Update on profile. Had PSMA scan in November showed 3 bone mets and lymph note involvement in chest and stomach. Started Nubequa in December, had to discountue for monthe due to hospitalization for non prostate issue. PSA kwas slowly declining before i stopped. Back on Nubequa since mid March. Dr will monitor PSA for next few months. My hot flashes seem to be getting worse and i asked my MO about estradoil patches. He said he does not like them because they affect some other markers. Thats about all he would say. Anyone see any reason why i should not try the patches?
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Joey40
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I wish more doctors were prepared to either justify their recommendations or else admit that they're offering a guess or a feeling of some kind, or that they seem to recollect reading a paper that said this but they don't remember where and when, if they don't have facts to justify what they say. In some cases when you ask a doctor about drug X he is ashamed to admit that he doesn't know a lot about it and so, for that reason, he doesn't want to prescribe it to anyone. Lots of us are ashamed to admit that we don't know something but it's not helping patients to not admit it.
I don't know what's best for you, or how bad your hot flushes are. I had them about once an hour. I didn't like them but I got used to them and each time I had one I'd tell myself - Ah, evidence that the drugs are working! I was only on ADT for 4-5 months but I have read that, for many men, the hot flushes do subside after a longer time than that.
If you want to pursue this, you might consider the following:
1) Read the articles cited above.
2) For more info, search Google, Pubmed ( pubmed.ncbi.nlm.nih.gov/ ), or use the search box at the upper right corner of a HealthUnlocked page to see what other forum members have said about hot flushes (or flashes).
3) If you think the oncologist you're seeing is being unreasonable about this and you have doubts about him in general, or if he's not a medical oncologist at all but a urologist or radiation oncologist, or a doc that treats every possible cancer and doesn't have time to do much reading about any one specific type, then consider getting a second opinion from another oncologist. Look for one who has a specialty in prostate cancer. If you live in the U.S., consider cancer centers recommended by the U.S. National Cancer Institute ( cancer.gov/research/infrast... ).
Thank you Alan.. All good advice, although i think my MO is excellent exept for this matter. I will push him at my next meeting. Wake up every hour bathed in sweat. Been going on for 10 years and getting worse since i went on Nubequa
Ten years! It looks like the treatment has worked well for you, but I also think you have earned the right to look for some relief from the side effects.
Are you saying E2 should be part of SOC if you are on extended ADT or do you feel the possible consequences of taking E2 far outweigh the benefits? I have seen five doctors requesting the E2 patch and so far none will prescribe it. No explanation other than not SOC. Frustrating!
Sounds like another MO who is not fully informed. He will not have an answer to your question “what markers?” Estradiol patch twice weekly are wonderful for mitigating some adverse effects and greatly reducing hot flushes. Can you consult with another MO (and possibly switch care)? Ask the nurses which are the most progressive and smartest docs on the staff.
"We have recommended that ideal ranges for estradiol for most aging men are between 20 and 30 pg/mL of blood. Below 18 pg/mL increases osteoporosis risk, while levels greater than 32 pg/mL increase heart attack and stroke incidence." [2]
...My suggestion, where bones were healthy before ADT (but not during ADT), is to use the lowest dose E2 patch that raises total E2 to the LEF 20-30 pg/mL range.
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.
Captured from another posts...
Dr. Charles "Snuffy" Myers used estradiol transdermal patches at low doses, 0.025 to 0.05 mg/day, to offset side effects for his patients on long term hormone therapy. He clearly was not concerned about estradiol "causing" prostate cancer, or he wouldn't have prescribed it for his patients with advanced cases.
For reference estradiol (E2) is the "active" part of estrogen which includes estrone (E1) and estradiol (E2). If you get your blood checked, be sure to ask for the E2 number specifically.
Reply (1)
Low-dose E2 patches are intended to replace the minimal amount of E2 essential for bone health. Men produce E2 by aromatization of T. ADT can therefore result in E2 defficiency. IMO, the target level for E2 should be 12-20 pg/mL.
E2 is only a threat to male health when >30 pg/mL. Some studies (e.g. cardio) equate the E2:T ratio with risk.
As of March 1 2022 my PSA was .2 (never been non detectable since a BCR in 2016, T 10 (after being on Orgovyx for 11 months), Estradiol 16 pg/ml after using a bioidentical Estradiol cream for several month. Without the cream my Estradiol was 5 with a T of 9.
I will be getting a DEXA scan in May to see if my Osteopenia has gotten worse. Dr. wants me to go Prolia...I have said no so far.
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