Plasma lipoproteins during anti-androgen treatment by estrogens or orchidectomy in men with prostatic carcinoma.

The incidence of cardiovascular disease is lower in women than in men, but is raised in men with prostatic cancer treated with estrogens. Changes of the plasma lipoproteins are related to the development of ischaemic cardiovascular disease and can be brought about by hormonal treatment. We have therefore studied plasma lipoproteins during estrogen treatment and after orchidectomy. 16 patients with prostatic carcinoma were treated with ethinyl estradiol daily by mouth and polyestradiol phosphate intramuscularly once a month. 15 other patients were treated by bilateral orchidectomy. Cholesterol (C), triglyceride (TG), and phospholipid (PL) concentrations in plasma and in the very low density (VLDL), low density (LDL) and high density lipoprotein (HDL) fractions were determined before starting treatment and 2 weeks and 8 weeks later. In the estrogen treated group the mean plasma C concentration decreased by 14 and 10%, while the mean HLD-C increased by 23 and 53%, and the mean LDL-C decreased by 24 and 25% at 2 and 8 weeks respectively. The mean PL concentration in HDL increased by 36 and 79% while that in LDL decreased by 12 and 18%. The mean plasma TG concentration was increased by 36 and 46%, mainly reflecting a rise of TG in the HDL-LDL fraction. Orchidectomy created only slight changes of plasma lipids. After 8 weeks the mean C concentration in plasma was raised by 10% and the mean PL concentration by 11%, owing to a 13% rise in the mean HDL-PL level. The changes in plasma lipoprotein pattern created by high doses of estrogens are mainly thought to protect against the development of atherosclerosis. The slight changes that take place after orchidectomy can hardly affect the incidence of cardiovascular disease.