title: Diethylstilbestrol in castration-resistant prostate cancer.
abstract: What's known on the subject? and What does the study add? Diethylstilbestrol (DES) was the first hormone treatment used for prostate cancer and has also shown effectiveness in castration-resistant disease in small studies; however, concerns over thromboembolic toxicity have restricted its use in the past. Over 200 elderly men with castration-resistant prostate cancer were treated with 1-3 mg of DES, given with 75 mg aspirin and breast bud irradiation. Almost 30% of men showed a significant PSA response and the median time to PSA progression was 4.6 months. Almost 20% of patients with pain had a significant analgesic benefit. The most important toxicity was thromboembolism in 10% of men. Overall the drug has an acceptable toxicity profile and offers a palliative benefit in frail elderly men who may not be fit for chemotherapy.
  
  
  OBJECTIVE
  • To assess the efficacy and toxicity of diethylstilbestrol (DES) in the management of castration-resistant prostate cancer (CRPC).
  
  
  METHODS
  • A total of 231 patients with CRPC received treatment with DES at the Royal Marsden Hospital between August 1992 and August 2000. • The median pre-treatment prostate-specific antigen (PSA) level was 221 ng/mL. • DES was used at a dose of 1-3 mg daily, with aspirin 75 mg. • The primary endpoint was PSA response rate.
  
  
  RESULTS
  • The PSA response rate (using PSA Working Group criteria) was 28.9%. • The median time to PSA progression was 4.6 months. • Of patients with bone pain, 18% had an improvement in their European Organisation for the Research and Treatment of Cancer pain score. • Thromboembolic complications were seen in 9.9% of all patients.
  
  
  CONCLUSIONS
  • DES has significant activity in CRPC and can be of palliative benefit. • DES has an acceptable toxicity profile in the management of patients with symptomatic CRPC when used at a dose of 1-3 mg, combined with aspirin and prophylactic breast bud radiotherapy.
authors.affiliation: Academic Urology Unit, Royal Marsden Hospital, Sutton, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Wilkins
authors.forename: Mehdi
authors.initials: M
authors.lastname: Shahidi
authors.forename: Chris
authors.initials: C
authors.lastname: Parker
authors.forename: Ranga
authors.initials: R
authors.lastname: Gunapala
authors.forename: Karen
authors.initials: K
authors.lastname: Thomas
authors.forename: Robert
authors.initials: R
authors.lastname: Huddart
authors.forename: Alan
authors.initials: A
authors.lastname: Horwich
authors.forename: David
authors.initials: D
authors.lastname: Dearnaley
mesh_terms: D000368:Aged; D004054:Diethylstilbestrol / Q000627:therapeutic use; D018450:Disease Progression; D004968:Estrogens, Non-Steroidal / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009919:Orchiectomy; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D004968:Estrogens, Non-Steroidal; D004054:Diethylstilbestrol; D017430:Prostate-Specific Antigen