Time To Move To More Powerful ADT

[Joeym1040]

Just a quick question, I am seeing my MO next week, not sure what his recommendation will be. Just want to make sure i have the right questions.

I have been on Intermittent therapy since 2011. On a year, usually off 14 months. Alway on Lupron + Casodex except for the year i was on estrogel in the trial. Everything worked fine. Usually went back on treatment when PSA to 8-10. Last time it was 19 before i started treatment again. My psa immediately fell to 4.3 after first injection but has Is not dropped below 4.2 since. Is it time to move onto stronger stuff? Would estrogel be worth a shot?

Any ideas.

Joe

[6357axbz]

Are you metastatic?

[Joeym1040 in reply to 6357axbz]

No. Last scan in Jan all clear.

[Tall_Allen in reply to Joeym1040]

Once you are metastatic, you are always considered to be metastatic.

[GP24]

I think your MO will recommend adding Abiraterone/Zytiga. You may ask, if you can try estrogel before that and see if that works for you for a while.

Did you have radiation to the prostate? Did the bone scan show mets? What is your Gleason score?

[Joeym1040 in reply to GP24]

Sorry so short. Had IMRT to pelvic area, followed by seeds in feb 2000.

Last scin Jan was clear.

[Tall_Allen]

How many metastases and where are they? Have mets increased lately? How did estrogel work when you took it before?

[Joeym1040 in reply to Tall_Allen]

Estrogel worked great. I was in a clinical trial.

Last scan in Jan was clear

[Joeym1040 in reply to Joeym1040]

Estrogel trial ended in Dec 2017 and i was off treatment until June 2019

[Tall_Allen in reply to Joeym1040]

So your only visible metastases were in the pelvic lymph nodes? Were any larger than 2 cm?

If you liked estrogel, a compounding pharmacy can make it up, and it will be a lot cheaper than Lupron. I'm not sure if your insurance will approve Zytiga or Xtandi if you are not taking Lupron.

[Joeym1040 in reply to Tall_Allen]

My last scan was Axuminn. I have n ever had any mets.

[Tall_Allen in reply to Joeym1040]

Why haven't you had curative therapy?

[Joeym1040 in reply to Tall_Allen]

Only thing i have had after IMRT and sees has been Lupron + Casodex, on and off, except for the year i was on estrogel. All bone scan and pet/ct scans have been negative.

[Joeym1040 in reply to Tall_Allen]

Had initial treatment in Fev 2000, and started IADT in 2011.

[Hidden]

Based on what I've read, it might be worth a try. Here's an article I found on the subject:

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

The conclusion: In heavily pre-treated patients with advanced castrate and chemotherapy refractory metastatic prostate cancer, transdermal estradiol was safe and had biochemical activity. These data support further studies to understand if transdermal estradiol can be useful following multiple standard therapies.

[Joeym1040 in reply to Hidden]

Thanks...Encouraging