In some patients with prostate cancer and who manifest disease progression during maximal androgen blockade(MAB) therapy, discontinuation of antiandrogen treatment might result in a significant fall in the level of serum prostate-specific antigen(PSA), and this is often correlated with clinical improvement(antiandrogen withdrawal syndrome). However, a decline in the PSA level after the withdrawal of estramustine phosphate is extremely rare. We report here on a case of dramatic decline in the PSA level after withdrawal of estramustine phosphate in a patient with hormone refractory prostate cancer.
Disease Progression ; Drug Therapy ; Estramustine* ; Humans ; Prostate* ; Prostatic Neoplasms*

PURPOSE: We wanted to evaluate the efficacy and side effects of estramustine monotherapy and estramustine plus etoposide or dexamethasone combined therapies for patients with hormone refractory prostate cancer(HRPC). MATERIALS AND METHODS: Between 2000 and 2004, 33 patients who were diagnosed with HRPC and treated with estramustine-based chemotherapy were evaluated. Eleven patients had oral estramustine monotherapy(group 1), 12 patients had oral estramustine plus oral etoposide(group 2), and finally 10 patients had oral estramustine plus oral dexamethasone(group 3). The prostate-specific antigen(PSA) response, progression-free survival and disease-specific survival were evaluated. RESULTS: The median patient age was 71 years and the median PSA was 97.3ng/ml. The median follow-up period was 17 months(range: 5-47). The overall response rate was 45.5%, and the response rate for each group was 36.4% for group 1, 41.7% for group 2 and 70.0% for group 3, respectively. The median time to progression(TTP) was 5 months(range: 1-16) overall and it was 5 months, 5.5 months and 5 months in groups 1, 2 and 3, respectively. Regarding the response rate, progression-free survival and disease specific survival, there were no statistically significant differences between the three groups(p>0.05). The most common hematologic complication was anemia that occurred in 28 patients and deep vein thrombosis occurred in 2. Severe toxicities(>or=grade 3) occurred in only 2 patients. CONCLUSIONS: Estramustine phosphate showed over a 45% response rates with less morbidities. Estramustine-based chemotherapy can be considered as an option for the treatment of HRPC. However, larger randomized controlled trials for regimens combined with other efficacious agents are necessary to elucidate the efficacy of chemotherapy for HRPC.
Anemia ; Dexamethasone ; Disease-Free Survival ; Drug Therapy* ; Estramustine* ; Etoposide ; Follow-Up Studies ; Humans ; Prostate* ; Prostatic Neoplasms* ; Venous Thrombosis

PURPOSE: We investigated the efficacy of ketoconazole and estramustine before chemotherapy for treating patients with progressive castration-resistant prostate cancer (CRPC) after anti-androgen withdrawal syndrome. MATERIALS AND METHODS: Eighty-four patients who were diagnosed with CRPC and were treated between 2005 and 2009 were included. Thirty-nine patients were treated with 600 mg of ketoconazole and 10 mg of prednisolone per day (group I), and 45 patients were treated with 560 mg of estramustine per day (group II). The prostate-specific antigen (PSA) response, progression-free survival, and side effects were compared. RESULTS: The median age of the patients, PSA level, and follow-up period were 72 years, 48.5 ng/ml, and 4 months (range, 1 to 29 months), respectively. The overall PSA response rate was 35.7%, and the PSA response rates were 33.3% for group I and 37.8% for group II (p=0.672). The median progression-free survival times were 8 months (95% confidence interval [CI] 5.9-10.1) overall, 5 months (95% CI 1.6-8.3) in group I, and 8 months (95% CI 5.9-10.0) in group II (p=0.282). The most common complications in groups I and II were nausea and vomiting (51.3%) and anemia (77.8%), respectively. Nausea and vomiting and hepatotoxicity were observed more often in group I, and gynecomastia, neutropenia, and anemia were observed more often in group II. The toxicities of each adverse effect were < or =grade 2. CONCLUSIONS: With a resultant PSA decline and mild adverse effects, both ketoconazole and estramustine are worth consideration as treatment options for progressive CRPC patients after primary hormonal therapy.
Anemia ; Disease-Free Survival ; Estramustine ; Follow-Up Studies ; Gynecomastia ; Humans ; Ketoconazole ; Male ; Nausea ; Neutropenia ; Prednisolone ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Vomiting