Role of estrogens in the secondary hormonal manipulation of hormone refractory prostate cancer

To evaluate the role of Estrogens [Honvan] in the secondary hormonal manipulation of patients with hormone refractory prostate cancer [HRCP]. Twelve patients diagnosed as hormone refractory prostate cancer received intravenous estrogens for six days [Fosfestrol, a synthetic phosphorylated estrogen derivative], followed by a maintenance oral dose of 120 mg thrice daily as second line hormonal treatment. During the treatment they were given deep venous thrombosis prophylaxis. Their stage at initial presentation, primary treatment, mode of androgen ablation, prostate specific antigen [PSA] level, duration of remission prior of HRPC status, PSA doubling time before and after estrogen treatment were recorded. The morbidity and mortality of the treatment was also recorded. A drop in PSA of > 50% was classified as major responder. The drop of < 50% was defined as minor responders. Treatment failure was defined as a rise in PSA > the level prior to the start of treatment. The mean age at diagnosis of prostate cancer was 66.6 + 5.4 years [range 57-73]. At the time of initial diagnosis only 3 patients [25%] had localized disease and 9 [75%] had metastatic prostate cancer. Six patients each opted for surgical or medical castration [LHRH analogs] as the mode of androgen ablation. The mean initial PSA at diagnosis was 340 + 728.1 ng/ml [range 4.1-2375, Median 94]. After development of HRPC, six patients [50%] had major response, four [33%] had minor response to estrogen administration. Two patients [17%] did not respond to estrogens. The mean PSA before receiving Fosfestrol was 60.5 + 82 ng/ml [range 0.013-246]. The PSA [nadir] after treatment was 24.3 + 33.2 ng/ml [range 0.9-81.3]. One patient developed gynaecomastia and one had congestive cardiac failure. Two patients died of non cancer related deaths and one patient died of cancer related death. Synthetic estrogens are well tolerated, in-expensive agents and could be considered for palliative use against hormone resistant prostate cancer

Optimization of low pre-operative hemoglobin reduces transfusion requirement in patients undergoing transurethral resection of prostate

To identify factors that influence peri-operative hemorrhage in view of reducing the need for transfusions in patients undergoing trans uretheral resection of prostate [TURP]. All patients undergoing TURP between January 1997 and December 1999 were identified using ICD 9CM coding and indexing system. Overall 430 patients were identified, however, 384 charts were included and reviewed for demographics, pre and intra-operative data and post-operative morbidity. Patients were divided into two groups on the basis of presence of significant hemorrhage. Overall 384 patients were analyzed. Nineteen patients had hemorrhage - group I whereas 365had no significant hemorrhage - group II. Mean age and co-morbidities in the two groups were similar. However, in group I, 58% presented with urinary retention compared to 33% in group II. In group I, factors that reached statistical significance include; operative time [p<0.05], mean resected tissue weight [p<0.02], and patient presentation [urinary retention] [p<0.032]. There was no significant difference in the two groups with respect to type of anesthesia [regional versus general] and histology of the resected tissue. Patients with mean pre-operative hemoglobin of 10.6% had a 37% transfusion rate. Operative time, weight of resected prostate tissue are inter related and are only partly controllable. Low pre-operative hemoglobin is the only reversible factor in reducing transfusion following TURP