I had PSA of 250 Gleason 9/10 in 2019 Mar. Was under ADT regime from Jun 19 followed by IMRT in Nov 19. It was 39 sessions of 78 Gy to prostrate, prostrate bed, pelvic nodes. Later in Sep 22 PSA started to rise indicating BCR. In Jan 22 underwent Orchidectomy followed by Nubeqa for 19 months now.
I've been on Alendronic Acid since Dec 19 for bone health. Now I wanted to switch to estrogen at 30 to 45 pg/dl. Got check for Estradiol in blood which showed 36.5pg. Is it possible with such low T levels following Orchidectomy that Estradiol would be so high?
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binati
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No I don't have hot flashes. All my data shows that men with normal T have 30 to 50 pg/ml. Hem e that is my target. My T levels are below 10 as far as I know. So how the high Estradiol! Adrenals mostly produce about 10 manograms/dl.
Bob, you have done extensive research on this topic. Do you have any references for the fact that estradiol levels have to be 100-150 pg/ml for bone growth?
Nicholas Russell's paper mentions a threshold of 40 pmol/L(~11 pg/ml) for bone density improvement.
In that paper from the PATCH study, the mean serum E2 level was 198 pg/ml, with a range of [100-518 pg/ml). N=63.
Losing bone can be a serious health problem down the road. Why mess with threshold levels of 11 pg/ml? The PATCH study is the only study on the effect of E2 patches on men with PCa.
Some data on post-menopausal women show a minimum of 60 pg/ml is needed to achieve a maximum effect on BMD.
Patch study is to bring T to less than 20 nanomoles/dl. It is another form of ADT using Estrogen. We are looking only to ameliorate osteoporosis. 30 to 40 pg/ dl will do the trick as per my study. If you have an Estrogen level of a normal man it is in the same range asentiomed above.
I appreciate your work. Do you have a reference that serum E2 = 30-40 pg/ml will do the same as what the PATCH study found, i.e., increase BMD over time?
Note that you mention 30-40 pg/dl. Do you mean pg/ml?
Yes I mean pg/ml. Sorry for the slip. That is logical of you consider that healthy men with healthy bones have only around 30 pg/ml on average. In fact 100 pg/ml is considered very high in normal men not undergoing ADT.
Today is a very exciting day! The UK PATCH team presents their long-term survival data on estrogen patches vs LHRH agonists at the ESMO conference in Europe.
I believe the PATCH studies were designed to get men down to the traditional "castrate" level (T <50 ng/dl), not to the sub-castrate level (T< 20 ng/dl). However, some men did reach that level, I believe, as there is a large variability in response to estradiol patches.
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