I made this chart which shows the historical timeline of Estrogen use for treating prostate cancer.
Estrogen has been used for about 85 years, with various forms of delivery.
With the exception of high-dose oral estrogen (DES) causing blood clots from 1945 to 1970, the other forms of estrogen (e.g., transdermal) have had a very successful history.
Most doctors have forgotten, or never learned, about the long history of estrogen use.
Bob
Fantastic history and you are right about doctors forgetting about estrogen and therapies derived from that. My question though is what has Lupron got to do with estrogen in the chart above? The GnRH agonist ends up suppressing estrogen production ... is my understanding, anyway. It's not a form of estrogen or an estrogen precursor.
Glad you liked it. It took a bit of work to dig up the old papers.
Good point about Lupron. I added Lupron since it's the preferred ADT drug today. It's not related to estrogen. Perhaps I'll make it italics, to highlight the difference.
Kewl …. Now, maybe you could convince my oncologist yayaya yayahahahaya.
One thing to remember tho …. If you croak ( by any means ) it will be found by your autopsy and your insurance will have an excuse to reneg on your payout.
Just say’in
❤️❤️❤️
Kewl...
My estrogen has naturally run high for most of my life, so a bit more won't be noticed. My MO is very open minded and will likely approve my proposed treatment plan.
Bravo!!!
" If you croak ( by any means ) it will be found by your autopsy and your insurance will have an excuse to reneg on your payout. "
What payout? are you talking about life insurance? If so, I see no way using the patch, etc. would impact the payout?
Also, most deaths are not followed by autopsy as far as I know....we had to request Mom's Doc to request one before he signed the death certificate.
Yea a little bit of sarcastic humor on my part that missed …. looks like. I’d think that a lot of us , if not most , have the life insurance from work …, mine ( $750,000 ) started dropping to nearly nothing as soon as I hit 65 . Now at 77 it’s worth some token amount, $25k I think … possibly less. I bought high option too. Yayahahahaya yayaha.
Autopsy wise , I dunno how that works locally , but both my recently deceased friend and my 36 year old daughter had an autopsy automatically here in central California. I’ll have one myself , for sure…. I’ve seen to that , for private reasons. Doesn’t seem like everyone gets them but I don’t really know.
Guess I’d better get a refresher course from j-o-h-n School of Humor .
Just say’in
❤️❤️❤️
Ha ! I thought your comment was great sarcasm, but I wasn't 100% sure. Thanks for explaining.
I do think that thinking about how medical insurance providers will react to alternative treatment (estrogen) is important. Getting them to pay for alternative therapies is difficult and challenging. I guess I'll be finding out.
The good news about estrogen treatment is that it's dirt cheap, especially from India, Thailand, etc. So, I don't need insurance coverage for it.
There's NO MONEY to be made with estrogen patches.......therefore, we'll NEVER see them as an alternative. Supplemental ? perhaps
Fortunately, there are lots of women that use estrogen patches for treating hot flashes and osteoporosis after menopause. So, there will always be a ready supply on hand. What is needed is a more-concentrated patch that puts out 300 µg/24 hr of estradiol (to match the PATCH study in the UK) that is tailored to men who have prostate cancer. No one wants to wear three, 100 µg patches at the same time.
I suspect Lupron helps the income of urology practices. Maybe $2000 per shot. Transdermal E will not help cash flow as it is a prescription based treatment.
great research ! Should make docs who are against it stand up and take notice. My urologist was one of those who used DES before it was stopped due to blood clots. He immediately approved the patches without question back in 2019 because he was aware of the PATCH trial findings.
Any consideration about patient compliance?One of the major benefits of the 3, 4, 6 months injection is the compliance aspect of treatment is removed from the equation. I read that prior to the inject depots,en were required to inject daily and compliance was not the best. Having to apply E gel or patches daily would be a real pain, IMHO. However, for those patients who prefer the Estrogen approach for ADT, it should generally be available.
Good point.
There is an alternative form of estrogen called PEP (polyestradiol phosphate) that is injected IM. I don't know how often it is injected, though. Perhaps once a month. I'll have to check.
There were many large trials of PEP in Sweden starting around 1995, that could be studied as an alternative to patches or gels.
People that have already reached a conclusion about specific issues tend to seek confirmation bias. I am certain that the thousands of MOs/ROs treating prostate cancer are aware of transdermal estrogen. If it were superior to ADT/Lupron or was just as efficacious without some of the admittedly difficult side effects, they would be prescribing it. The treating docs don't have a dog in this hunt. They want whatever is the best treatment for their patients with the least side effects. The ever present risk/reward. I occasionally read that some clinic in Mexico or some specific diet or some drug on the Internet is the magical cure for fill in the blank disease or condition. If there was a significant advancement or cure out there somewhere, the results would be verified and the information would spread like wildfire. I was President/CEO of a healthcare system for a brief time during the Covid pandemic. We routinely encountered patients with questions about Ivermectin or some other unproven treatment. People just want to believe they have found the Holy Grail and that the healthcare professionals have overlooked it or have some vested interest in not using it. This is just not the case. Maybe transdermal estrogen will become the next thing. Possible, but I would think that it would be more widely prescribed if it were a better answer. I honestly know next to nothing about it.
I think it's great that patients learn about heir disease and ask questions and become involved with their treatments. But I believe it is a fool's errand when they/we start believing we know more than a well trained, experienced MO/RO practicing at a COE.
Just my opinion.
Well said. I agree with you.
I think that until the NCCN guidelines change to accept TDE, that it won't be adopted by most MO's.
Unfortunately, many of those MO's think that transdermal estrogen (TDE) causes blood clots. Many papers refute this, but there are a large number of docs that still think this way. TDE is very different than the old oral estrogen (DES).
I was told that the Phase-III PATCH trial results will be published this Fall. I expect that it show non-inferiority to LHRH ADT w/r/t 5-yr and 10-yr outcomes.
I have about twenty papers showing excellent properties of using TDE. Send me a private message and I will send them to you.
Its not just blood clot concerns, but also genetic interactions and off-target wildcard effects. Also there could be concern that estrogen raises male breast cancer, CVE, etc risks. That it may interact with other sequential / adjuvant medicines. There is a reason for trials in depth and that is udderly lacking with TDE. (pardon the pun. I couldn't help myself.
Results with estrogen. 
Cycle estrogen and casodex/dutasteride
Estrogen for BRCA positive patients
I am 1 year post RP psa has been 0.03 yesterday result came back as 0.05. 
Are estrogen patches safe?
