Estramustine phosphate in the treatment of hormone escape prostatic carcinoma - a 3 year follow-up

• Main Authors: Altaf H Syed, Mohd N Akhtar, C Shearing, P R Bollina, D N Tulloch
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2003-01-01
• Series: Indian Journal of Urology
• Subjects: Estramustine phosphate. prostate specific antigen. advanced prostate cancer; bone pain; side effects/toxicity.
• Online Access: http://www.indianjurol.com/article.asp?issn=0970-1591;year=2003;volume=19;issue=2;spage=129;epage=134;aulast=Syed
• ISSN: 0970-1591; 1998-3824

Objective: A recent literature review has shown rekin-dled 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 hor-mone 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 chem-istry (PSA, etc) was done and further investigations, i.e., bone scan, CT scan, etc. were requested if thought neces-sary. 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 in-sensitivity 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 treat-ment was generally well tolerated (72%) as only 7 patients had to discontinue EMP because of severe side ef-fects. Conclusions: EMP treatment in patients with hormone escaped prostatic cancer does produce immediate PSA response which is reflected simultaneously in pain improve-ment in the majority of cases but overall the benefit is shortlived. Patients who have> 80% reduction in pre-treat-ment PSA value at 6 weeks may have longer period of pro-gressionfree intervals. However EMP was generally well tolerated.