@chippydoo
If you’re questioning about whether or not estradiol has fewer side effects, but is just as effective as ADT please go to ancan.org And search for estrodiol. That will bring up the videos from Richard Wassersug PhD Discussing his use of estradiol for a decades.
@chippydoo
If you’re questioning about whether or not estradiol has fewer side effects, but is just as effective as ADT please go to ancan.org And search for estrodiol. That will bring up the videos from Richard Wassersug PhD Discussing his use of estradiol for a decades.
@jeffmarc It seems one study state CV related effects were about the same as Lupron and the other states fewer events. Either way if I have to go back on I will probably try it. Equal to or less. Good information as always. Thanks
@chippydoo
If you’re questioning about whether or not estradiol has fewer side effects, but is just as effective as ADT please go to ancan.org And search for estrodiol. That will bring up the videos from Richard Wassersug PhD Discussing his use of estradiol for a decades.
@jeffmarc IN the PATCH trial, what happened with men who became castrate resistant while on the Estradiol? Were they continued on Estradiol or switched to Lupron or other ADT medications
@jeffmarc IN the PATCH trial, what happened with men who became castrate resistant while on the Estradiol? Were they continued on Estradiol or switched to Lupron or other ADT medications
@overage
I’m pretty sure they stayed on the estradiol patch.
If you go to ancan.org And search for estradiol, you can watch the two videos put up there about using estradiol patches.
I know a few people that are using estradiol full-time. The guy who does the videos for ancan.org Has been using it for over 10 years. I know other people in the same situation. Come to the reluctant brotherhood meeting tonight and you can meet one of the guys that uses it full-time.
Richard Wassersug Who does the videos uses the gel instead of the patch because he prefers it. I know another guy that uses injections of estradiol.
The PATCH (Prostate Adenocarcinoma Transcutaneous Hormone) trial is a large-scale clinical program evaluating the use of transdermal estradiol (tE2) patches as an alternative to standard hormone injections (LHRH agonists) for treating prostate cancer.
Core Findings
Effectiveness: Studies show the patches are as effective as standard injections at suppressing testosterone to "castrate" levels.
Bone Health: Unlike standard therapy, which can cause osteoporosis, the patches actually improve bone mineral density (+7.9% vs. -3.0% with injections).
Side Effects: Men using patches reported significantly fewer hot flushes (8% vs. 46%) and better overall quality of life. However, the patches cause higher rates of gynaecomastia (breast tissue swelling/tenderness).
Metabolic & Heart Health: Patches showed a lower impact on blood pressure and actually decreased cholesterol and glucose levels, whereas standard injections often cause them to rise. There was no significant difference in major cardiovascular events between the two groups.
Trial Details
Status: Recruitment is complete for both the M0 (non-metastatic) and M1 (metastatic) cohorts.
Location: Primarily conducted at dozens of sites across the United Kingdom.
Sponsorship: Sponsored by University College London (UCL) and funded by Cancer Research UK.
Me, I'm not so sure. My decision may depend in large part on what the clinical data says at the time. Most of my clinical data is "locked," GS, GG, the PSDAT and PSAV are generally the same, four months...So, what's different, well, the imaging results, that is the long pole in the tent or the center of gravity...
Some of my rules for my medical team that apply to a decision of this type:
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!
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.
Just saying, shared decision making, majority shareholder...
@jeffmarc IN the PATCH trial, what happened with men who became castrate resistant while on the Estradiol? Were they continued on Estradiol or switched to Lupron or other ADT medications
@overage
I missed answering one part of this question.
When someone becomes castrate resistant, they are given an ARPI. The patch or ADT they are on would be continued because not all of the cells are castrate resistant. Usually people go on Zytiga first, Unless they have heart issues in which case a lutamide Is much safer.
I became castrate resistant six years ago and my oncologist added Biclutamide to my drugs, it didn’t work well, keeping my PSA down so after 14 months, I was switched to Zytiga. It kept my PSA low, but not undetectable.
@overage
I missed answering one part of this question.
When someone becomes castrate resistant, they are given an ARPI. The patch or ADT they are on would be continued because not all of the cells are castrate resistant. Usually people go on Zytiga first, Unless they have heart issues in which case a lutamide Is much safer.
I became castrate resistant six years ago and my oncologist added Biclutamide to my drugs, it didn’t work well, keeping my PSA down so after 14 months, I was switched to Zytiga. It kept my PSA low, but not undetectable.
@jeffmarc I raised the question because of a notice in the book Androgen Deprivation Therapy, Third Edition, by Richard J. Wassersug et.al. On page 24 there is this note on the use of estradiol in the event of castration resistance.
"There is also a concern that, with castration-resistant prostate cancer
(CRPC), there can be a change in the hormone receptors on the cancer cells. In that situation, estrogens, which may help patients in managing ADT side
effects, could start to stimulate cancer cell growth. There is not much research on this, but as a cautionary note, it may be best to stop using trans-dermal estradiol
if there is indication that standard ADT can no longer control the cancer."
Perhaps you might inquire with those you know that are using Estradiol on what thy know about what is being done in the PATCH trial with the castration resistant patients.
I asked my oncologist once for estradiol as an add back but received an outright refusal. If I am faced with the possibility of lifetime ADT I would prefer estradiol, but I don't want to be using something that can fuel the cancer.
@jeffmarc I raised the question because of a notice in the book Androgen Deprivation Therapy, Third Edition, by Richard J. Wassersug et.al. On page 24 there is this note on the use of estradiol in the event of castration resistance.
"There is also a concern that, with castration-resistant prostate cancer
(CRPC), there can be a change in the hormone receptors on the cancer cells. In that situation, estrogens, which may help patients in managing ADT side
effects, could start to stimulate cancer cell growth. There is not much research on this, but as a cautionary note, it may be best to stop using trans-dermal estradiol
if there is indication that standard ADT can no longer control the cancer."
Perhaps you might inquire with those you know that are using Estradiol on what thy know about what is being done in the PATCH trial with the castration resistant patients.
I asked my oncologist once for estradiol as an add back but received an outright refusal. If I am faced with the possibility of lifetime ADT I would prefer estradiol, but I don't want to be using something that can fuel the cancer.
@overage
Richard Wassersug has showed up at some of the ancan.org meetings which I go to every week. I would definitely be interested in asking him about this if he showed up.
I may have some information on how to contact him. I will pursue your question if I can.
I know in my case because I have BRCA2 I cannot use estrogen so estradiol is out of the picture.
I was diagnosed with PC last fall with a gleason score of 8 with a significant tumor, and it had spread locally to adjacent lymph nodes. I decided against a full prostatectomy, since it had already spread outside my prostate, and had a TURP instead to help with urination then followed by ADT and radiation. I have been on lupron and Zytiga for a little more than three months, and I start radiation tomorrow. My PSA is now undetectable, and testosterone is similar. So the treatment is working well. However, I can't imagine taking these drugs for two years or more. I recently saw articles discussing estradiol patches for treating PC. The few studies have shown the patches to be just as effective with fewer nasty effects and a greater life quality than ADT.
However, when discussing this my urologist and oncologist there was minimal knowledge of the treatment method, neither were willing to prescribe estradiol patches, both showed minimal interest, nor direct me to clinical trials or other sources of information. I am not sure where to go from here, and I could really use some help.
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@chippydoo
If you’re questioning about whether or not estradiol has fewer side effects, but is just as effective as ADT please go to ancan.org And search for estrodiol. That will bring up the videos from Richard Wassersug PhD Discussing his use of estradiol for a decades.
@jeffmarc It seems one study state CV related effects were about the same as Lupron and the other states fewer events. Either way if I have to go back on I will probably try it. Equal to or less. Good information as always. Thanks
@jeffmarc IN the PATCH trial, what happened with men who became castrate resistant while on the Estradiol? Were they continued on Estradiol or switched to Lupron or other ADT medications
@overage
I’m pretty sure they stayed on the estradiol patch.
If you go to ancan.org And search for estradiol, you can watch the two videos put up there about using estradiol patches.
I know a few people that are using estradiol full-time. The guy who does the videos for ancan.org Has been using it for over 10 years. I know other people in the same situation. Come to the reluctant brotherhood meeting tonight and you can meet one of the guys that uses it full-time.
Richard Wassersug Who does the videos uses the gel instead of the patch because he prefers it. I know another guy that uses injections of estradiol.
The PATCH (Prostate Adenocarcinoma Transcutaneous Hormone) trial is a large-scale clinical program evaluating the use of transdermal estradiol (tE2) patches as an alternative to standard hormone injections (LHRH agonists) for treating prostate cancer.
Core Findings
Effectiveness: Studies show the patches are as effective as standard injections at suppressing testosterone to "castrate" levels.
Bone Health: Unlike standard therapy, which can cause osteoporosis, the patches actually improve bone mineral density (+7.9% vs. -3.0% with injections).
Side Effects: Men using patches reported significantly fewer hot flushes (8% vs. 46%) and better overall quality of life. However, the patches cause higher rates of gynaecomastia (breast tissue swelling/tenderness).
Metabolic & Heart Health: Patches showed a lower impact on blood pressure and actually decreased cholesterol and glucose levels, whereas standard injections often cause them to rise. There was no significant difference in major cardiovascular events between the two groups.
Trial Details
Status: Recruitment is complete for both the M0 (non-metastatic) and M1 (metastatic) cohorts.
Location: Primarily conducted at dozens of sites across the United Kingdom.
Sponsorship: Sponsored by University College London (UCL) and funded by Cancer Research UK.
Recent Results: 2024 and early 2025 updates confirmed that tE2 is a viable, non-inferior option for androgen deprivation therapy (ADT) and should be considered a standard-of-care option for M0 disease.
https://www.urotoday.com/conference-highlights/asco-gu-2025/asco-gu-2025-prostate-cancer/158247-asco-gu-2025-transdermal-oestradiol-patches-as-androgen-deprivation-therapy-efficacy-and-safety-of-combining-with-androgen-receptor-pathway-inhibitors-in-metastatic-m1-prostate-cancer-randomised-comparison-from-the-stampede-trial-platform.html
https://pmc.ncbi.nlm.nih.gov/articles/PMC7614681/
https://pubmed.ncbi.nlm.nih.gov/33581820/
While my oncologist seems dead set on 24 months ADT + ARI whenever the next time comes to go on treatment.
Me, I'm not so sure. My decision may depend in large part on what the clinical data says at the time. Most of my clinical data is "locked," GS, GG, the PSDAT and PSAV are generally the same, four months...So, what's different, well, the imaging results, that is the long pole in the tent or the center of gravity...
We'll have options.
MDT monotherapy
MDT + Systemic therapy - 6-24 months
ADT (Orgovyx)
ADT (Orgovyx) + ARI (Nubeqa)
PATCH
ADT +/- ARI + LU-177
There may be something else,,,,
Some of my rules for my medical team that apply to a decision of this type:
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!
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.
Just saying, shared decision making, majority shareholder...
Kevin
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I missed answering one part of this question.
When someone becomes castrate resistant, they are given an ARPI. The patch or ADT they are on would be continued because not all of the cells are castrate resistant. Usually people go on Zytiga first, Unless they have heart issues in which case a lutamide Is much safer.
I became castrate resistant six years ago and my oncologist added Biclutamide to my drugs, it didn’t work well, keeping my PSA down so after 14 months, I was switched to Zytiga. It kept my PSA low, but not undetectable.
@jeffmarc I raised the question because of a notice in the book Androgen Deprivation Therapy, Third Edition, by Richard J. Wassersug et.al. On page 24 there is this note on the use of estradiol in the event of castration resistance.
"There is also a concern that, with castration-resistant prostate cancer
(CRPC), there can be a change in the hormone receptors on the cancer cells. In that situation, estrogens, which may help patients in managing ADT side
effects, could start to stimulate cancer cell growth. There is not much research on this, but as a cautionary note, it may be best to stop using trans-dermal estradiol
if there is indication that standard ADT can no longer control the cancer."
Perhaps you might inquire with those you know that are using Estradiol on what thy know about what is being done in the PATCH trial with the castration resistant patients.
I asked my oncologist once for estradiol as an add back but received an outright refusal. If I am faced with the possibility of lifetime ADT I would prefer estradiol, but I don't want to be using something that can fuel the cancer.
@overage
Richard Wassersug has showed up at some of the ancan.org meetings which I go to every week. I would definitely be interested in asking him about this if he showed up.
I may have some information on how to contact him. I will pursue your question if I can.
I know in my case because I have BRCA2 I cannot use estrogen so estradiol is out of the picture.
@formscapeds, you might be interested in this related discussion:
- A note from Richard Wassersug PhD About the use of estradiol over ADT https://connect.mayoclinic.org/discussion/a-note-from-richard-wassersug-phd-about-the-use-of-estradiol-over-adt/
See all: https://connect.mayoclinic.org/group/prostate-cancer/
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