Testosterone fall after surgical castration vs oral estrogen

[vesal_mas (imported)]

For our information.

Greetings,

Vesal!

Urology. 1994 Jun;43(6):834-7.

The time for serum testosterone to reach castrate level after bilateral orchiectomy or oral estrogen in the management of metastatic prostatic cancer.

Lin BJ, Chen KK, Chen MT, Chang LS.

Department of Surgery, Veterans General Hospital-Taipei, Taiwan, Republic of China.

OBJECTIVE. To understand the time for serum testosterone to reach castrate level after bilateral orchiectomy or oral estrogen in the management of metastatic prostatic cancer.

METHODS. A total of 20 consecutive patients with adenocarcinoma of the prostate with bony metastasis were enrolled in this study. Their mean age was 72.8 years old (range, 57 to 82 years). Pretreatment serum testosterone levels were obtained in all men. Thirteen men were treated with bilateral orchiectomy. Immediately after removal of testes, serial blood samplings for serum testosterone levels were drawn every fifteen minutes for the first two hours, then hourly for another sixteen hours. Seven men were treated with oral estrogen diethylstilbestrol (DES), 3 mg per day. Serum testosterone levels were checked on a weekly basis for two months, and then biweekly for another two months.

RESULTS. Castration time of bilateral orchiectomy ranges from three to twelve hours (mean, 8.6 hours). The biological half-life of serum testosterone was from thirty to sixty minutes (mean, 45 minutes). Castration time of oral estrogen (DES) was from twenty-one to sixty days (mean, 38.3 days).

CONCLUSIONS. Bilateral orchiectomy and oral estrogen were both effective ways of castration for patients with bony metastatic prostatic cancer. Bilateral orchiectomy provides a more rapid castration and is one hundred seven times faster than oral estrogen in reaching castrate level.

[Beau Geste (imported)]

Are the effects of diethylstilbesterol permanent? Also, if the cancer has already metastatized to the bones, isn't it too advanced for the testosterone reduction to have much effect?

[JesusA (imported)]

The following is a response from Richard Wassersug, a professor in the school of medicine at Dalhousie University and a prostate cancer eunuch. He and Talula have participated in the Pride Parade in Halifax as the “Eunuch Unit.” Richard has some publications on eunuchs in print that can be found either through a Google search or by searching here on the Archive for references to them.

Are the effects of diethylstilbesterol

(DES) permanent?

I am assuming we are talking about a genetic male taking this drug. The man's age and gonadal status at the outset will be issues. The younger he is and the shorter time he is on the drug, the more likely the side effects will be reversible.

Depending on the dose, one can expect some breast development (i.e., gynecomastia) and breast tenderness. If the person takes DES short term, and then stops, the tenderness may subside, but the breast development is not likely to disappear.

DES can cause hair loss on the body, but not the face or in the pubic area. The body hair will come back, if one is on DES only short term and still relatively young.

DES is a cheap oral estrogen. However it is a dangerous one in that it has a high rate of cardiovascular risks associated with it. If one has had a blood clot in their leg or a pulmonary embolism, he should be very careful about taking DES. Often MDs prescribe anticoagulants when they put patients on DES. As an aside, topical estrogens, like Estrogel, seem to have less cardiovascular risk.

Also, if the cancer has already metastatized to the bones, isn't it too advanced for the testosterone reduction to have much effect?

I am assuming we are talking about prostate cancer here. Prostate cancer can spread to the bones and still be very responsive to androgen deprivation. [Taking DES is one way to achieve androgen deprivation.] It is not necessarily too late to suppress testosterone, if one has bone mets. However since androgen deprivation does not kill all the cancer cells, eventually the cancer can mutate and then be androgen independent. At that point androgen suppression, will not stop the spread of the cancer.

If I had bone mets, I would surely want to try androgen suppression. I would prefer to achieve that with an estrogenic drug rather than an orchiectomy or castrating drugs, like LH-RH agonists. Those drugs are very expensive. They also weaken bone and cause hot flashes. Estrogenic compounds, however, help maintain bone strength and prevent hot flashes (just as they do in menopausal women.)

[I would add to Richard’s comments that the average increased life expectancy for advanced prostate cancer patients who are either surgically castrated or who go on androgen deprivation therapy (eg, LH-RH agonists) or on estrogen therapy to counter testosterone is currently about seven years and rising with improved treatment options.]