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Cardiovascular toxicities of systemic treatments of prostate cancer: oestrogen to the rescue?

Nature Reviews Urology volume 14, page 575 (2017)Cite this article

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In their Review (Cardiovascular toxicities of systemic treatments of prostate cancer. Nat. Rev. Urol. 14, 230–243 (2017))1 Veccia et al. offer useful insight into current knowledge concerning cardiovascular complications of oral oestrogen, androgen deprivation therapy (ADT), and prostate cancer. However, we do not share the confidence and strength of their assertion that “oestrogens are no longer used in patients with prostate cancer owing to the severity of their adverse events, which include thromboembolic and cardiovascular effects”. This misconception, based on the oral mode of administration of the drug, has led to a long period of disuse, but early data derived from the current UK national Prostate Adenocarcinoma TransCutaneous Hormones (PATCH) study2,3, promise to improve our understanding of the value of oestrogen for treating prostate cancer and to explain the reasons for the various adverse effects (including, for example, osteoporosis and metabolic syndrome). This study could also provide a possible route to personalized medicine in hormone therapy for prostate cancer and an improved quality of life for men with this disease.

Initially, ADT (or total orchidectomy) was widely accepted to achieve androgen suppression for treating advanced prostate cancer. However, the Veterans' Administration Cooperative Urological Research Group studies on prostate cancer revealed unexpected outcomes; oral oestrogen resulted in improved prostate-cancer-specific survival, but overall survival worsened substantially, exposing patients to particularly serious cardiovascular and thromboembolic toxicities arising from oral use4. Thus, oral oestrogen, which necessarily passes through the enterohepatic circulation and bathes the liver in high levels of oestrogen resulting in induction of procoagulant molecules5, was soon abandoned4.

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References

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Authors and Affiliations

  1. Syed Imran A. Shah is at the Biochemistry Department at Central Park Medical College, Central Park Housing Scheme, 31 km Ferozepur Road, Kahna Nau, Lahore, Punjab, Pakistan.,

    Syed Imran A. Shah

  2. Hannah C. P. Wilson is at Imperial NHS Trust, The Bays, South Wharf Road, St Mary's Hospital, London W2 1NY.,

    Hannah C. P. Wilson

  3. Paul D. Abel is at South Kensington Campus, London, SW7 2AZ, UK.,

    Paul D. Abel

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  1. Syed Imran A. Shah
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  2. Hannah C. P. Wilson
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  3. Paul D. Abel
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Contributions

S.I.A.S. and P.A. had the idea for the article, S.I.A.S. researched data for the article, all authors wrote, edited and reviewed the manuscript before submission.

Corresponding author

Correspondence to Syed Imran A. Shah.

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Competing interests

P.A. is coprincipal investigator of the UK national Prostate Adenocarcinoma TransCutaneous Hormones (PATCH) study and has grant funding from Cancer Research UK. The PATCH study is a phase III randomized controlled clinical trial comparing efficacy and toxicity of transcutaneous oestrogen patches and luteinising-hormone-releasing hormone agonist funded by Cancer Research UK and supported by the UK Medical Research council S. I. A. S. received a PhD grant from the Commonwealth Scholarship Commission. H.C.P.W. declares no competing interests.

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Shah, S., Wilson, H. & Abel, P. Cardiovascular toxicities of systemic treatments of prostate cancer: oestrogen to the rescue?. Nat Rev Urol 14, 575 (2017). https://doi.org/10.1038/nrurol.2017.126

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