ADT vs. Estradiol

The patch trial completed in England many months ago. It showed that the estradiol patch worked just as well as ADT, but had many fewer side effects. One of the big proponents of the patch is Richard Wassersug, PhD. A research scientist, who received his PhD in evolutionary biology from the University of Chicago. He’s given a lot of talks about estradiol patches and has been using estradiol for a couple years at least. He wrote the book “androgen deprivation therapy”.

He went from using the patch to using estradiol gel, And there are also injections you can use.

Wassersug has done multiple videos about Estradiol Here’s a link to one of them.
https://www.youtube.com/watch?time_continue=3502&v=lxDUbUkv_9Y&embeds_referring_euri=https%3A%2F%2Fancan.org%2F&source_ve_path=Mjg2NjY

I participated in a Mayo prostate cancer support group webcast last month about proctectomy surgeries. At the end of the webcast someone asked a general question about using estrogen with or in lieu of ADT (sorry I can't remember exactly how the question was posed).

For what it's worth, the webcast presenter, a Mayo surgeon, replied along the lines of, "We no longer use estrogen in that manner." This caught my attention because I had read about estrogen being used in lieu of ADT a while ago.

There’s actually two possible uses for estrogen. One is to replace ADT the other as an adjunct to ADT.

Adding estrogen in a small dose increases the sex drive, which is almost eliminated by ADT. Usually, your body has some estrogen, but it’s normally hard to find if you’re on ADT. This exact issue was discussed in a recent prostate cancer bi monthly meeting where a GU oncologist answers questions for the first hour and discussed the use of some estrogen for that purpose.

Hmmm.

Did the surgeon go on to explain why?

Besides the PATCH trial, I recall, albeit with a 69 year old mind literature on studies and use here in the US.

I hold my medical team to the same standards I hold myself when it comes to discuss treatment options, what's your reasoning and supporting "literature (aka, research) supporting that.

From my foxhole, making a statement like you describe is reason in my mind to say, hmmm, would I go with this person as a member if my medical team? The answer, likely not.

A friend, during his consult at Sloan Kettering, asked about the estradiol patch. The RO snapped, “We don’t use that!” When asked why he got the same answer.
We all know that these institutions have protocols - a very well defined set of treatments which only use certain drugs, specific types of radiation or combos of them.
We are mere data points in a graph, outcomes to be fed into an algo. No one is getting the ‘individual treatment designed specifically for you!’ as all the ads and promos assert.
It is rare to find a doctor stepping out of the box and prescribing estrogen or estradiol, unfortunately.
My own RO, whom I really like and trust, told me that he is on an advisory panel (and probably gets compensation) to study the efficacy of Orgovyx. No way he is giving you the patch!☹️

No, unfortunately the surgeon did not elaborate on why he believed estradiol was no longer
used for this purpose. It puzzled me a bit and I didn't attempt to challenge him because I was waiting to ask my own question on another issue.

Violates several of my rules...

I inform myself as completely as possible and take the time I needed in making a treatment decision, I always know that no matter the outcome of a particular choice, I made the best possible decision. That knowledge that I have thought my decisions through carefully is what is really important—and may be more important than the decision itself.

I am in charge. Not my doctor. They need to be consulted, and their training, education, experience, opinions and ideas should carry weight as I make my decisions. But I never forget it is my life, my today, and my future. I have made the best possible, fully educated decisions that makes sense for me, with the focus on long life.

Rules for my medical team ...

Know your stuff. As part of my medical team, you must have a thorough knowledge of my cancer and of the latest developments in research and be ready to formulate a plan of attack. If what I ask about based on my research is not familiar with you, then admit it, say you will look into it and discuss on my next consult. Better yet, you will call me!

Do your homework. I expect you to have reviewed my medical records prior to my appointment, talked with other doctors I have seen that day.... You’ve looked at my x-rays; you have my pathology report, labs. I can tell when you're looking at my clinical data from tests for the first time !

Respect my point of view. Listen to all sides thoughtfully before reaching a conclusion. With patience and finesse, I’m sure you can help me to feel confident about the plan you and I have shaped for me.

Don’t close your mind to new hypotheses and don’t ignore clues that might lead you toward the best results. Rid yourself of the temptation to make your day easier by delivering perfunctory care.

6. Follow up on promises and follow through on tasks. I can tell you with absolute certainty that there is no greater disappointment than realizing that you cannot rely on your doctor.

7. Please talk to me. I need your advice, comfort, and expertise; I am scared and discouraged—are you willing to take a seat, look me in the face, and answer my questions?

And yes, the front desk is key, sets the tone, pleasant, efficient on check in and scheduling on the way out...a kind word, smile...and don't call me "honey." You have my records, I am ok with you calling me by my first name or Mr. ____

Here's one link, you can find others - https://pmc.ncbi.nlm.nih.gov/articles/PMC4052190/

As much as I like your attitude, Kevin, and agree with you on most points, I differ with respect to who is in charge.
If one cares to, one can doctor shop until they hear exactly what they want to hear. But in reality, if you want to be treated at a top institute like Sloan you have to follow their protocol, not yours.
Of course, you are free to leave and find another equally ranked cancer care hospital, but where we live that might involve a small airplane or a 4 hr car ride.
Estrogen/estradiol is just not that widespread in the US - don’t ask me why - but it’s effective and inexpensive - oh wait, maybe that’s why!!
Phil

Phil

Understand and no issue.

I did exactly what you say in late 2016, sought a 2nd opinion at the NCCN center here after SRT was a miserable failure. I saw their Director of Urology who was also head of a major North American medical association. Impressive resume, very!
I laid out my clinical history, discussed how if it continues,, it would be likely similar to those in the CHAARTED and STAMPEDE studies. I asked if thought I should do triplet therapy now.

His response, your PSA is increasing, that's the only clinical data you have, I would put you on ADT mono therapy only.

I left, drove the 8 hours to Mayo, Kwon recommended I do triplet therapy after the results of the C11 Choline scan. I was able to do it here.

Game changer.