Influence of treatment with diethylstilbestrol for carcinoma of prostate on platelet aggregation and plasma lipoproteins

Use of PC-SPES, a commercially available supplement for prostate cancer, in a patient with hormone-naive disease

OBJECTIVES

PC-SPES, an over-the-counter supplement, is actually a combination of eight different herbs. It is being used by patients to treat cancer of the prostate at different stages of the disease and has been commercially available since November 1996. It has been observed to dramatically decrease prostate-specific antigen (PSA) values in several patients; however, its out-of-pocket cost ($162 to $486/mo) and potential side effects must be weighed against its potential objective benefits. We reviewed its use in 1 patient.

METHODS

A patient with clinically localized prostate cancer (T1c) with a PSA of 8.8 ng/mL, who decided to delay any conventional treatment, began treatment with 9 PC-SPES capsules/day.

RESULTS

After 3 weeks, his PSA dropped to 1.4 ng/mL and after a total of 8 weeks, his PSA was less than 0.1 ng/mL (undetectable). He has continued on a maintenance dose of 6 capsules per day, decreasing to 4 capsules per day, with a continuing undetectable PSA. During this time the patient also experienced a number of strong estrogenic effects: loss of libido, erectile dysfunction, extreme breast enlargement and tenderness, reduction in overall body hair, pitting edema, and a significant drop in his lipoprotein (a) level (from 46 to 11 mg/dL).

CONCLUSIONS

PC-SPES may provide additive advantages (or disadvantages) over prescribed hormonal treatments but must be compared with other hormonal and nonhormonal treatments in clinical trials with hormone-sensitive and -insensitive patients with prostate cancer to determine its future use or nonuse.

European trials and the management of prostate cancer

Efforts continue to improve the outlook for patients with all stages of prostate cancer. The addition of adjuvant or neo-adjuvant hormone therapy to radical prostatectomy may improve the curability of advanced localized disease. Various novel forms of maximal androgen blockade continue to be explored, including the reintroduction of safer forms of estrogen therapy. Chemotherapy remains largely experimental but its earlier introduction, when the patient's general condition remains good, may lead to improvement in the quantity and quality of life of patients with advanced disease.