Download PDF
CC BY-NC-ND 4.0 · Revista Urología Colombiana / Colombian Urology Journal 2018; 27(01): 042-047
DOI: 10.1055/s-0038-1639583
Original Article | Artículo Original
Sociedad Colombiana de Urología. Publicado por Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Eficacia y seguridad del dietiletilbestrol, en el tratamiento del cáncer de próstata resistente a la castración

Effectiveness and Safety of Diethylstilbestrol in the Treatment of Castration Resistant Prostate Cancer
Jorge Eduardo Gómez Meza
1   Departamento de Urología, Fundación Universitaria Sanitas, Clínica Universitaria Colombia, Bogotá, Colombia
,
Rodolfo Varela
2   Departamento de Urología, Jefe del servicio de Urología Oncológica, Instituto Nacional de Cancerología, Ciudad de México, CDMX, México
,
Angie Ramírez
3   Department of Medico General, Instituto Nacional de Cancerología, Bogotá, Colombia
› Author Affiliations
Further Information

Publication History

29 September 2016

07 December 2017

Publication Date:
26 March 2018 (online)

Also available at
   Permissions and Reprints

Resumen

Introducción y objetivos Existen múltiples opciones de tratamiento en pacientes con cáncer de próstata resistente a la castración, entre ellas el Dietilestilbestrol (DES) sin embargo, su uso es controversial. Este estudio tiene como objetivo determinar la eficacia y seguridad del DES, en el tratamiento de pacientes con cáncer de próstata resistente a la castración en nuestra población.

Métodos y Materiales Se realizó un estudio de corte transversal, incluyendo los pacientes con cáncer de próstata resistente a la castración que recibieron tratamiento con DES. Se realizó un análisis demográfico, bivariado, tomando como desenlace la respuesta del PSA (Ausente, Completa o Parcial), el tiempo medio de progresión del PSA y la presencia de eventos adversos asociados al medicamento.

Resultados  Noventa y un pacientes incluidos al final del estudio. La distribución de respuesta del PSA fue así: Respuesta en 57 (63,7%) pacientes, (Completa 28% - 31,1% y parcial 29% - 32,2%). Ausente en 33 (36,7%) pacientes. El análisis bivariado no evidenció asociación entre las variables y los desenlaces propuestos. El tiempo medio de progresión del PSA fue de 10,43 meses (Log-rank p = 0.001), no se encontraron diferencias estadísticamente significativas para el tiempo medio a progresión en asociación con la respuesta al PSA (respuesta o ausente y la presencia de enfermedad metastásica), Log-rank p = 0,789, Log-rank p = 0,218, Log-rank p = 0,780 respectivamente. La tasa de complicaciones asociadas a DES fue del 4,4% y correspondió en todos los casos a trombosis venosa profunda.

Conclusiones El DES en pacientes con cáncer de próstata resistente a la castración continúa siendo una herramienta de tratamiento eficaz y con baja tasa de eventos adversos en nuestra población.

Abstract

Introduction and Objectives There are multiple treatment options in patients with castration-resistant prostate cancer, including diethylstilbestrol (DES), but its use is controversial. This study aims to determine the efficacy and safety of DES in the treatment of patients with castration resistant prostate cancer in our population.

Methods and Materials A cross-sectional study was performed, including patients with castration resistant prostate cancer who were treated with DES. A demographic analysis was performed, bivariate analysis, taking as outcome PSA response (Complete or partial), the median time to PSA progression and the presence of adverse events associated with the drug.

Results 91 patients included at the end of the study. The distribution of PSA response was so; Response in 57 (63.7%) patients (Full 28 to 31.1% and partial 29 to 32.2%). Absent in 33 (36.7%) patients. Bivariate analysis evidenced no association between the variables and proposed outcomes. The median time to PSA progression was 10.43 months (log-rank p = 0.001), no statistically significant differences in the average time to progression was found in association with PSA response (response or absent and the presence of disease metastatic), Log-rank p = 0.789, log-rank p = 0.218, log-rank p = 0.780 respectively. The rate of complications associated with DES was 4.4% and corresponded in all cases to deep vein thrombosis.

Conclusions DES in patients with resistant prostate cancer castration continued to be an effective choice of tool of treatment with a low rate of adverse events in our population.

Palabras Claves

cáncer de próstata - resistencia a castración - antígeno prostático específico - dietiletilbestrol - efectos adversos - terapia hormonal

Keywords

prostate cancer - castration resistance - prostate-specific antigen - diethylstilbestrol - adverse effects - hormonal therapy
 

  • Referencias

  • 1 Saad F, Miller K. Treatment options in castration-resistant prostate cancer: current therapies and emerging docetaxel-based regimens. Urol Oncol 2014; 32 (02) 70-79
    CrossrefPubMedGoogle Scholar
  • 2 Piñeros M, Gamboa O, Hernández-Suárez G, Pardo C, Bray F. Patterns and trends in cancer mortality in Colombia 1984-2008. Cancer Epidemiol 2013; 37 (03) 233-239
    CrossrefPubMedGoogle Scholar
  • 3 Ryan CJ, Smith MR, de Bono JS. , et al; COU-AA-302 Investigators. Abiraterone in metastatic prostate cancer without previous chemotherapy. N Engl J Med 2013; 368 (02) 138-148 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3683570&tool=pmcentrez&rendertype=abstract [Internet]
    CrossrefPubMedGoogle Scholar
  • 4 Carter HB, Albertsen PC, Barry MJ. , et al. American Urological Association (AUA) Guideline GUIDELINE American Urological Association Early Detection of Prostate Cancer. 2013: 1-28
    Google Scholar
  • 5 Parker C, Nilsson S, Heinrich D. , et al; ALSYMPCA Investigators. Alpha emitter radium-223 and survival in metastatic prostate cancer. N Engl J Med 2013; 369 (03) 213-223
    CrossrefPubMedGoogle Scholar
  • 6 Clemons J, Glodé LM, Gao D, Flaig TW. Low-dose diethylstilbestrol for the treatment of advanced prostate cancer. Urol Oncol 2013; 31 (02) 198-204
    CrossrefPubMedGoogle Scholar
  • 7 Cookson MS, Roth BJ, Dahm P. , et al. Castration-resistant prostate cancer: AUA Guideline. J Urol 2013; 190 (02) 429-438
    CrossrefPubMedGoogle Scholar
  • 8 Aggarwal R, Weinberg V, Small EJ, Oh W, Rushakoff R, Ryan CJ. The mechanism of action of estrogen in castration-resistant prostate cancer: clues from hormone levels. Clin Genitourin Cancer 2009; 7 (03) E71-E76
    CrossrefPubMedGoogle Scholar
  • 9 Shore ND, Cookson MS. Proper Sequencing of Treatment for Castrate Resistant Prostate Cancer. Urol Pract 2014; 1 (01) 2-6
    PubMedGoogle Scholar
  • 10 Wilkins A, Shahidi M, Parker C. , et al. Diethylstilbestrol in castration-resistant prostate cancer. BJU Int 2012; 110 (11 Pt B): E727-E735
    CrossrefPubMedGoogle Scholar
  • 11 Malkowicz SB. The role of diethylstilbestrol in the treatment of prostate cancer. Urology 2001; 58 (02) (Suppl. 01) 108-113
    CrossrefPubMedGoogle Scholar
  • 12 Scherr DS, Pitts Jr WR. The nonsteroidal effects of diethylstilbestrol: the rationale for androgen deprivation therapy without estrogen deprivation in the treatment of prostate cancer. J Urol 2003; 170 (05) 1703-1708
    CrossrefPubMedGoogle Scholar
  • 13 Oh WK. The evolving role of estrogen therapy in prostate cancer. Clin Prostate Cancer 2002; 1 (02) 81-89
    CrossrefPubMedGoogle Scholar
  • 14 Turo R, Smolski M, Esler R. , et al. Diethylstilboestrol for the treatment of prostate cancer: past, present and future. Scand J Urol 2014; 48 (01) 4-14 http://www.ncbi.nlm.nih.gov/pubmed/24256023 [Internet]
    PubMedGoogle Scholar
  • 15 Manikandan R, Srirangam SJ, Pearson E, Brown SCW, O'Reilly P, Collins GN. Diethylstilboestrol versus bicalutamide in hormone refractory prostate carcinoma: a prospective randomized trial. Urol Int 2005; 75 (03) 217-221
    CrossrefPubMedGoogle Scholar
  • 16 Smith DC, Redman BG, Flaherty LE, Li L, Strawderman M, Pienta KJ. A phase II trial of oral diethylstilbesterol as a second-line hormonal agent in advanced prostate cancer. Urology 1998; 52 (02) 257-260
    CrossrefPubMedGoogle Scholar
  • 17 Grenader T, Plotkin Y, Gips M, Cherny N, Gabizon A. Diethylstilbestrol for the treatment of patients with castration-resistant prostate cancer: retrospective analysis of a single institution experience. Oncol Rep 2014; 31 (01) 428-434
    CrossrefPubMedGoogle Scholar