A multi-centre randomised phase III trial of Dexamethasone vs Dexamethasone and diethylstilbestrol in castration-resistant prostate cancer: immediate vs deferred Diethylstilbestrol

2011

Immediate vs Deferred Diethylstilbestrol in Prostate Cancer Treatment

Sample size: 270 publication 10 minutes Evidence: moderate

Author Information

Author(s): Jonathan Shamash, Tim Oliver, Shahid J. Sarker, Andrew Protheroe, Nitin Mithal, Richard Mills, Rachael Beard, Paul Wilson, Nick Tranter, Nigel O'Brien, Simon McFaul, Tom Oliver

Primary Institution: St Bartholomew's Hospital

Hypothesis

Does the immediate addition of Diethylstilbestrol improve outcomes compared to deferring its use in castration-resistant prostate cancer?

Conclusion

Deferring Diethylstilbestrol until failure of Dexamethasone is preferred due to similar efficacy and reduced toxicity.

Supporting Evidence

68% of patients in the immediate group achieved a PSA response compared to 64% in the deferred group.
The median time to progression was significantly longer in the immediate group (8.6 months) compared to the deferred group (4.5 months).
Patients with previous haemoglobin levels ≥11 g/dl had a significantly decreased risk of death.
22% of patients in the immediate group experienced veno-thromboembolic events compared to 11% in the deferred group.
Painful gynaecomastia occurred in 40% of the immediate group compared to only 1% in the deferred group.

Takeaway

This study looked at two ways to treat prostate cancer: giving a drug right away or waiting until the disease gets worse. It found that waiting is better because it causes fewer side effects.