Estrogen tablets : Been to oncologist... - Advanced Prostate...

Advanced Prostate Cancer

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Estrogen tablets

Wongle1
Wongle1

Been to oncologist today said they won't up hubby on next chemo as on docetaxel he got sepcis which doubles his chance to get it again can't have radium as has lympnode disease so they have just put him on estrogen tablets is this the start of the train coming to the last station please can someone explain we live in England so the amenities are a lot less than America I'm so scared for my hubby xx

23 Replies
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There is less chance of blood clots with the patch instead of the tablets. Consider tamoxifen (10 mg) too to prevent gynecomastia. Did he already try Zytiga?

Wongle1
Wongle1 in reply to Tall_Allen

Yes

Estrogen tablets? Not patches? What is the dose?

Estrogen can be used for androgen deprivation, as an alternative to Lupron, say, but an oral dose increases the risk of a clot.

A low dose can be used for bone health, where oral should not be a concern I would think.

-Patrick

Wongle1
Wongle1 in reply to pjoshea13

Will let you know tomorrow when we pick up the prescription x

Why and how would you get sepsis from docetaxel?

If it is from injection site, ask for a shunt to be installed in the injection vein?

Wongle1
Wongle1 in reply to cesanon

No it was when his white blood cells were down that's when he contracted sepsic

'Estrogen' as ADT

Knowing that the 68Ga PSMA scan and subsequent sacral LN surgery (August 2017) would be only 'palliative', I chose those options in my efforts to delay the common side effects and expense of conventional ADT.

Since Medicare does not cover any medical expenses outside of the US, I had to look into alternate, less costly forms of ADT when the time came for me to start on some kind of regimen. This along with my family PCa history was the impetus to prompt me to start reading every 'DES' (diethylstilbestrol, an oral synthetic estrogen) article I could possibly find. My grandfather, father and his two brothers were all diagnosed with PCa in their late 50s/early 60s, had RPs, took DES upon recurrence, seldom ever complained about side effects, and lived to very active, 'ripe old ages’ (with the exception of grandpa who died at 74). When I recently discussed my situation with my 'mature and well respected' urologist at Loyola in Chicago (who had prescribed it for his patients in the 80s prior to Lupron taking its place), he suggested DES (if I could even find it) in 2 mg doses along with 80 mg of aspirin. Since I was unable to locate it, I started looking into 'the patch' and transdermal E2. Richard Wassersug, PhD (Richard is an Adjunct Professor in the Department of Urological Science at the Univ. of British Columbia and Co-lead of the Vancouver Prostate Centre's new Prostate Cancer Supportive Care Program) is having great success with tE2 gel and has been mentoring me in my recent trek with with the gel. Just briefly (I have previously posted a more comprehensive account of my history), PCa has metastasized to my LN’s and excision surgery reduced my PSA from 1.2 to 0.71. After starting on the gel in April of 2018 my PSA is now down to 0.19. The ONLY side effect that I am experiencing is gynecomastia which IMO is a small price to pay for what I consider a significant reduction in PSA. I am increasing my dosage since my T level is still too high and my E2 level is low.

cesanon
cesanon in reply to ronronHU

Hmmm seems likely Des may be impossible to get in the USA?

ronronHU
ronronHU in reply to cesanon

'Compounding pharmacies' (if you can find one) should be able to concoct DES. To the best of my knowledge, veterinarians may be able to prescribe it since it supposedly reduces incontinence issues in spayed dogs.

Wongle1
Wongle1 in reply to ronronHU

Hi thank you all for your comments the name is diethylstilbestrol starting on 1mg daily could you tell me the name of that cream again as all I can see is E cream x

ronronHU
ronronHU in reply to Wongle1

Dear "Wongle",

The name of the gel is "Oestrogel" and it is produced in France. If you click on my 'smily face icon' you can read all of my previous posts and at the top you will find a photo of the gel which is included in my "Transdermal Estradiol update" post. If anyone wants to post a photo on this site you can do so by clicking on your icon and going to "What's on your mind?" at the top of the page.

You may have to increase the dosage to 2 mg to achieve results. 2 mg doesn't have nearly the CV/thrombolytic risks that 5 mg had and should have similar efficacy.

Wongle1
Wongle1 in reply to ronronHU

Can both be used at the same time cream and tablet

ronronHU
ronronHU in reply to Wongle1

I assume that they could be used concurrently; however, I wouldn't use more than 1 mg of either one from the start. I am using slightly over what I assume to be about 2mg of E2 from the gel and have been getting T and E2 levels monitored along with my PSA. In order to achieve best results T levels should be <50 (castrate level) and E2 should start approaching female pre-menopausal levels which is about 300 and above. My levels are way out of ideal parameters; however, I am already seeing encouraging PSA reductions...I will probably increase my dosage slightly after I get my latest T and E2 scores which should be this week.

The advantage of transdermal E2 is that it avoids the first pass hepatic metabolism effects associated with oral estrogens which are responsible for the CV issues.

cesanon
cesanon in reply to ronronHU

Hmmm is Oestrogel the same as Des?

ronronHU
ronronHU in reply to cesanon

DES is a synthetic, nonsteroidal estrogen (not just estradiol) taken orally, whereas Oestrogel is a transparent, transdermal gel consisting of only 17B estradiol (E2). However, they are both agonists of the estrogen receptors and work in similar ways to reduce gonadal hormone production.

The gel and 'the patch' are both transdermal (absorbed directly into the bloodstream through the skin) estradiols; however, I am using the gel since it is very easy to use...dries within a couple of minutes and causes NO skin irritation. So far, I am thrilled with the results! The ONLY side effect is the slight development of gynecomastia (man boobs); however, 'Tall_Allen' suggests taking tamoxifen to help reduce this SE.

Dan59
Dan59 in reply to Wongle1

Dieethylstilbestrol is DES, and 1 mg is a fairly low dose. It was used for many years as Ronron says at 5mg with anticoagulation, 2 mg was shown to have lessCV issues. I hope it works well for you, as it has for many in the past. I have heard Dr Sartor say, he has seeDES work when transdermal did not.

"When I recently discussed my situation with my 'mature and well respected' urologist at Loyola in Chicago (who had prescribed it for his patients in the 80s prior to Lupron taking its place), he suggested DES (if I could even find it) in 2 mg doses along with 80 mg of aspirin."

1. Do you know why they stopped using Des? There must have been a reason.

2. Why is Des so hard to find?

3. Seems like if Des works using a non ADT mechanism, it would make sense for many of us to use it with ADT.

4. May I ask the name of your Des prescibing Dr. at Loyola?

ronronHU
ronronHU in reply to cesanon

1.) 5 mg doses used to treat PCa increased cardiovascular/thrombolytlic risks by about 30%, and mothers/daughters exposed to DES had an increased risk of a rare clear cell carcinoma. Consequently, the pharmaceutical companies were sued and it was taken off of the market by the turn of the century. Recent studies have indicated that 2 mg doses are as effective as 5 mg without the same CV risks. One of the big advantages of estrogen over other forms of ADT is that the estradiol (E2), the most potent of the three major estrogens actually maintains bone density in both men and women.

2.) Refer to above:

3.) The brain reads elevated androgens and estrogens in the same way, and if they are substantially elevated, it reduces the signal to the gonads to make more gonadal hormones. It is a generalized feedback control system that acts the same way regardless of whether there are elevated levels of estrogen or testosterone.

A man’s brain interprets the presence of DES (diethylstilbestrol) as testosterone (since estrogens are aromatized from T). Elevated gonadal hormone levels send a signal to decrease gonadal hormone production.

DES, tE2 (transdermal estradiol), Lupron and Zoladex all can shut down the signal from the brain to the gonads to make more gonadal hormones. DES and tE2 work directly on the part of the brain called the hypothalamus and Lupron and Zoladex work on the feedback link between the hypothalamus and the pituitary gland. Either way they shut down the signal from the pituitary gland to the gonads to make gonadal hormones.

4.) Dr. Robert Flanigan (Contact info: Rexine - 708-216-5405

Dan59
Dan59 in reply to cesanon

DES cost $200 a year, and can be had at a compounding pharmacy, ronron has good info on DES, see studies by LM Glode et al

I too do not understand why some of the older therapies are not used any more.

cesanon
cesanon in reply to Dan59

"I too do not understand why some of the older therapies are not used any more."

Sometimes, it's new shiny objects, backed up with money, sometimes it's new better shiny objects.

It is a very imperfect market.

There are a couple of the things the doc put me on after chemo. Lupron or Eligard same thing. And as a replacement to chemo. A oral pill. Xtandi. Not sure if it’s available there and at what cost. Good luck. Fight the good Fight

I'm on a low dose myself, half of a 0.1 patch. The patch is better, but either way patch or pill, ask about a daily aspirin as a blood thinner to prevent clots. Patch will also help with osteoporosis and memory loss. Medicare copay is steep, but there are coupons on the internet to get the cost down without medicare, and a coupon for first box of patches for free. Avoid Clamara patch. It is too big and the size can give a skin rash. Smaller the patch the better to prevent rash. That is why I cut the .1 patch in half rather than buy the .05 patch. Cheaper that way too.

As another example, my husband has been on estrogen patches for 3+ years to keep his testosterone at bay (diagnosed in 2002; now metastatic). They have worked quite well for that purpose. For a while they also reduced and maintained a low PSA, but no longer do. Still, he much prefers the patches to Lupron and is using other methods, such as Enzalutamide, for the cancer.

As @abmicro says, it's very important to use patches instead of a pill to avoid blood clots. He's also right about estrogen protecting against osteoporosis and helping with cognitive issues.

As @ronronHO suggested, also check into Richard Wassersug's writings and check out the PATCH trials in the UK for additional information.

Finally, my husband first used the gel, but the patches have worked better to more consistently deliver a dosage that works. We have decent insurance through my job; a month's supply of the patches (4 at a time, changed every 4 days) costs us just under $8 (USD).

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