Alternate ADT drug shaking things up: Estrogen?

This has been discussed a lot in this forum. The Patch study done in England, looked into this and found out about the fact that it works just as well as ADT with fewer side effects. It does cause breast enlargement in about 50% of men. Radiation to the chest can stop that from happening.

If you go to ancan.org You can watch a couple of videos by Richard Wassersug PhD That discuss the positives of using estradiol. Do a quick search there and you can find those videos.

If you have BRCA2, then estrogen can be very detrimental, so it is not a usable alternative.

thanks for the reply. I thought the oncologist who brought this up at my appointment said estrogen could be useful if a cancer was neuroendocrine.

@climateguy The Patch Study did confirm this but because it’s not a big money maker, its efficacy has been buried.
Kudos to your oncologist for even considering it!

@heavyphil the docs involved with my case are suspicious about my PET scan result, and my biopsy pathology - they've put in an order for one of their in house pathologists to redo the biopsy pathology, but it hasn't been done yet. So even though they have prescribed EBRT and 2 years of ADT emphatically, they have more uncertainty than usual, which I think accounts for this one mentioning they were talking up estrogen in their general talking shop discussions recently, and it might be an alternate in my case if he gets a completely different idea about what to do with me as or if new info comes in.

@climateguy Got it…nothing inspires confidence like experts not knowing what to do; but at least it shows they are not taking a cookie cutter approach to treatment.
Others on the forum have had no uptake in the gland either and much higher PSA’s - some with mets as well.

@heavyphil Did you have a Decipher test? In your case, the number would be really low or really high; I say this because of the ambiguity in your test results.
Phil

@heavyphil Cookie cutter? My docs looked at my biopsy report that confirmed seminal vesicle invasion and whipped out their NCCN "high risk" cookie cutter and duly prescribed EBRT + 2 years ADT.

The RO's business card says he's Chief of the Brachytherapy program there but there was no discussion of BT boost until I told them I was aware of the data the BT proponents have, what they are saying, and how long they have been saying it. I'm sure he knows of, or more likely knows, all the main proponents, eg. Stock, Stone, Sylvester, Keyes, etc. It was after I told him I was impressed by Stone's presentation at the 2024 Prostate Cancer Symposium he booked a re-evaluation appointment to see me about my case, but I don't know if its BT boost that will be discussed or they've just discovered something and he wants to see me in person to make the announcement. I've sent documents away to several possible BT proponent centers asking for 2nd opinion appointments, in case after this re-evaluation I decide to check out of where I am.

@heavyphil One thing I've found so far, from "Transdermal Estrogen May Offer Another Option for ADT in Men With Metastatic Prostate Cancer "

"Estradiol patches could be particularly attractive to patients who are on an LHRHa and troubled by side effects like hot flashes, Dr. James said. But they also have appeal from a cost standpoint, he added, whether for health systems or, in places like the United States, for patients who lack insurance or are underinsured.

“This sort of repurposing of an older, cheap drug,” Dr. James said, “is an important way to improve outcomes, separate from developing new drugs.”

I'm on Medicare Part D. The records I am sent indicate the US government pays the insurance company $40,000 per year minus a copay I'm insured for, for me to get Orgovyx. Estradiol would cost a tiny fraction of that. But if incoming data proves it should be the standard of care for many or even just some patients, many other jurisdictions will adopt and promote it.

@climateguy Yes, the NCCN nomograms are the ultimate cookie cutter, but at least there’s some equivocation and questioning going on.
In the normal world your scenario about Estradiol would make sense - let’s use a much, much cheaper drug and more people will be able to afford it, right? And we can even use all that extra $$ we saved to actually treat more patients whose insurance might not be that
good…a total win/win! But unfortunately, it does not work that way.
Big Pharma gives millions and millions of dollars - especially to Institutes of excellence like Sloan Kettering to run pilot programs for their drugs, such as Orgovyx.
My own RO at Sloan was being sponsored by the maker of that very drug. So after all that, do you really think he is going to be allowed to dispense a much cheaper drug that the manufacturer of Orgovyx did not even have a hand in producing? And Big Pharma had already lobbied Medicare to actually pay for these expensive drugs…it’s a mystery how this is allowed to happen. Not complaining, as I was a beneficiary of Orgovyx, but I still had to fork over 2K before it was ‘free’.
It’s Money, Politics and Power in whatever order you prefer.
But Kudos to you for doing your homework and letting your docs know that you had intimate knowledge of Brachy + Boost and you are willing to go elsewhere to get treatment. It really makes a LOT of sense and obviates the need for years on ADT. Best,
Phil