NCCN adds transdermal estradiol to its prostate cancer ADT guidelines

Thanks for the update 👍🥰.
My husband is considering switching to estradiol after 6 mos even though he has almost zero side effects on Orgovyx and Nubeqa. He will be on ADT of some kind for 18 mos (per MO suggestion) so estradiol might be a better option for bone health.

Does anyone who has researched this know if this is a daily patch? Also, how does it compare to Orgovyx price wise? I too will be on ADT for another 14 months, and while Orgovyx side effects have been moderate, muscle and bone health are a major concern along with my WBCs and neutraphils crashing shortly after starting Orgovyx.

Transdermal estradiol (tE2) as studied in the NEJM article was patches changed twice a week. Most men prefer gels. I think gels are applied twice a week as well. The NCCN didn't restrict their statement about tE2 to only patches. My doctor at Fred Hutch initially told me he would only prescribe patches. But that was before NCCN changed their guideline.

Bone health improves when tE2 is used for ADT. Paul Schellhammer, I think he is 85 and on tE2 for more than 15 years, says his latest scan showed his bones as good as if he were 40 or something.

The Estradiol Initiative was circulating the attached graph showing the cost comparison.

@carlsbadguy Cost will be cheap compared to other ADTs since the patches are generic and there are several brands on the market. Primary side effect is increased breast size and this occurs at 2-3 times the rate of other ADTs. Other side effect such as hot flash, night sweats, etc. are rare. Patches last a few days. Go to the initiative to find out more about dosing, etc.

@climateguy thank you, quite a difference in cost, although I maxed out my $2100 Part D out of pocket with my third bottle of Orgovyx. My MO has me on Prolia, as my Dexa came back showing osteopenia, with a drop in density from a Dexa done 3 years ago.

@jim18 thank you as well. I've already developed a strong A cup in the 4 months I've been on Orgovyx, but if estradiol is as effective as Orgovyx I can deal with that if I don't have to deal with everything else. I see my MO in a couple of weeks, it will be an interesting conversation.

@carlsbadguy With estradiol you will be able to stop the Prolia at some point since estradiol keeps your bones strong (males convert testosterone to estradiol in fat tissue so ADT breaks this leading to bone loss). Will still need resistance exercises since testosterone is directly involved in maintaining muscle mass.

The PATCH regimen is four patches (0.1mg) applied twice a week (8 patches per week).
I've been on them now for two months. Only side effect is some mastalgia in both nipples, particularly when bumped. No gynecomastia so far but I had two prophylactic doses of RT to reduce the likelihood. Nothing has changed in the libido department but there may be some shrinkage. 77 y.o. with active sex life - usually use Sildenafil and on occasion Tri-mix.
On a road trip and won't get estradiol and T tested till late next week. I'll report results when I have them.

Different brands of tE2 patches of the same reported concentration (0.1 mg/day), are noted for delivering differential or variable amounts of estradiol over time. So utilizing the same repeated brand would seem to make sense wherever possible, and regardless of brand, the availability of tE2 patches, can be (excuse the pun), rather "patchy", regardless of where you might reside.

Moreover, like most folks on other forms of ADT, those fortunate enough to get their oncologist or attending physician to prescribe tE2, are likely to be on estradiol for an extended period of time. So once the patient has confirmed the efficacy of 'patches' to successfully depress PSA and reduce total-T to castrate levels as desired, the feasibility of a cream- or gel-based product, becomes rather attractive for multiple reasons . . .

1) Reduced cost
2) Ease of Application
3) Dosage consistency
4) Reduced prescription frequency

However, when considering the transition from patches to a topical cream or gel, determining the optimum concentration for that compounded (specialty) product, becomes somewhat problematic, because by all accounts, there is an indeterminate absorption discrepancy between patches and gels (or creams), but unfortunately, clarification on this factorial discrepancy from seemingly qualified others (including physicians, compounding pharmacists, patients currently utilizing tE2 topicals, even officials at the Estradiol-Initiative), becomes rather elusive.

@toomany I wonder about these issues as well. What I'm going to do, if the current shortage gets to the point where I'm switching to compounded gels or different patches is to get my T tested more often. The main thing is to only use enough tE2 in whatever form to keep T low.

@climateguy Yessir, I totally understand. My central point was, that when (or if) anyone does wish to switch from patches to a gel, given the much higher dosages typically utlized for male PCa, they're going to have to order a specific concentration from a compounding pharmacist. And unless one gets guidance from someone who is using (or has used) such a topical gel, that pharmacist is unlikely to be cooperative or of any meaningful help, since the use of tE2 for prostate cancer is so new.

To be clear, those men with direct experience ordering and using topicals gels, are likely to be somewhat reluctant to provide such guidance to others, since they are not licensed medical doctors, which is completely understandable.