As a quick follow up to my recent post, my MO has agreed to let me try 5-6 patches (Dotti, 0.1) changed 2x weekly to get to a castrate state more quickly, up from 4 patches, before I then drop back to a maintenance dose (TBD). He is happy with my PSA decline so far even though my T is not yet where it needs to be, and he's confident we are on the right track.
I discussed, with both my MO and my pharmacy, the issue of my pharmacy changing brands without notice, as that is common practice with generic prescriptions. Both will put a note on the prescription to make an effort to stay with a single brand, so that I might avoid the potential difference between brands that arose during the PATCH trial. (I did not bother discussing the possibility of a gel, as I think we are both eager to see results from the mode of treatment already started.)
We agreed that monthly testing of E2 is not essential but would be of interest, at least academically. He noted that some insurers don't want to cover it. Surprise, surprise.
The more important purpose of this post is to let people know that I rather bluntly asked my MO (Dr. Mark Pomerantz) if he and other Dana Farber MOs were really comfortable doing tE2, since he was initially reluctant last year, when he preferred (but also a bit reluctantly) to let me try bicalutamide monotherapy.
The big difference between last May and this May is that PATCH trial results show safety and a reasonable expectation of efficacy. So "probably no" turned into "probably yes" on that basis. When I mentioned that many docs were still reluctant, as it is still outside of the SOC, he said that it is far easier to justify alternative approaches if the data is there in black and white. So my timing of failing bicalutimide was excellent, as it coincided with the Lancet article of Feb. 2021 detailing PATCH results as positive.
So men in the greater Boston area (or beyond) can reasonably expect any MO at Dana Farber to openly consider tE2 as a possible form of ADT, if it seems appropriate for that patient. If some MOs there ARE hesitant they can readily refer you to another MO at DF. (The Lancet editorial suggesting it is a reasonable approach was authored by Charlene Mantia, MD, and Atish D. Choudhury, MD, PhD, both of Dana-Farber Cancer Institute, Boston, MA.)
Men who are far away from Boston might consider this another piece of ammo when trying to convince their local docs to consider it: hey, it looks promising enough for Dana Farber to say yes, so why won't YOU look at the data?
A helpful link:
Early Results from Transdermal Estrogen PATCH trial
Transdermal low dose patch Estradiol for ADT S.E.
Estrogen May be The Cause of CRPC while on ADT
Continuing intermittent ADT? or more?
