PARENTERAL OESTROGEN FOR PROSTATE CANCER

Parenteral oestrogen for prostate cancer: a systematic review of clinical effectiveness and dose response

Background

CRD supported a subgroup of the Prostate Clinical Studies Group who were developing a trial to evaluate transdermal oestrogens in prostate cancer. The aim of this systematic review was to examine the literature on the use of parenteral oestrogen in prostate cancer. The review addressed questions about the efficacy of parenteral oestrogen compared to other therapies, mortality and morbidity rates, the effect of varying dose, and any associated adverse events and side effects.

Findings

The studies included in this review did not provide sufficient evidence to allow a clear conclusion to be reached on the efficacy and safety of parenteral oestrogen in prostate cancer. The available evidence suggests that parenteral oestrogen administered alone, in adequate dosage, may be an effective therapeutic option for men with prostate cancer.

Cardiovascular, cancer-specific and overall mortality appeared similar to orchidectomy or luteinising hormone releasing hormone, although an excess of cardiovascular morbidity was associated with the use of parenteral oestrogen.

The available evidence on parenteral oestrogen in combination with oral oestrogens suggests that cardiovascular mortality and morbidity may be considerably elevated by their use. It is therefore more difficult to justify further research into this combined therapy.

Conducted by: Michael Emmans Dean², Gill Norman¹, Zoé Hodges⁶, Gill Ritchie³, Kate Light¹, Alison Eastwood¹, Ruth Langley⁴, Matthew Sydes⁴, Mahesh Parmar⁴, Paul Abel⁵

1. Centre for Reviews and Dissemination; 2. Department of Health Sciences, University of York; 3.National Collaborating Centre for Primary Care; 4. MRC Clinical Trials Unit; 5. Imperial College; 6. Department of Public Health and Policy, London School of Hygiene and Tropical Medicine

Publications

The Centre for Reviews and Dissemination. Parenteral oestrogens for prostate cancer: a systematic review of clinical effectiveness and dose response. CRD Report 33. York: University of York. 2006

Norman G, Dean ME, Langley RE, Hodges ZC, Ritchie G, Parmar MKB, Sydes MR, Abel P, Eastwood AJ. Parenteral oestrogen in the treatment of prostate cancer: a systematic review. Br J Cancer. 2008; 98(4):697-707

Funding

Commissioned by the National Cancer Research Network