The Effect of Parenteral Estrogen versus Orchiectomy on Blood Coagulation and Fibrinolysis in Prostatic Cancer Patients

Cardiovascular complications in patients with advanced prostatic cancer treated by means of orchiectomy or polyestradiol phosphate

“…Because of the first-pass metabolism, the effect on the liver is greater with oral estrogens than with parenteral PEP [23]. Both combination therapy [24] and PEP monotherapy [25,26] induce a significant decrease in the antithrombin III level, which can increase the risk of thromboembolic complications, especially in the presence of other procoagulant triggers [27,28]. In addition, combination therapy induces a significant increase in the factor VII (F VII) level, whereas PEP monotherapy does not [24Á/26].…”

Parenteral polyoestradiol phosphate vs orchidectomy in the treatment of advanced prostatic cancer. Efficacy and cardiovascular complications: a 2‐year follow‐up report of a national, prospective prostatic cancer study

“…Regarding the effect of oestrogens on the coagulation system in patients with prostate cancer, it was reported that oral oestrogen [ 25] induced a significant increase in factor VII level and a decrease in antithrombin III (AT III) level, whereas PEP 160 mg [ 26] or 320 mg [ 27] monthly was associated with a significant decrease in AT III, with no change in the factor VII level. The increase in factor VII during oral oestrogen therapy has been shown to correlate with the change in electrocardiographic ST depression in an exercise test, i.e.…”

Transdermal Estradiol Therapy for Prostate Cancer Reduces Thrombophilic Activation and Protects Against Thromboembolism

“…PEP reduces plasminogen and PAI-1 activities, as well as the numbers of patients with abnormal D-Dimer values. 12,13 Do these findings correlate with the clinical reality? In the SPCG-5 study comparing 915 men treated by PEP vs maximal androgen blockade (mAb) the incidence of thrombembolism was identical (1.98% PEP and mAb), the cardiovascular morbidity substantially reduced compared with that expected from the equivalent dose of oral estrogen (expected oral estrogen toxicity up to 35% vs 12.5% PEP vs 7.9% mAb) and the overall cardiovascular mortality equivalent (3.5% PEP vs 3.1% mAb).…”

“…Over three-quarters occur within the first 12 months of initiating therapy and it is independent of disease stage (ie a treatment related effect). [1][2][3][4][5][12][13][14] Oral estrogen therapy has been shown to cause progressive activation of many components of the coagulation cascade that increase the likelihood of thrombosis. These include factors VII, VIII, IX, X and fibrinogen.…”