Update on starting Estradiol Patches for RT ADT

[MateoBeach]

I started Estradiol Patches (4 X 0.1mg/24hr twice weekly patches; one patch changed out daily) 5 days ago. This is for short-term ADT as adjuvant for IMRT of oligometastatic disease of the left pelvic lymphatics identified on Ga-PSMA scan at UCLA. One week in and 10 days more until the RT (60Gy/30fx) begins. I feel very good on this so far. On day 4 with the patches I noticed onset of breast swelling and tenderness. Started Tamoxifen 10 mg daily. Within 2 days all breast symptoms disappeared.

Next week I will have estrogen/estradiol and testosterone levels measured to see where that is. Does anyone have information on what should be the target zone for estrogen or estradiol levels when using E2 Patches for ADT?

[GP24]

After reading this I have doubts if you need ADT with salvage radiation:

healio.com/hematology-oncol...

If you want to have ADT, I would simply use Casodex instead.

[MateoBeach in reply to GP24]

Thank you GP24. This is not early salvage RT after recurrence. I did have prostate be RT in 2007 because of positive RP margins. No long term ADT until further progression. I did use Casodex but it stopped working after 5 years. And I hate lupron (etc), hence the Estradiol patch choice. I don't plan long term use, but short term ADT has enhanced stereotactic RT for oligometastatic nodal disease. My PSA is low now (0.25) but has been as high as 5.5. So I am in an unclear situation on that. I am compromising by just using the E2 for ADT during the RT then plan to stop it. (Not long term.) Thanks for your input. This article is helpful.

[GP24 in reply to MateoBeach]

If I recall correctly, these patches will lower the testosterone in a different way than Lupron. So you just have to check the testosterone to see if it is effective.

[Lawrencee in reply to MateoBeach]

Is their a specific manufacturer of the patch you will use?

[MateoBeach in reply to Lawrencee]

My local pharmacy only had the Grove Pharmaceuticals generic Estradiol Transdermal System (twice weekly 0.10 mg/24 hrs). Due to quantity limits (2 patches/week) I ordered 8 more boxes from a Canadian pharmacy, they are sending a Sandoz generic. The cash pay cost is less than my Medicare co-pay, about $24 US per 8 patch box.

[Lawrencee in reply to MateoBeach]

Thanks. Is a prescription required?

[MateoBeach in reply to Lawrencee]

Yes. I am a prescribing physician though retired. Your physician could fax or email one if they are on board with your plan. This is a legitimate community Canadian pharmacy I have used for several years in Scotch Creek B.C. (Peoples' Drug. Pharmachoice). Phone ‭[phone] and Fax ‭[phone]‬. Need to call and set up your medical profile and billing with them. Very reliable.

[Lawrencee in reply to MateoBeach]

Thanks for your help. Happy Retirement

[Hidden in reply to MateoBeach]

So inexpensive . Very interesting . Good luck .

[pjoshea13]

As you will see from this 2008 PATCH paper, the estradiol [E2] response can be quite variable. In this case:

"442 (52.1–1542) pmol/L" ... 120 pg/mL

ncbi.nlm.nih.gov/pmc/articl...

"After 12 weeks, testosterone levels (nmol/L) in eight of the 13 patients were <1.7 {<49 ng/dL}, two were 1.7–2 and three were >2 {>57.6 ng/dL}."

Note that the true target is dihydrotestosterone [DHT], although most docs use T.

Best, -Patrick

[MateoBeach in reply to pjoshea13]

Thank you. This is exactly the information I needed. Interesting discussion also present suggesting possible additional therapeutic mechanism for DES vs. Patches for use in CRPC from LHRHA. Though I would not touch that cardiovascular risk!

And since you pointed out the importance of DHT it makes me wonder if adding a 5-alpha reductase inhibitor ( dutasteride or finasteride) should be considered for those using this for long-term androgen suppression.

[pjoshea13 in reply to MateoBeach]

With regard to DHT, Dr. Myers found that a small percentage of his patients produced DHT by a pathway that did not involve testosterone [T] - so he always checked DHT as well as T.

But, additionally, one of the ways PCa may become resistant to ADT, is by "discovering" that pathway. So, a number of men here use Avodart to close that escape route.

I am currently using a version of BAT (bipolar androgen therapy). I inject T cypionate on the 1st day of alternate months. On day 8 of that month, I begin using 1 mg DES daily.

DES has almost been forgotten. It was once prescribed at doses of 5 mg & up. At the 1 mg dose, it can be quite effective without the coagulation risk. However, I take no chances. I periodically do a D-dimer test. I take nattokinase daily & I would increase the dose if D-dimer were to rise above the minimum reading.

An attraction of DES is that it has a direct anti-PCa property. Some men who fail ADT respond to DES.

I found it difficult to find a compounding pharmacy that could fill my prescription. In fact, the pharmacy that ultimately did so had very little left. I didn't ask how old it was, but I knew that suppliers had been unable to get hold of the powder for some time.

Best, -Patrick

[MateoBeach in reply to pjoshea13]

Thank you. Very useful information.

[Break60]

Early this year I started using 4 .1 mg patches changed twice weekly to stop side effects of standard ADT . After my first blood test my T was down to 7 )( where it was when I was on trelstar or Lupron) so I dropped one patch and now use three changed twice weekly. I’m only concerned that T stays in castrate range ( below 20) and PSA stays low. I also monitor E2 , CBC and AK. I use Sandoz patches but I don’t see why it matters what brand you use.