most common complications in groups I and II were nausea and vomiting (51.3%) and anemia (77.8%), respectively. Nausea and vomiting and hepatotoxicity were observed more often in group I, and gynecomastia, neutropenia, and anemia were observed more often in group II. The toxicities of each adverse effect were ≤grade 2.
  
  
  CONCLUSIONS
  With a resultant PSA decline and mild adverse effects, both ketoconazole and estramustine are worth consideration as treatment options for progressive CRPC patients after primary hormonal therapy.
authors.affiliation: Department of Urology, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Bu Hyeon
authors.initials: BH
authors.lastname: Yun
authors.forename: Eu Chang
authors.initials: EC
authors.lastname: Hwang
authors.forename: Dong Hoon
authors.initials: DH
authors.lastname: Yoo
authors.forename: In Sang
authors.initials: IS
authors.lastname: Hwang
authors.forename: Sun-Ouck
authors.initials: SO
authors.lastname: Kim
authors.forename: Seung Il
authors.initials: SI
authors.lastname: Jung
authors.forename: Taek Won
authors.initials: TW
authors.lastname: Kang
authors.forename: Dong Deuk
authors.initials: DD
authors.lastname: Kwon
authors.forename: Kwangsung
authors.initials: K
authors.lastname: Park
authors.forename: Soo Bang
authors.initials: SB
authors.lastname: Ryu