Androgen deprivation therapy for prostate cancer - the potential of parenteral estrogen

被引:0
|
作者
Ockrim, Jeremy [1 ]
Abel, Paul D. [2 ,3 ]
机构
[1] Univ Coll Hosp NHS Trust, Dept Urol, London, England
[2] Imperial Coll London, Surg Biotechnol, London, England
[3] Imperial Coll Hosp NHS Trust, Dept Urol, London, England
关键词
prostate cancer; androgen deprivation therapy; andropause; estrogen; drug administration routes;
D O I
10.5173/ceju.2009.03.art1
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
The treatment of choice for carcinoma of the prostate for over a generation was oral estrogen but this was abandoned due to an excess of cardiovascular and thromboembolic toxicity. We now recognize that most of this toxicity relates to first pass portal circulation where hepatic metabolism of hormones, lipids and coagulation proteins is up regulated. It has been shown that most of such toxicity can be avoided by parenteral (intramuscular or transdermal) estrogen administration; this avoids hepatic enzyme induction. A modest short term increase in cardiovascular morbidity (but not mortality) is compensated for by a long term cardioprotective benefit, which accrues progressively as vascular remodeling develops with time. A major advantage of estrogen therapy is protection against the effects of the andropause (cf female menopause), which with conventional androgen suppression causes significant morbidity including osteoporotic fracture, hot flushes, lethargy and cognitive dysfunction. Parenteral estrogen therapy is also much cheaper than contemporary endocrine therapy, with substantial economic benefits for health providers.
引用
收藏
页码:132 / 140
页数:9
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