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Sir,

I read this article [1] with interest. The Veterans Administration Cooperative Urology Research Group (VACURG) reports of 1968 (I), 1978 (II), 1986 (III) concluded that: (i) diethylstilbestrol (DES) 1 mg/day was safe and effective; (ii) DES 1 mg was more effective than orchidectomy; and (iii) DES 1 mg plus orchidectomy was no better than DES 1 mg alone, as measured by bone scan, acid phosphatase and death. In all of these studies (>40 000 men over 30 years) hormone therapy was initiated immediately on diagnosis [2].

Scherr et al.[3,4] showed that DES 1 mg prevents the osteoporosis of androgen deprivation. Scherr and Pitts [4] reviewed the nonsteroidal effects of DES, e.g. those against osteoporosis, angiogenesis, mitosis, tubulin, decrease in cognitive function, atherosclerosis, hot flashes and asthenia. Pitts [5] reviewed previous reports and showed that immediate androgen deprivation without oestrogen deprivation using DES 1 mg was the only form of therapy to slow progression and prolong life of any prostate cancer therapy (surgery, radiation, orchidectomy or other chemotherapy).

  • 1
    Dearnaley DP. Additional treatment for pT3 prostate cancer: now, later or never. BJU Int 2007; 100: 9779
  • 2
    Byar DP, Code DK. Hormone therapy for prostate cancer: results of the Veterans Administration Co-operative Urology Research Group. NCI Mongr 1988; 7: 165170
  • 3
    Scherr DS, Pitts WR Jr, Vaughan ED Jr. Diethylstilbestrol revisited: androgen deprivation, osteoporosis and prostate cancer. J Urol 2002; 167: 535
  • 4
    Scherr DS, Pitts WR Jr. Review: The non-steroidal effects of diethylstilbestrol: the rationale for androgen deprivation therapy without estrogen deprivation in the treatment of prostate cancer. J Urol 2003; 170: 1703
  • 5
    Pitts WR Jr. The clinical rationale for immediate androgen deprivation without estrogen deprivation. Clin Prostate Cancer 2003; 2: 127