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The use of aspirin with PC‐SPES may not prevent pulmonary embolism

hormone-dependent disease taking PC-SPES. Small et al. [2] later reported a significant response in 54% of patients with androgenindependent disease, documenting thromboembolic events as significant side-effects. They reported three of 70 patients (4.3%) with pulmonary embolism when taking nine capsules of PC-SPES daily [2]. Two occurred in androgen-sensitive patients after 7 months of treatment, and one presented at 2 weeks in an androgen-independent patient, associated with a deep vein thrombosis. These patients were not on anticoagulative prophylaxis and all other hormone therapies had been stopped 30 days before the trial. The present patient with androgenindependent disease was taking a lower dose of PC-SPES in conjunction with low-dose aspirin. Stilboestrol therapy had been administered at a dose not considered to be associated with increased risk of thromboembolism, which was discontinued 19 days beforehand. He had no other risk factors for pulmonary embolism. To date, there are no data on the potential benefit of aspirin or other forms of anticoagulation in preventing thrombo-embolic side-effects of PC-SPES. This case shows that a low dose of aspirin failed to prevent a pulmonary embolism, but a higher dose of aspirin (e.g. 300 mg) or even warfarin could be considered. As PC-SPES becomes a popular treatment for androgenindependent prostate cancer, it is important to consider therapeutic measures to reduce the risk of such life-threatening adverse events.