Authors' objectives:

This review was undertaken to inform the design of a clinical trial using transdermal oestrogen patches in prostate cancer. The main objectives were:

1. To examine the clinical effectiveness and safety of parenteral oestrogen therapy in prostate cancer. 2. To examine the relationship between dose and efficacy and safety of parenteral oestrogen in prostate cancer. 3. To compare the safety profile of oestrogen given transdermally with other routes of administration, in males or male-to-female transsexuals with any condition.

Authors' recommendations: The studies included in this review do not provide sufficient evidence to allow a clear conclusion to be reached on the effectiveness and safety of parenteral oestrogen in prostate cancer.The great majority of evidence was concerned with i.m. PEP, but was largely of poor quality or was poorly reported. None of the trials in the review reported in any detail on longterm serious adverse events such as osteoporosis, and the largest and highest quality trials included in the review do not provide long-term survival data.No studies of cost-effectiveness were found. The available evidence suggests that parenteral oestrogen administered alone, in adequate dosage, may be an effective therapeutic option for men with prostate cancer. Cardiovascular, cancer-specific and overall mortality appeared similar to orchidectomy or LHRH, although an excess of cardiovascular morbidity was associated with the use of parenteral oestrogen. The nature and severity of this excess cardiovascular morbidity is not clear from the available evidence. In the light of these results, and of the limited quality and quantity of the evidence available, further well-designed trials should address both efficacy and safety, particularly cardiovascular effects, osteoporosis and cognitive function, hot flushes and quality of life, and provide long-term follow-up data. A full economic evaluation of the cost-effectiveness of parenteral oestrogen therapy should also be undertaken. The available evidence on parenteral oestrogen in combination with oral oestrogens suggests that cardiovascular mortality and morbidity may be considerably elevated by their use. It is therefore more difficult to justify further research into this combined therapy.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.york.ac.uk/inst/crd/CRD_Reports/crdreport33.pdf

Year Published: 2006

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England

Organisation Name: University of York

Contact Address: University of York, York, Y01 5DD, United Kingdom. Tel: +44 1904 321040, Fax: +44 1904 321041,

Contact Name: crd@york.ac.uk

Contact Email: crd@york.ac.uk

Copyright: Centre for Reviews and Dissemination