I would like to try it estrogen patches for a period of 3 months and see how my psa does. I have a few questions please on this subject :
1) is it safe?
2) does it give a false reading in terms of slowing the psa but the cancer itself is growing?
3) why Medical Oncologists DONT like to prescribe it?
4) I have about 3 months to investigate imaging scans before I make a decision to start adt now or not, so my thinking is why not try the patches and see, is that a reasonable approach especially when my DT is good. ?
Thanks a lot for the help
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Just sticking my toe into this too!!! Looking forward to the feedback!!
Jc
As far as I know, it's one of the safest treatments available. No hot flashes or bone density loss either. It's more likely to cause breast enlargement than other treatments. My doctor is one who won't prescribe it. He's afraid to administer hormones of any kind with the concern that the cancer could end up using them. I don't know if that has been seen in trials.
I just read on article on it and posted a link in another post. The article was referencing a study that showed a biological effect after castrate resistance.
Here is my reply to other post:
Based on what I've read, it might be worth a try. Here's an article I found on the subject:
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.
(1) Patches are safer than pills, which can cause blood clots. That's why they stopped using estrogen as a PC treatment back in the day. Monitoring liver enzymes and clots is prudent. I think it should be taken with tamoxifen to prevent gynecomastia, but Richard Wassersug is wary of tamoxifen with estrogen for PC.
(2) It's not a false reading - it slows progression by inhibiting free testosterone production. It also affects the cancer by way of the estrogen receptor.
(3) See #1. I think a lot more MOs will prescribe it after the UK trials are completed in a few years. There was a selective estrogen receptor α agonist called capesaris that did well in Phase 2 trials. The specificity for the α receptor was thought to reduce the probability of blood clots. It was better than Lupron in suppressing free testosterone and PSA, and it showed much lower incidence of hot flashes, bone mineral density reduction, but it did have slightly higher rates of clots than Lupron . Unfortunately, GTX chose not to pursue it further.
(4) It will affect imaging in exactly the same way as any other kind of ADT.
TA, I have one question please: does it make castration resistance set in earlier in the case of starting the usual ADT drugs when the patches are no longer effective?
I would like to try the patches but concern that when time comes to use Lubron, etc. it will make it fail quickly, just concern and curious about this.
I don't see why it would make any difference on when castration resistance sets in. One would use it instead of Lupron, not before Lupron as you seem to imagine. The UK trials are comparing them. In fact, in men in whom Lupron alone doesn't get testosterone down low enough, estrogen may take it lower. Castration resistance means progression continues in spite of adequate suppression of testosterone.
You are correct again,TA. I misunderstood the use of it. Dr. Wassersug just explained to me the use of it. I was trying to push away the use of Adt but since IT IS another form of adt with less side effects, I don’t think I am ready yet. I am trying to go the other route for now, find the oligometastatic Mets and treat with radiation. I hope I am in the right track.
But if I understood you correctly, you posted a study Recently that showed that SBRT have some beneifits for treating oligometastatic disease. Did I misunderstood that?
The "benefit" observed was in T-cell activation, which may have some progression benefit down the line. The study only lasted 6 months, so it is impossible to conclude anything about long-term progression. Because radiation to observable mets "treats" PSA (ie, most of one's PSA comes from the larger, observable mets), it is inappropriate to conclude that just because PSA declined, the cancer was treated as well. Thus, delaying ADT on the basis of treating PSA may be counterproductive.
TA is correct. I've done SBRT to mets and gone back on IADT three times and every time I stopped ADT (went on vacation) PSA came roaring back. But subsequent scans found no recurrence in any areas zapped, but found brand new mets! So yes radiation works but only for the specific mets zapped! Cancer is all over your body in microscopic amounts if your high risk gl 9 like me. But at least my mets have been very few each time i.e. "oligomets"!
That's exactly why I concluded that I needed to be on continuous ADT, but hating Lupron and its kin I decided to use estradiol instead. Why brutalize your body if there's a kinder, gentler remedy even though not yet FDA approved? I'm sure big pharma fears approval which will decimate its lhrh agonist and antagonist sales. Many doctors are not up to speed on estradiol or won't approve because its not FDA approved or won't ok it outside of a clinical trial in the USA. But Medicare approves it!! You need to educate your doctor!!
Thank you break60 for your response. I am on the side line and trying to figure out what to do next for my rising psa, I am 65 years old now and obviously trying to slow my cancer down. My psa is .74 with a doubling time 27 months. So, the question is when should I start adt. I know it’s gonna be in my future but the question is when. Dr. Zelefesky at MSK told me he won’t start adt now. So very very frustrated because I can’t make a decision. I know there are cancer outthere but DO NOT know what to do at this time. Thanks again
I sense you are frustrated by doing nothing. If you want to zap the existing mets, and it is safe to do so, there is no reason not to. I'm only saying that it may be unwise to zap them instead of using ADT when it is needed. I am also saying that after you have zapped them, you will not be able to use PSA (or PSADT) as your signal of when to start ADT - you will have to monitor progression with scans instead.
Anyone considering using tamoxifen should be made aware that it can cause cognitive side effects by damaging cells that produce the myelin sheath that insulates nerves. Dr. Mark Noble at the University of Rochester has done work in this area.
One must be careful in generalizing from data on women with breast cancer who have also had BCa-specific chemo (and sometimes, "chemo brain") and never take it with estrogen, and men who take tamoxifen with estrogen or drugs like Casodex that increase serum estrogen. . When post-menopausal women (non-BCa-treated) women were given raloxifene , a similar drug, for osteoporosis there was no effect on cognitive function.
Are we on the same page? I'm not talking about bisphosphonates, which are taken to build/preserve bone, but about tamoxifen, which is used to suppress estrogen (SERM).
Yes- raloxifene is an alternative to tamoxifen - they are both SERMs. Like taxoxifen, it has been used against gynecomastia. Raloxifene has additionally been used to prevent loss of bone mineral density without taking bisphosphonates, which is why it was used in the above trial on otherwise healthy women with osteoporosis. In a comparative trial, raloxifene and tamoxifen had equivalent cognitive effects.
Only one problem.... once you remove it.... it leaves a tattoo of a naked woman..and a naked man in a love embrace.... (so no more wearing short sleeve shirts to the office).
I’ve been using them together with ADT for over 4 years now. They were originally prescribed by Snuffy Myers to help with ADT SE’s which they did and still do. I’ve had no problems other than a little boobage but no big deal, no worse than other 60+ year old guys.
I’m not ready to take that leap being Gleason 9, Stage 4. PSA has been undetectable for over 4 years now, Dr. Myers (before retirement) said stay the course with ADT, now Dr. Sartor and my local onc say the same. PCa seems to have been beaten into dormancy and I don’t want to wake it up. Very fortunate to be where I am today.
The patch trial has proven their safety after years of study. Since they use estrogen to stop testosterone production it seems to me that using tamoxifen to mitigate gynecomastia would be counterproductive because it reduces estrogen.
I’ve used since Feb with great results. See profile.
I've been using estrogen patches for three years and no adverse effects apart from man boobs. Testosterone is at castrate level and PSA is <.008 which is below what LifeLabs can measure .
I get regular bloodwork done and have DHT test every three months to monitor if cancer is using that pathway.
Works for me and worth a try before any other ADT therapy.
I put them on on a daily basis I can increase the number of patches if/when required.
So your daily dose is .2 mg ? That’s really low but if it’s keeping your T below 20 good for you. Seems like you’re wasting money tossing patches so often before they’re depleted. Are you using twice weekly patches or something else? I use three .1 mg patches changed on Monday and Friday. So I’m getting .3 mg daily dosage.
I was also a Dr Charles Myers patient in 2008. He put me on 9 patches initially along with ketoconazole and Leukine + a blood thinner to prevent clots. He worked into the ketoconazole slowly starting at 1 pill and increasing slowly carefully checking my liver. Longest remission ever. PSA from 10 down to 0.1. Joints improved. Memory improved. Osteoporosis improved. Felt great. He also had me on Urosodiol because of a previous problem with a Kaiser Dr trying ketoconazole alone. Dr Myers also put me on hydrocortisone with the Keto. He prescribed me a statin for high cholesterol. Later cut back to 2 patches 6 months later, and cut the Leukine to 2 wks on 2 wks off as a maintenance dose for control until I could no longer get Leukine from my provider due to a switch to medicare. Now I use half 0.1 patch for hot flashes and osteoporosis.
Did lite surgery for the breast enlargement problem which could also be blamed on Lupron.
I think the patch changed since 2008. It lasted a week before, but now you have to change them twice per week. Dont use the big Clamara patch. It will give you a rash because it covers too much skin. The Vivelle patches are very small.
The patches will work especially with PCSPES. They are like DES so I say use them intermittently for sure. You can do a month on and up to 6 months off with the natural PCSPES. This protocol is especially effective on CRPC when nothing else is working.
I have not used any form of ADT at all. My psa is climbing up , current is (.74). I am just trying to slow it down without using the normal route of lubron/firmgon, etc. I am not sure what PCSPES is.
I am using the patches (Estradiol 0.05MG , one patch per week). My MO is looking for more information because we can not seem to stabilize my Estradiol blood tests. One patch is good for three days . Blood test right after three days shows 33.6 pg/mL , then it drops to 13.4 pg/mL during off period. If I use two patches per week the results are too high. Trying to stablize between 20 and 30 pg/mL per research for what is best for a male of my age (75).
I am going to ask my Uro on Friday to prescribe the patches for me. Can you tell me please what should I ask him to do just Incase he is not familiar with this. I mean brand names/dosages, etc.
Read my profile for dosages. I use Sandoz brand but since estradiol is now generic it matters not which brand. I tried the weekly patches. They are 2 1/2-3 inches in diameter, thick and pink (opaque). I found them too big and easier to come off in a shower. The twice weekly patches are small rectangular ( 1 1/2x 1 inch or so ) , thin, and translucent . So easier to place on your abdomen or upper buttocks. They leave a sticky residue like a band aid around the edges when taken off which you should use baby oil to remove then soap and water to clean off the skin. You are not supposed to place them on the same spot in succession.
I've been trying to figure out the E2 thing lately. Somewhere around 20 seems to be the recommended target (much lower is not good for bones), but I can't find any reference information or associated papers. Friedman talks a lot about E2, but doesn't appear to go as far as giving an optimal number or range. And is E2 slightly above 30 not good?
New Study Published in the Journal of the American Medical Association
Conventional doctors tend to ignore hard science until it appears in their own medical journals.
A study published in the Journal of the American Medical Association (JAMA) measured blood estradiol (a dominant estrogen) in 501 men with chronic heart failure. Compared to men in the balanced estrogen quintile, men in the lowest estradiol quintile were 317% more likely to die during a 3-year follow-up, while men in the highest estradiol quintile were 133% more likely to die.24
The men in the balanced quintile—with the fewest deaths—had serum estradiol levels between 21.80 and 30.11 pg/mL. This is virtually the ideal range that Life Extension® has long recommended male members strive for.
The men in the highest quintile who suffered 133% increased death rates had serum estradiol levels of 37.40 pg/mL or above. The lowest estradiol group that suffered a 317% increased death rate had serum estradiol levels under 12.90 pg/mL.
The dramatic increase in mortality in men with unbalanced estrogen (i.e., estradiol levels either too high or too low) is nothing short of astounding. It uncovers a gaping hole in conventional cardiology practice that is easily correctable.
This study revealing the lethal dangers of estrogen imbalance was published in conventional medicine’s Bastille of knowledge—the Journal of the American Medical Association. Physicians no longer have a basis to question male Life Extension® members who take aggressive approaches to maintain their serum estradiol levels in optimal ranges.
Yes because estrogen is natural and Lupron is de eloped by pharmaceuticals
With a PSA of next to nothing and an undamaged immune system, why are you not trying diet and Vit C etc. first? That may buy you many years before your next visit to a Doc. Half us would kill to be in your shoes (we got damaged by the system with little chance to escape)!
I too am going to move off ADT and get a holiday on Estrogen, but I have to wait 6 months to a year before I will need my first patch. There is currently no good "rule book" to manage the change-over. 4 years of Lupron has left me weak and debilitated. I could sell my skin to a shoe maker and my gut fat to a soap maker.
I have been vegan with little fish for more than 4 years now. I did the SRT January of 2017 but psa continues to go up. I would like to slow it down before it gets out of hand, just trying to be proactive. I don’t want to wait until I am stuck and have to start Lupron. NOT SURE, what is the best approach is. I see patients like me here who has had good results with the patch so I figured to try it and see if it stops the psa or holds it steady for a year or two. Is that a reasonable approach or am I doing something wrong with this thinking?
By the way I tried all the natural supplements I heard about online and none of them stopped the psa from rising.
Alas there are 10000 "cures" out there. A balanced diet is the best "cure". The problem is hundreds of plants have some anti-cancer properties, but added together they may boost the immune system 10%. That may translate into 2 or 3% more cancer being killed "naturally", but that does not make a cure. Just slows it down. To increase the kill you have to use things like sodium ascorbate IV. That is also not a cure, but will kill about 5% of the cancer cells (more in combinations). The maths is simple - if your cancer is growing slowly (caught early), then a 5% kill is actually making headway and reducing the cancer. If the cancer was growing at 1% a week, and you kill 5% a week, that means 4% less per week. A few months later, the active cancer may have been halved and you can stop for a while. That's the sort of thing where someone claims they are "in remission" the natural way. You can still give this a go with your numbers and stay out of the Big Cancer Money Machine.
Alas, most of us started doing something too late with the cancer growing at about 3% a day (compound - 23% a week), and a 5% weekly kill will not keep up with the cancer growth. You can double up doses and do an IV every second day, but you are not likely to get more than a 10-15% kill in a week - still going backwards. But add "low dose" conventional medications to the IV regimen, and that can triple the kill to the 30% level - and you are gaining. And still no ADT.
But if you start out at 5% a day growth, then the ascorbate will not be enough. That is why some people die on a "natural" route - they did not do the maths. The Oncologist has his place (but I wish more of them threw away the rule book and got their survival rates substantially higher).
Diet by itself is great for weight loss but does nothing for cancer once you have it. I’ve lost 35 lbs to get rid of my ADT gut and reduce CV risk. But the patches are keeping my cancer at bay .
I disagree. All the killing is your immune system at work. Your survival time is directly related to the state of your immune system. Your immune system's state is directly related to what you eat (and what you are missing). The state of your gut biome is the the foundation of your immune system. Eat to live!
The patches (and most other medications) slow the cancer growth - but kill nothing.
I've seen it work well with PCSPES too with CRPC. Intermittent is best otherwise serious gynacomastia results and is painful. Far better than LUPRON. I loath it.
"I was using 4 patches at a time and changing one daily on a rotating basis (per PATCH trial findings). These are supposed to deliver 0.10 mg/24 hours each and are semi-weekly patches (4 day)."
The only negative I’ve found so far is gynecomastia. I had some from casodex but after starting the patches my nipples were sore for a month or so. I now have perky little tits but Iost 35 lbs from dieting , I work out -6 days a week and my gut is gone and boobs are smaller.
But all the lousy side effects of adt are gone , PSA is <.1 and T is 17. I’m very pleased!
Thanks to all contributing!! Not the author of the post but been trolling as I’m as interested as Ahk1! I am wrapping up my 2nd 6 month QoL vacation (after the first 6months, I was still AD) and I believe I’ll have to face the music next week. Depending on my bloodwork, if need be, I believe I can speak a lot more intelligently about telling my Dr to shove his Eligard!!!
Jc
I did estrogen patches (0.3 mg/day weekly patches - simple to apply and monitor). Undetectable testosterone.
No issues other than libido and muscle loss which you might not be able to get away from with zero T.
I'm currently experimenting with some drugs to see if muscle loss is inevitable. It's early on but it appears to me that muscle loss is easy to reverse. I'm not sure about libido. That's for future experimentation once I am satisfied with the muscle gain.
Oncologists are probably reluctant to go with estrogen ADT because of the history of oral estrogen and the cardiac issues (not the case with transdermal). Also, in my case, I did estrogen ADT 3 years ago and at that time none of the doctors that I talked to knew that high estrogen would cause testosterone to drop via LH feedback. Surprising yet true. Two MOs and 2 urologists. Probably be more likely that they would know today since the government has done the PATCH trial. Disturbing however that the ones I talked to weren't as up on hormones as many of us non-doctors are.
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