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    with Prostate Cancer

    Men whose treatment for prostate cancer includes removing the testicles to deprive the body of androgen, a male hormone, are at risk for osteoporosis-the "bone wasting" disease. But another way of creating androgen deprivation is to treat the cancer with estrogen. This treatment, however, has become less popular because estrogen increases the risk for blood clots. Some researchers say it's time to reconsider this, and go back to using estrogen.

    The controversy started when a researcher from the University of California Davis reported in 1997 that men who'd had their testicles removed to treat prostate cancer were significantly more likely to develop osteoporosis than those who hadn't had this surgery. He looked at both osteoporotic bone fractures and at bone density and concluded that androgen deprivation caused osteoporosis in these men.

    These findings were supported by researchers from the Veterans Affairs Medical Center in Miami, Florida, who reported that among their prostate cancer patients, those treated by removing the testicles showed significant bone loss, while those treated with estrogen did not. Both sets of researchers suggested that physicians should reconsider using estrogen to treat prostate cancer.

    In 1998, another researcher from the Veterans Affairs Medical Center in Charleston, South Carolina, noted that osteoporosis had become epidemic and cited more research linking this bone disease with androgen deprivation in men.

    Last month, still another set of scientists called for more research on estrogen therapy for prostate cancer, again citing several studies showing that estrogen maintains bone mass in men. These researchers from New York-Presbyterian Hospital in New York pointed out that estrogen treatment had been shown to be effective and safe and did not cause more blood clots than other hormonal therapy.

    In the same issue, the original researcher from the 1997 report agreed that estrogen therapy should be reconsidered for treating prostate cancer and noted that, in his own research, none of the patients treated with estrogen showed any bone loss. He went on to recommend that men receiving this treatment take daily aspirin to prevent blood clots that might be caused by the estrogen.

    So what's the bottom line? Experts are rethinking the use of estrogen for treating prostate cancer in the hope that it will prevent the bone loss seen in men whose surgical treatment deprives them of androgens. Large clinical trials, however, have not been undertaken.


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