Abstract
Conjugated oestrogen is one of the more affordable secondary hormonal options available for castrate-resistant prostate cancer (CRPC) in Jamaica. The present study was conducted to examine the disease response in Jamaican men with CRPC treated with conjugated oestrogen. This study retrospectively reviewed the medical notes of patients who attended the urologic clinic of the University Hospital of the West Indies from 1 January 2009 to 31 December 2013 and a private urology clinic from 2 November 2005 to 3 June 2015 to identify patients diagnosed with CRPC treated with conjugated oestrogen (Premarin ®) as secondary therapy. The primary endpoint of favourable response, using the Prostate Cancer Clinical Trials Working Group 2 criteria is a decline of ≥50% in serum prostate-specific antigen (PSA) concentrations from baseline after treatment. The proportion of patients responding by the first 3-month follow-up visit and the maximal PSA declined over the 24 months of follow-up which were recorded. Thirty-two patients diagnosed with CRPC and treated with conjugated oestrogen were identified. All patients were prescribed 5.0 mg (2.5 mg tablets, twice daily) orally, as well as low dose aspirin. Favourable response was observed in 14 (43.8%) patients; however, eight other patients showed a decline in serum PSA concentration of <50%. There were no reported adverse effects. Conjugated oestrogen produced a PSA decline in Jamaican CRPC patients of this study and may therefore be a useful option for secondary therapy of CRPC. Further assessment is needed.
Highlights
In Jamaica, prostate cancer is the most common cancer affecting men [1] and the leading cause of male cancer-related deaths [2]
In the absence of other clinical parameters of improved outcome in patients with prostate cancer, the Prostate Cancer Clinical Trials Working Group 2 determined that the percentage decline in prostate-specific antigen (PSA) from baseline to 12 weeks, as well as the maximum decline in PSA that occurs at any point after treatment, be reported as a surrogate marker for favourable response [7]
The aim of this study is to examine the disease response in Jamaican men with castrate resistant prostate cancer (CRPC) treated with conjugated oestrogen
Summary
In Jamaica, prostate cancer is the most common cancer affecting men [1] and the leading cause of male cancer-related deaths [2]. Most prostate cancer cases are usually locally advanced or progress to metastatic disease [3] and are mainly treated by medical castration, the costs of which are subsidised by the National Health Fund. For patients who develop castrate resistant prostate cancer (CRPC), the secondary therapy from the National Health Fund subsidised list is the conjugated oestrogen preparation, Premarin®, commonly prescribed at a dose of 2.5 mg twice daily. With oestrogen remaining a popular choice for CRPC therapy in Jamaica, an assessment of clinical benefit is important in this group of patients. The aim of this study is to examine the disease response in Jamaican men with CRPC treated with conjugated oestrogen
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