my husband will begin ADT, probably Firmagon. since he has already some micro bone mets and to some degree osteopenia, bone loss while on ADT is an even more serious issue.
What are the differences in this regard between Xgeva and E2 add-back in men undergoing non-estrogen ADT?
Xgeva will make the bones "harder" and mitigate bone loss this way. The guidelines recommend it. I personally will never take it because I think estrogen patches are the better alternative.
Estrogen patches avoid bone loss because bone loss is caused by the low estrogen levels caused again by low testosterone. E2 can even increase bone density again.
How much do you take as E2 patch?
I currently do not use ADT but a patient I know follows the recommendation of Dr. Myers. He uses a 100 ug (=0,1 mg) patch twice a week.
He uses Vivelle patches. Not all patches work equally well, you have to monitor the estrogen level while using them and see if it increases to a normal value and not above that.
They work in different ways but accomplish the same thing - preserving bone mineral density. Adding estrogen will also reduce his hot flashes and preserve lean body mass, and it doesn't carry a risk of jaw necrosis. Take with 10 mg tamoxifen to prevent gynecomastia.
I spoke today to the oncologist and he asked if I have any at least phase 3 study for my wish to have estrogen patch instead of Prolia. do you know one? what would be the dosage?
There are no such studies that I know of. Richard Wassersug may know more. You may want to PM him (Wassersug).
ok, but normally you don't like advises based on individual cases and still you thought it could be a good idea. Where does it come from? Maybe many cases you know?
I didn't say there was a comparative study. There have been large-scale studies on estrogen for BMD, and different large-scale studies on denosumab for BMD, like these studies in post-menopausal women:
ncbi.nlm.nih.gov/pmc/articl...
ncbi.nlm.nih.gov/pmc/articl...
ok for BMD, but maybe it could have adverse affects on ADT efficacy?
It increases ADT efficacy:
touchoncology.com/androgen-...
"There was no significant change in serum testosterone or luteinizing hormone levels."
goldjournal.net/article/S00...
"ADT is an incomplete treatment. For a more complete treatment of PCa, we recommend concurrent androgen and estrogen ablation, together with the inhibition of selected steroid biosynthetic enzymes."
here we are speaking of additional low dose ed patch, not e2 adt therapy, right?
There was an RCT of ADT + toremifene, a selective estrogen receptor modulator, vs ADT:
Xgeva vs Zometa
Met Bone Pain Vs Normal Bone / Muscle Pain
SOC standard info on starting Xgeva without bone issues.
Bone density loss
Bone scan vs 18F NaF PET
