Quick Answer
Estramustine — Estramustine Phosphate 140 mg (WHO-GMP certified manufacturer). Combined estrogen-nitrogen-mustard alkylating agent — historically used for hormone-refractory prostate cancer. Largely superseded by abiraterone and enzalutamide; remains in palliative settings.
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⚠️ Specialist-supervised cancer therapy — this medication is started, monitored, and stopped by an oncologist or haematologist. Dosing depends on tumour type, stage, body surface area, organ function, and concomitant therapy. Self-treatment is not appropriate; the information below is educational and supports informed conversations with your specialist.
Estramustine has a strong oestrogen component — increased risk of DVT, PE, MI, gynaecomastia, fluid retention. Avoid in active CV disease, recent thrombosis, or severe heart failure. Monitor for thromboembolic symptoms.
Frequently Asked Questions
When is this used?
Combined estrogen-nitrogen-mustard alkylating agent — historically used for hormone-refractory prostate cancer. Largely superseded by abiraterone and enzalutamide; remains in palliative settings.
Side effects to watch?
Hot flushes, gynaecomastia, fatigue, sexual dysfunction (anti-androgen class effect). Drug-specific monitoring as outlined in the safety boxes above.
Drug interactions?
Vary by molecule — abiraterone is CYP3A4 substrate; bicalutamide is CYP3A4 substrate. Always disclose all medications. Strong CYP3A4 inhibitors/inducers significantly affect levels.
When should it be stopped?
On disease progression, intolerable toxicity, or successful response with planned treatment break. Always specialist-decided — abrupt cessation can result in transient PSA rise (withdrawal response) which is generally not concerning.
PSA monitoring?
PSA every 1-3 months while on therapy. Rising PSA on castration suggests castration-resistance — may need switch to second-line agents (abiraterone, enzalutamide, docetaxel).
Combined androgen blockade?
LHRH agonist (goserelin, leuprolide) + bicalutamide is a common combination. Maximal androgen blockade has modest survival benefit over LHRH alone.
Bone health?
Long-term androgen deprivation accelerates bone loss. Add a bisphosphonate (zoledronic acid) or denosumab in osteopenia/osteoporosis. Calcium and vitamin D supplementation.
Pregnancy?
Anti-androgens are teratogenic — partners must use effective contraception during therapy. Most relevant for younger men with localised disease.
What if I miss a dose?
Take when you remember if same day; otherwise skip. Specialist may have specific guidance for missed doses depending on regimen.
Cardiovascular monitoring?
Mandatory for fosfestrol; advised for abiraterone (BP, fluid retention, electrolytes); routine for bicalutamide (occasional CV review).
Other Cancer & Anti-Androgen Therapy
- Calutide — bicalutamide 50 mg — alternative anti-androgen brand
- Xbira — abiraterone 250 mg — CYP17 inhibitor for mCRPC
- Honvan — fosfestrol 120 mg — diethylstilbestrol diphosphate
- Estramustine — estramustine phosphate — alkylator for hormone-refractory disease
- Zoldria — zoledronic acid IV for bone metastases

























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