| RESEARCH ARTICLE |
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| Year : 2003 | Volume
: 19
| Issue : 2 | Page : 129-134 |
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Estramustine phosphate in the treatment of hormone escape prostatic carcinoma - a 3 year follow-up
Altaf H Syed1, Mohd N Akhtar2, C Shearing1, PR Bollina1, DN Tulloch1
1 Department of Urology, Western General Hospital, Lothian University Hospitals NHS Trust, Edinburgh, United Kingdom
2 Southern General Hospital, Glasgow, United Kingdom
Correspondence Address:
Altaf H Syed
Department of Urology, Western General Hospital, Lothian University Hospitals NHS Trust, Edinburgh, EH4 2XU
United Kingdom
 Source of Support: None, Conflict of Interest: None  | Check |
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Objective: A recent literature review has shown rekindled interest in the use of estramustine phosphate (EMP) inpatients with advanced prostatic cancer. This led us to assess prostate specific antigen (PSA ) response and drug tolerability following EMP therapy inpatients with hormone refractory prostate cancer
Patients and Methods: Twenty-five patients with a mean age of 73.5 years (range 49 to 85 years) received EMP for hormone insensitive prostate cancer from January 1996 onwards. They were received at 6 weeks initially followed by 3 monthly intervals to monitor further progression of disease. At each visit clinical examination and blood chemistry (PSA, etc) was done and further investigations, i.e., bone scan, CT scan, etc. were requested if thought necessary.
Results: According to the WHO score of pain 71 %found immediate symptomatic relief following EMP treatment but only 29% were pain free after one year PSA level showed a persistent decline of >50% of pre-treatment value in 16 patients (64%) at 6 weeks. However, at 1 year 22% had either a still declining PSA or had reached a stable nadir PSA level while the rest showed rising PSA suggesting insensitivity to EMP. Three out of 5 patients (excluding I patient with intolerance at 2 months) with >80% decrease in PSA at 6 weeks had longer period of progression free interval (1 year in 2 and 2 years in 1 patient). The treatment was generally well tolerated (72%) as only 7 patients had to discontinue EMP because of severe side effects.
Conclusions: EMP treatment in patients with hormone escaped prostatic cancer does produce immediate PSA response which is reflected simultaneously in pain improvement in the majority of cases but overall the benefit is shortlived. Patients who have >80% reduction in pre-treatment PSA value at 6 weeks may have longer period of progressionfree intervals. However EMP was generally well tolerated. |
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