Abstract
Androgen deprivation therapy (ADT) for prostate cancer is now used in earlier disease stages and as adjuvant treatment. Recognizing and reducing the toxicity of this therapy, including worsened lipid levels and cardiovascular disease (CVD) risks, has become an important clinical concern. Oral estrogen therapy induces hypogonadism and mitigates many side effects of ADT, but has a high thrombosis risk. Transdermal estrogen therapy (TDE) has a lower thrombosis risk than oral estrogen and may improve CVD risk compared with ADT. This prospective pilot study of 18 men with androgen-independent prostate cancer receiving ADT measured effects of TDE on lipid and inflammatory CVD risk factors before and after 8 weeks of TDE (estradiol 0.6 mg/day). During treatment, estradiol levels rose 17-fold; total cholesterol, LDL cholesterol, and apolipoprotein B levels decreased. HDL2 cholesterol increased, with no changes in triglyceride or VLDL cholesterol levels. Dense LDL cholesterol decreased and LDL buoyancy increased in association with a decrease in HL activity. Highly sensitive C-reactive protein levels and other inflammatory markers did not worsen. Compared with ADT, short-term TDE therapy of prostate cancer improves lipid levels without deterioration of CVD-associated inflammatory markers and may, on longer-term follow-up, improve CVD and mortality rates.
Highlights
Androgen deprivation therapy (ADT) for prostate cancer is used in earlier disease stages and as adjuvant treatment
Recent data in men with prostate cancer have shown that the mortality from prostate cancer has declined such that by 1996, cardiovascular disease (CVD) had become a more likely cause of death than their cancer in these men [13]
In studies lasting longer than three months, medical or surgical castration led to increases in total cholesterol, Abbreviations: ADT, androgen deprivation therapy; CVD, cardiovascular disease; DEXA, dual energy X-ray absorptiometry; High-sensitive C-reactive protein (hs-CRP), high-sensitive C-reactive protein; IL-6, interleukin-6; SHBG, sex hormone binding globulin; TDE, transdermal estrogen therapy; Tumor necrosis factor-a (TNFa), tumor necrosis factor-a
Summary
Androgen deprivation therapy (ADT) for prostate cancer is used in earlier disease stages and as adjuvant treatment. In studies lasting longer than three months, medical or surgical castration led to increases in total cholesterol, Abbreviations: ADT, androgen deprivation therapy; CVD, cardiovascular disease; DEXA, dual energy X-ray absorptiometry; hs-CRP, high-sensitive C-reactive protein; IL-6, interleukin-6; SHBG, sex hormone binding globulin; TDE, transdermal estrogen therapy; TNFa, tumor necrosis factor-a.
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