Estrodiol and PC

[Knittingque]

My husband has been rediagnosed with NMPC he is on ADT which is holding the Testosterone very low but psa shot upto 82. New MO is starting Enzalutimide plus continuing ADT. Not looking forward to the side effects, but will perservere until psa drops. We have been discussing using Estradiol to help with side effects, however the MO says cancer will eventually feed of the estrogen?. I found that answer to be confusing seeings Dr Richard Wassersug has been using high E2 as his monotherapy for 25+ years as well as l have read on the postjngs on the E2 patch lots of guys are using this with either Adt or even after surgical orchiectomy and no mention of problems, just good results. Any feedback would be interesting and welcome.

[Knittingque]

Sorry he is NM Castrate Resistant

[Tall_Allen]

The PATCH trial is not investigating the use of transdermal estrogen in non-metastatic CRPC. The trial, which we do not yet have the results of, is only on patients who are mHSPC. Estrogens have historically been used on more advanced patients, but there is no controlled data.

[PCaWarrior]

Can you ask him for trials or studies? In particular for low-dose estrogen replacement? Physiological doses.

Oral estrogen was used for ADT for 40 years.

[skiingfiend]

I have mHSPC and Osteoporosis and started Prolia recently. I too asked my MO about using low dose estrogen patches to help with preserving bone density and got the same answer you did, that estrogen will eventually stimulate PCa growth.

I have been looking for studies or research in support of this position but haven't been able to find anything yet. I intend to raise the issue again in my next consult and will ask for evidence.

[PCaWarrior in reply to skiingfiend]

E2 addresses ADT osteoporosis/fracture risk, lipid changes, fat accumulation, insulin resistance and hot flushes: Transdermal oestradiol as a method of androgen suppression for prostate cancer within the STAMPEDE trial platform

stampedetrial.org/media/187...

0.9mg E2 gel: E2 treatment increases some measures of bone density and bone strength in men and reduces bone remodeling. E2 also reduces FSH; a potential oncogenic hormone: Effects of estradiol on bone in men undergoing androgen deprivation therapy: a randomized placebo-controlled trial – PubMed pubmed.ncbi.nlm.nih.gov/356...

Estrogen replacement reduces cognitive side effects: Testosterone loss and estradiol administration modify memory in men – PubMed pubmed.ncbi.nlm.nih.gov/164...

[skiingfiend in reply to PCaWarrior]

Thanks. Yes I am aware of positive results and would like to take advantage of them if possible. In particular I want to avoid intensifying Densosumab at a later stage if possible.

The evidence I am looking for is estrogen can stimulate PCa as per MO statement, at least then I am better prepared to have this conservation again.

[PCaWarrior in reply to skiingfiend]

I have seen some speculation about how estrogen can interact with prolactin and also some speculation about ERa - an oncogenic receptor some of the time. This ignores ERb - a protective receptor some of the time.

The speculative stuff that I have seen isn't in the same ballpark with a clinical trial or study. I don't think I've even seen so much as a case study.

I'd like to see what the MO produces. If he can override PATCH and 40 years of oral estrogen use and the men who have used low-dose estrogen, I'm all ears (I used high-dose estrogen for ADT and low-dose for estrogen replacement during BAT low T periods).

[JohnInTheMiddle in reply to PCaWarrior]

This is great to mention the whole ERa and ERb (assuming in the context of E2 as ADT).

[skiingfiend in reply to PCaWarrior]

Here is an older article (2007) discussing AR, ERa and ERb mechanisms based on lab and rodent studies:

jme.bioscientifica.com/view....

[JohnInTheMiddle]

You've probably seen my big post clarifying the difference between E2 as ADT and E2 as estrogen add-back. (I only did it as a reply. Eventually maybe I'll make it a full-on post.)

You made a good point and I think somebody added to your point in one of the replies here - which is that your MO thinks that eventually PCa will start "feeding" on the estradiol. Obviously this is bad.

I'm interested to be 100% sure we all agree what we're talking about here. Do the MO's understand that they are talking exclusively about E2 as ADT? And that in their mind this has nothing to do with much lower doses of "E2 as estrogen add-back"?

Given what I've heard about levels of knowledge that MOs have I think it's possible that some are more knowledgeable than others.

Here's my original reply a couple of weeks ago:

healthunlocked.com/advanced...

[Knittingque in reply to JohnInTheMiddle]

Thanks for all your indepth comments ( trying to get my head around some of them) however it's truly wonderful to know we are all supporting each other. Just to be clear, l do not discount that some MO's are more knowledgeable than others that is a fact, but l have seen more evidence on the benefits of E2 to question the answer he gave. Our next meet with MO will be interesting when l broach the question again and ask for some evidence. Watch this space......./We (my husband and l) have educated ourselves on PC since my husband's diagnosis in 2013, l am like a dog with a bone and research everything for valuable answers, Pc has been in my husbands and my life for the past 10 years and it can be challenging at times so anything that we learn that can help us all to understand the drugs we are offered with all the side effects and also in turn the drugs we are not offered to alleviate the side effects of chemical castration toxins, Surely we all want to teach ourselves so as to make better decisions for the future. Thank you to this community.

[maley2711 in reply to Knittingque]

Obviously you are going to inform the MO of the extensive research efforts you have made, your failure to find any studies supporting the "feed the cancer" hypothesis, and ask the MO if he /she could advise you where to look?

I don't knw anything about your insurance....have you considered a consult with a PCA center of excellence MO ?

[Knittingque in reply to maley2711]

We certainly will be going into a more indepth conversation when we finally meet in person (so far only telecalls)on new treatment and E2 question on this subject with our MO who incidentally is also a Research Onc and quite top of his game by all accounts (maybe he does have some evidence, we shall see)however MO's are not God and we feel if we consider to take full responsibility for what drugs we have seen work for years and there is evidence out there and we request them then MO's should respect that also and prescribe them. Btw we are not American so Medical Insurance is not an issue however having stated that our only other alternative to obtain E2 would be out of our own pocket from another country and as seniors it becomes very expensive game as l am sure some of you know.

[dhccpa in reply to maley2711]

I doubt that will help on this question. Aren't they strict SOC facilities?

[skiingfiend in reply to JohnInTheMiddle]

Here is a nice recent article summarizing the impacts of E deprivation and the benefits of tE2 and E4, specifically in the context of bone sparring. Be aware I think some of the authors have significant conflicts with respect to E4:

ncbi.nlm.nih.gov/pmc/articl...

[GP24]

This study states: "It is unlikely, given the safety of high-dose parenteral E2 for ADT, that low-dose E2 would increase cardiovascular or thromboembolic risk, or have clinically significant pro-carcinogenic effects."

erc.bioscientifica.com/view...

[FourString]

I’ve done very well with Estradiol patches. Lessens ADT side effects, but also shrinkage of prostate (no more catheter!) and major shrinkage of metastases. Four 0.1 patches twice a week. It took five years to talk my oncologist into it, tho.

My brother and I just did a podcast on estradiol and ADT. Move the audio player to 8:42 for the segment:

open.substack.com/pub/brosh...

[petercraig2]

I had RP, 35 sessions of radiation and PSA was not eliminated so is metastatic and have been on high dose Estrogen patches for 5 years, PSA and Testosterone are both below measurable values (<.008 and <.4)

Scan for bone density shows perfect condition, no sweats or cardiac issues and only downside is Gynecomastia which I can live with. Highly recommend it so long as not planning to go to the beach bare chested.

[Knittingque in reply to petercraig2]

Thanks for your replies Guys😍

[dhccpa]

Question. How does one get E2 patches/gel in the USA?

[petercraig2]

I've been on high dosage Estrogen patches for five years now as monotherapy. PSA and Testosterone are below measurable values (<.008 and <.1). No CV issues or night sweats and r3ecentbone scan show absolutely no bone loss at all. May be difficult to fine a MO who will prescrible but maybe keepp knocking on doors until you get what you want.

Best of luck