New study below [1].
We see so many posts on Zytiga, Xtandi & even more expensive drugs. This study is from Lahore, Pakistan & reports on DES [Diethylstilbestrol] use in CRPC cases.
"All patients were treated with DES (2.5 mg) initially, but the dose was increased for some patients to 5 mg in combination with aspirin (75 mg)."
I do not presently have CRPC - I use 1 mg DES, which I view as a low-dose (some manage on less) as part of my home-grown BAT regimen. 5 mg or higher was common in the old days. So 2.5 mg is an intermediate dose.
"A total of 91 patients were included in the study, and the mean patient age was 66 ± 8 years. The median baseline PSA was 150 ng/mL (range: 56-626 ng/mL), and the median Gleason's score was eight. A total of 90.1% of patients had metastatic disease at the time of diagnosis."
Pretty much what one would expect in a population with a low level of screening. i.e. those destined for advanced PCa were mostly already there at diagnosis.
"the median time to PSA progression was 597 days" after orchiectomy or LHRH analog. Just short of 20 months.
"After DES treatment was started, 78 patients (87.7%) showed a PSA response, and median time to progression was 212 days. In 24 patients (26.4%), the PSA response was maintained for more than a year. The PSA response was quantified as a good response (i.e., ≥50% PSA drop) or as a partial response (i.e., <50% PSA drop). The good PSA response was observed in 56 patients (61.5%) with a median time to progression of 273 days, and 22 patients (24.2%) had a partial response maintained for 109 days. Thirteen patients (14.3%) did not respond to DES treatment.
"DES is an effective, economical, and relatively safe drug in patients with CRPC."
DES is a synthetic estrogen which was used for ADT for decades. I have known two men with a great response to DES without a drop in testosterone [T]. Both maintain high T levels & low (near zero) PSA. I wish I knew the secret.
But it's clear from the response in CRPC cases that DES does more than cause castrate T levels. Something to consider.
-Patrick
[1] ncbi.nlm.nih.gov/pubmed/312...
Cureus. 2019 Apr 16;11(4):e4470. doi: 10.7759/cureus.4470.
Diethylstilbestrol in the Treatment of Castration-resistant Prostate Cancer: A Lower-middle-income Country Experience.
Ali A1, Khalil MAI1, Khan N1, Abu Bakar M2, Amjad A3, Ahmed I4, Mir K1.
Author information
1
Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, PAK.
2
Biostatistics and Epidemiology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, PAK.
3
Surgery, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, PAK.
4
Urology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, PAK.
Abstract
INTRODUCTION:
Prostate cancer is the second most common cancer and the fifth leading cause of death worldwide. Its metastatic stage is associated with considerable morbidity and may lead to death. In Pakistan, given the high levels of economic constraint, patients with castration-resistant metastatic prostate cancer can be treated with cost-effective medications like diethylstilbestrol (DES).
OBJECTIVES:
The goal of this study was to assess the efficacy and adverse effects of DES when used in patients with castration-resistant prostate cancer (CRPC).
MATERIALS AND METHODS:
From January 2011 to December 2016, all medical records of patients with a diagnosis of prostate cancer resistant to the effects of castration presenting at Shaukat Khanum Cancer Hospital and Research Centre, Lahore, were reviewed. All patients were treated with DES (2.5 mg) initially, but the dose was increased for some patients to 5 mg in combination with aspirin (75 mg). The patients were followed clinically with prostate-specific antigen (PSA) value assessment. The PSA response to treatment, time to disease progression, and adverse events were recorded and analyzed using IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp., Armonk, NY).
RESULTS:
A total of 91 patients were included in the study, and the mean patient age was 66 ± 8 years. The median baseline PSA was 150 ng/mL (range: 56-626 ng/mL), and the median Gleason's score was eight. A total of 90.1% of patients had metastatic disease at the time of diagnosis. Hormonal ablation was provided with bilateral orchiectomy for 71 patients (78.0%), and luteinizing hormone-releasing hormone (LHRH) analog was provided for 20 patients (22.0%). With this treatment, the median time to PSA progression was 597 days. After DES treatment was started, 78 patients (87.7%) showed a PSA response, and median time to progression was 212 days. In 24 patients (26.4%), the PSA response was maintained for more than a year. The PSA response was quantified as a good response (i.e., ≥50% PSA drop) or as a partial response (i.e., <50% PSA drop). The good PSA response was observed in 56 patients (61.5%) with a median time to progression of 273 days, and 22 patients (24.2%) had a partial response maintained for 109 days. Thirteen patients (14.3%) did not respond to DES treatment. The median percent change in PSA was -55.52% (range: -99.9 to +422). Thromboembolic complication was observed in eight patients (8.7%) patients while two patients suffered from liver toxicity.
CONCLUSION:
DES is an effective, economical, and relatively safe drug in patients with CRPC.
KEYWORDS:
castrate resistant prostate cancer; diethylstilbestrol
PMID: 31249748 PMCID: PMC6579324 DOI: 10.7759/cureus.4470
Pembrolizumab in Patients With Heavily Treated Metastatic Castration-Resistant Prostate Cancer 
Post-hoc of ARASENS for metastatic hormone sensitive prostate cancer
