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RESEARCH ARTICLE
Year : 2003  |  Volume : 19  |  Issue : 2  |  Page : 129-134

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


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
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Source of Support: None, Conflict of Interest: None


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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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