To those who have read Dr Richard Wassersug's book....

[swwags]

As mentioned in other posts, off Erleada as it's contraindicated in my treatment of Multiple Myeloma. I was just approved for Zytiga. Hurray for me. Anyway, I have not read his book yet but it's on my list. I recently watched his Tube Video and found it interesting but covered other higher priority topics than what I was hoping to hear. Still enjoyed it very much and recommend it.

As I understand it, in exchanging and reading posts from Ron and others, the good Doctor is a proponent of estrogen as a viable ADT.

I can reach out to him and certainly will if I want to go that route. My question is, does the book delve into the use of estrogen in depth. I'm aware of the PATCH trial and someday the final results will come out. I want to drill down on the efficacy of the cream vs this harsh F'n drugs I'm already on.

Thoughts? Input? and Thank you!

[Wassersug]

I guess I can/should reply to that.

Currently I more or less follow the PATCH study protocol for my own ADT; i.e., using high does transdermal estradiol for androgen suppression. The new expanded edition of the ADT book mentioned the PATCH study, but it does NOT endorse transdermal estradiol for ADT. That ia becuase my coauthor and I wanted the book to be truly evidence-based and not hearsay.

The book has the formal endorsement of both the Canadian Urological Association and the European Associaton of Urology. To get that endorsement the draft text was extensively reviewed by MDs in both North America and Europe. It is thus does not promote treatment protocols that have not been adequately tested.

The book does discuss the use of low dose transdermal estradiol to manage some of the more bothersome side effects of androgen suppression from the standard LHRH agonists and antagonists used for ADT. BUT it also notes that this is an "off-label" use and needs to take a variety of factors into consideration.

I, likely many others here, await the publication of the overall final survival data from the PATCH study.

SWWAGS,

Did I abswer you question?

Richard Wassersug

[swwags in reply to Wassersug]

Thank you Doctor, you did. Your qualifications were never in doubt on my end so if my question reflected that, it is due to my lack of writing skills. I may look into the use of low dose to manage side effects but more interested in the PATCH results and possible subsequent switch away from these harsh ADT therapies. I didn't expect an endorsement of the patch at this point. Do you, or does anyone have an ETA on the publication of the final results of PATHC trial? Thank you. Enjoyed the video btw. Please do more as time permits.

[Wassersug in reply to swwags]

Hi SWWAGS,

I am a PhD type of doctor, not an MD. I didn't think you were questioning my knowledge about ADT, but I don't want folks to be misled and think I am pretending to be an MD. Hence feel free to call me Richard and not "doctor".

I'm just another PCa patient on ADT, who happened to be a research scientist before getting PCa. And, as a scientist, I found the side effects of ADT so interesting that I started studying them about 15 years ago. Much of my research now is on how to maintain a good quality of life on ADT and how to manage ADT side effects. [That evolved into the ADT book.]

Over a year and a half ago, there was an expectation that the last paper on the PATCH study would be out in the first half of this calendar year. That obviously didn't happen. I do not have an official ETA, but my guess is that a PATCH paper will be out in the next few months.

Richard W.

[swwags in reply to Wassersug]

Yes sir, I know your degree is PhD and not MD. Just using it out of respect, but going forward, Richard it is! I look forward to reading your book.

[dhccpa in reply to Wassersug]

Whether or not you endorse it, are you aware of a way to get transdermal version in the US? I've struck out with local MDs, although one may be lurking. I've been on Lupron for five years (and have made no decision to abandon it yet).

Thanks very much for your input here.

[KocoPr]

Hi swwags, i read your bio. I didn’t see any genetic testing done.

Also the las update said you were to continue on ADT till summer of 2022. I take it the chemo, radiation and ADT is just barely slowing your beast down. Are you still hormone sensitive?

You might want to look into a modified BAT ifyou are looking for alternatives to ADT.

I feel for you brother.

[swwags in reply to KocoPr]

Hey KokoPr thx for the reply. I have been in PCA remission since 7/20. Still Hormone sensitive. I've updated my profile. Indeed it has been a fun ride. I updated my bio. My doctors notes don't show it because I went outside their system but I had a bilateral orchiectomy on 3/17/23. I will fit that into the bio.

My PSA is undectible. I have an F18 scan next month. Erleada is contraindicated with my Multiple Myeloma treatment so they are working on another ADT, which has led me to Dr. Wassersug and this post.

[FourString]

I am using transdermal patches (4 X 0.1) twice a week. No longer using catheter. My scans reveal greatly reduced size of prostate and Mets. No flashes, edema, crazy weight gain, or crippling fatigue. So, yes. Me like.

[Shorehousejam]

Thank you for sharing this post

[Wassersug]

Dear all on this thread,

I am a slow typist and thus much prefer to talk rather than type. Nevertheless I am back here on the transdermal estradiol (tE2) thread to respond to a couple of things posted in the last couple of days.

1. If one is on an LHRH agonist, like Lupron, and their PSA is still climbing, they are heading into castrate resistant territorial. In that situation there is no reason to think that high dose tE2 will give better cancer control than any standard of care modality for ADT.

2. If someone in the USA is exploring with their MDs the possibility of using low dose tE2 for ADT side effect management, I suggest that they bring in the abstracts of the relevant papers by Nick Russell in Australia for discussion. Those abstracts can be pulled up from PubMed and here is a URL to a recent one:

3. I have seen confusion on this list between DES and estradiol. The early and orginial estrogen used to treat prostate cancer was not estradiol, but DES.

4. If someone still wants to talk with someone, who has been on high dose tE2 long terms for ADT (>10 years) for control of metastatic PCa, they can contact me directly for a reference. The person has micro-mets (i.e., PSA too low for imaging) but has maintained PSA control for well over a decade.

Richard Wassersug