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Keywords:

  • diethylstilbestrol;
  • oestrogen;
  • castration-resistant prostate cancer;
  • PSA response rate

Study Type – Therapy (case series)

Level of Evidence 4

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).

PATIENTS AND 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.