Submitted on July 1, 2005
Revised on November 10, 2005
Accepted on November 19, 2005
Effects of transdermal estrogen on levels of lipids, lipase activity, and inflammatory markers in men with prostate cancer
Jonathan Q. Purnell, Lisa B. Bland, Mark Garzotto, Dianne Lemmon, Emily M. Wersinger, Christopher W. Ryan, John D. Brunzell, and Tomasz M. Beer
Endocrine, Oregon Health & Science University, Portland, OR 97239
Corresponding Author: purnellj{at}ohsu.edu
Androgen deprivation therapy (ADT) for prostate cancer is now used in earlier disease stages and as adjuvant treatment. Recognizing and reducing toxicity of this therapy, including worsened lipid levels and cardiovascular disease (CVD) risks, has become an important clinical concern. Oral estrogen therapy induces hypogonadism and mitigates many side effects of ADT, but has a high thrombosis risk. Transdermal estrogen therapy (TDE) has a lower thrombosis risk than oral estrogen and may improve CVD risk compared to ADT. This prospective pilot study of 18 men with androgen-independent prostate cancer receiving ADT measured effects of TDE on lipid and inflammatory CVD risk factors before and after 8 weeks of TDE (estradiol 0.6 mg/day). During treatment, estradiol levels rose 17-fold; total cholesterol, LDL cholesterol, and apolipoprotein B levels decreased. HDL2 cholesterol increased with no changes in triglyceride or VLDL cholesterol levels. Dense LDL cholesterol decreased and LDL buoyancy increased in association with a decrease in hepatic lipase activity. Highly sensitive C-reactive protein levels and other inflammatory markers did not worsen. Compared to ADT, short-term TDE therapy of prostate cancer improves lipid levels without deterioration of CVD-associated inflammatory markers and may, on longer-term follow-up, improve CVD and mortality rates.
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