Any news on estrogen patches or gel in comparison to lupron or degarelix regarding cardiovascular problems, blood clots?

My husband will probably begin ADT but still concerned about cardiovascular issues, specially blood clots. What about estrogen patches or gel, any news?

[Tall_Allen]

The PATCH/STAMPEDE trial is supposed to have its first results in August 2021

[GP24]

Degarelix (Firmagon) has shown significantly lower cardiovascular risks than lupron:

pubmed.ncbi.nlm.nih.gov/311...

If you start with ADT, I would recommend Degarelix.

[Christopherg in reply to GP24]

Good morning

I asked 2 MOs if I should switch from lupron to firmigon

I have heart problems

BOTH of the MOs said it was a marketing angle by firmigon and not to change drugs

I am concerned about this reply

Is there any evidence re firmigon advantage versus lupron?

Thanks so much and Good health to you

Chris

[GP24 in reply to Christopherg]

Chris, just click on the link I provided and read the study! The patients included had cardiovascular problems when they were included in the study. Patients without cardiovascular problems may not have a clear benefit. But Myriammole's husband and you do have cardiovascular problems so the results of this study do apply.

[Hidden in reply to GP24]

exactly, I just must check which type of cardiovascular problems were taken into account. My husband has atherosclerosis, but apart that a good heart.

[pjoshea13]

The good news about estrogen patches is that the PATCH study is still in progress - implying that there are no significant excess cardiovascular or other morbid events as yet.

For many years, Diethylstilbestrol [DES], a synthetic estrogen, was used for ADT. There were coagulation issues.

Transdermal estradiol [E2] does not have those issues.

Classic ADT & E2-patch ADT both effectively inhibit gonadal testosterone production & men develop symptoms of the metabolic syndrome [MetS], which increases the chance of CVD events. It would be interesting to hear how men in the group are dealing with the MetS problem.

-Patrick

[Hidden in reply to pjoshea13]

so, you are saying that estrogen patches do not provoke blood clots, but that because of testosterone down MetS occur (that would be cholesterol, high blood pressure, high blood sugar, body fat).

Still, there are differences between different ADT meds in relation to CVD, why? and where would the estrogen patches stand, nearer to lupron or degarelix, I think there is no such study.

[pjoshea13 in reply to Hidden]

The best I can offer is:

"GnRH agonists appear to increase the risk of cardiovascular morbidity by 20-25% in men on these agents compared those who do not receive ADT. GnRH antagonists may appear to have halve this risk while improving PSA progression-free survival. GnRH antagonists may be superior to GnRH agonists for patients with significant cardiovascular disease, significant metastatic disease burden, or severe lower urinary tract symptoms." [1]

The PATCH trial excluded anyone with cardio-disease.

-Patrick

[1] pubmed.ncbi.nlm.nih.gov/284...

[Hidden in reply to pjoshea13]

the other problem is that to apply to the PATCH trial you can not have any serios CVD, so it is quite difficult to know more about it's effect for people with CVD.