I'm starting to read more about the PATCH trial using estrogen against ADT.
Have any of you taken literature on the PATCH trial to your main cancer doctor (whether urologist, RO, or MO) and convinced the doctor to switch you from ADT to estrogen patches (for those already on ADT), or start you on estrogen patches instead of ADT (for those about to start ADT)?
If so, was your doctor more of an independent doctor with his or her own clinic, or one at a large cancer center (or even center of excellence)?
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Being on ADT for several years already makes me think about this, you’re right to ask about it. But it’s not yet considered a SOC alternative here for mCRPC. ChatGPT mentions deep vein thrombosis and pulmonary embolism as risks of the patch; prefers ADT in combination with the drugs we know.
A little too soon -- we only have the presentation so far. I'm hoping the published peer-reviewed trial will be released next week in conjunction with the ASCO GU Conference.
when one goes off ADT and tries something like patch, if that option ( patch) fails, when u go back on ADT you are not guaranteed you will “re establish control of your PCA again. Is this correct?
I'm not sure what you're asking, but castration-resistance means the cancer progresses despite castration. It does not matter if castration was achieved with GnRH antagonists, GnRH agonists, estrogen patches, or orchiectomy.
sorry for confusion. If one takes an ADT vacation and the PSA rises , then he resumes ADT, assuming still hormone sensitive, what odds the PSA drops to original level when he went on ADT vacation?
Not under doctors care. I used the amount that was indicated on the little plastic ruler that comes with a groove on it. You squeeze out a bead in the groove which is about 5 cm long. I'm not sure how much in mg/ml it was but a similar amount to what Ron on this forum was also using. I think it may have been more successful for him as he's had his prostate removed. Me not.
Q. What do you think about a parallel use of ADT plus estradiol patch?
A. The idea of combining **androgen deprivation therapy (ADT)** with an **estradiol patch** in the treatment of metastatic castration-resistant prostate cancer (mCRPC) is intriguing and could theoretically offer some benefits. However, this approach is not standard practice and would need to be carefully considered based on the available evidence, potential risks, and individual patient factors. Let’s break this down:
---
### **Potential Rationale for Combining ADT and Estradiol Patch**
1. **Enhanced Hormonal Suppression**:
ADT works by suppressing testosterone production, while estradiol (estrogen) can further suppress androgen signaling and may have direct anti-tumor effects on prostate cancer cells. Combining the two could theoretically provide a more comprehensive hormonal blockade.
2. **Bone Health**:
ADT is associated with bone loss (osteoporosis) and an increased risk of fractures, while estrogen has a protective effect on bone density. Adding an estradiol patch to ADT might help mitigate bone-related side effects.
3. **Synergistic Anti-Tumor Effects**:
Estrogen has been shown to have direct cytotoxic effects on prostate cancer cells in some studies. Combining it with ADT could potentially enhance tumor control.
4. **Reduced ADT Side Effects**:
Estrogen therapy might help alleviate some of the side effects of ADT, such as hot flashes, by providing an alternative hormonal environment.
---
### **Potential Risks and Challenges**
1. **Thromboembolic Events**:
Estrogen therapy is associated with an increased risk of **deep vein thrombosis (DVT)** and **pulmonary embolism (PE)**, especially in older men or those with a history of blood clots. Combining it with ADT, which may also increase cardiovascular risk, could exacerbate this issue.
2. **Cardiovascular Risks**:
Both ADT and estrogen therapy can increase the risk of cardiovascular events (e.g., heart attack, stroke). Combining the two could further elevate this risk, particularly in men with pre-existing cardiovascular disease.
3. **Gynecomastia**:
Estrogen therapy often causes breast tissue growth (gynecomastia), which can be uncomfortable or distressing for some men. This side effect might be more pronounced when combining estrogen with ADT.
4. **Lack of Clinical Data**:
There is limited clinical evidence to support the combination of ADT and estradiol patch in mCRPC. Most studies on estrogen therapy in prostate cancer have focused on its use as a monotherapy or in combination with other agents, not alongside ADT.
5. **Overlapping Mechanisms**:
Since both ADT and estrogen suppress testosterone production, there may be overlapping mechanisms that do not provide additional benefit but instead increase the risk of side effects.
---
### **Current Evidence and Clinical Practice**
- **Estrogen Monotherapy**:
Estrogen therapy (e.g., oral estrogens, transdermal patches) has been studied as an alternative to ADT in prostate cancer, with some studies showing comparable efficacy in terms of testosterone suppression and cancer control. However, due to the risks of thromboembolism and cardiovascular events, it has not been widely adopted.
- **Combination Therapies**:
ADT is typically combined with other agents (e.g., abiraterone, enzalutamide, docetaxel) in mCRPC, as these combinations have been shown to improve survival and are supported by robust clinical evidence. There is no established role for combining ADT with estrogen therapy in current guidelines.
---
### **Key Considerations**
If you’re considering a parallel use of ADT and estradiol patch, here are some important points to discuss with your healthcare team:
1. **Individual Risk Factors**:
Assess your risk of thromboembolic events, cardiovascular disease, and other comorbidities. Men with a history of blood clots or heart disease may not be good candidates for this combination.
2. **Monitoring and Management**:
Close monitoring for side effects (e.g., DVT, PE, gynecomastia) would be essential. Prophylactic measures, such as low-dose aspirin or anticoagulants, might be considered to reduce thromboembolic risk.
3. **Clinical Trial Context**:
If available, participating in a clinical trial investigating the combination of ADT and estrogen therapy could provide access to this approach in a controlled setting with close monitoring.
4. **Alternative Options**:
Discuss whether other established combination therapies (e.g., ADT + abiraterone, ADT + enzalutamide) might be more appropriate and evidence-based for your situation.
---
### **Conclusion**
While the combination of ADT and estradiol patch is theoretically interesting, it is not currently a standard or well-supported approach for mCRPC. The potential risks, particularly thromboembolic and cardiovascular events, may outweigh the benefits in many cases. If you’re interested in exploring this option, I recommend having a detailed discussion with your oncologist to evaluate whether it might be appropriate for your specific situation, ideally in the context of a clinical trial or rigorous monitoring plan.
Thanks, interesting to see something from deepseek. I have not tried it and mostly likely will not. Part of my role is cybersecurity and I would not use Chinese software. I think you'll like the o3-mini model from openAI. Have you tried it?
Getting a bit "meta" here but this is a "fact check" from one AI of another. 😉
Not to worry about deepseek and security......... just remember when you ask for the vanilla ice cream for dessert from their menu they always bring you the cherry Jell-O instead. Also their AI will be continue generating those stupid fortune cookies with their vague prophecies and the same six digit winning lotto numbers....Give me a break and just let me use TikTok instead.
I totally understand and agree with you. I am exactly the same like you except that I don't really mind (I am not paranoid about that the Chinese or Russian will spy on me. I am more paranoid about USA, north Korea and Iran spying on me.
Information can be used against us and some people are in positions where a hack (rather than just information loss) can be attractive to bad actors. I just proposed a ban on deepseek where I work.
That is fine for me, but honestly I am paranoid enough without thinking that someone will spy on me through my phone. I have to admit that I am not using my phone for anything sensitive. I know someone who is not using a smartphone at all. He is only using a plain feature phones with a very limited capabilities in order to avoid being hacked.
I think I am fine if I am using my phone for basic things like browsing the internet etc. I don't believe that I am an interest much. I also have a 4 G feature phone but I am to laizy to use it. I have a Kaspersky anti-virus and VPN and often reinstall the software on my phone in order to avoid being hacked.
I believe my medical oncologist is conducting a clinical trial with ADT plus 3 or 6 monthly estrogen injections. I talked to one of his patients briefly and it looked to me that he is not taking seriously a gel form of estradiol delivery. I would not contemplate Oral estrogen delivery. As I said I believe physical exercise could be better in theory than estrogen for bone health.
I am afraid (but I don't know) that some prostate cancer could have estrogen receptors not just androgen receptors therefore I am simply afraid to use estrogens. Plus you could develop breast cancer if you have a BRCA genetic mutations. Therefore you should check your genes before starting estrogens.
I really not very enthusiastic about estrogen. Ok, I am learning but I am definitely not jumping into estrogens.
You could also play with ChatGPT I am not the only with the licence to do that, just don't believe everything what ChatGPT said. It is still a useful tool if you ask me.
Certainly! Let’s expand the comparison to include **3-monthly and 6-monthly estrogen injections** (e.g., **polyestradiol phosphate** or **estradiol valerate**). These long-acting injectable forms of estrogen are another option for prostate cancer treatment and have their own unique side effect profiles. Here’s an updated comparison:
---
### **Key Differences Between Oral Estrogen, Estradiol Patches, and Estrogen Injections**
1. **Metabolic Pathway**:
- **Oral Estrogen**: Passes through the liver (first-pass effect), increasing clotting factors and thromboembolic risk.
- **Estradiol Patch**: Bypasses the liver, reducing thromboembolic risk.
- **Estrogen Injections**: Administered intramuscularly or subcutaneously, bypassing the liver initially but still metabolized systemically over time.
2. **Dosing and Stability**:
- **Oral Estrogen**: Variable absorption and hormonal fluctuations.
- **Estradiol Patch**: Stable and consistent hormone release.
- **Estrogen Injections**: Provide long-lasting effects (3-6 months), but hormone levels may decline over time, requiring re-administration.
3. **Convenience**:
- **Oral Estrogen**: Daily administration.
- **Estradiol Patch**: Requires regular replacement (e.g., weekly or biweekly).
- **Estrogen Injections**: Administered every 3 or 6 months, offering greater convenience.
| **Injection Site Reactions** | N/A | N/A | Possible pain, swelling, or infection |
---
### **Additional Notes on Estrogen Injections**
1. **Thromboembolic Risk**:
While injections bypass the first-pass effect of the liver, they still introduce estrogen into the systemic circulation, which can increase the risk of thromboembolic events compared to patches but likely less than oral estrogen.
2. **Cardiovascular Risk**:
The risk of cardiovascular events with injections is thought to be lower than with oral estrogen but potentially higher than with patches. However, data specific to prostate cancer patients is limited.
3. **Gynecomastia**:
Like other forms of estrogen therapy, injections commonly cause gynecomastia. Prophylactic measures (e.g., breast irradiation or tamoxifen) may be needed.
4. **Bone Health**:
Estrogen injections, like patches and oral estrogen, have a protective effect on bone density, which is particularly beneficial for men on long-term ADT.
5. **Convenience**:
The infrequent dosing schedule of injections (every 3-6 months) can improve adherence and quality of life for some patients.
---
### **Relevance to Prostate Cancer Treatment**
- **Estrogen Injections**: These have been studied in prostate cancer, particularly in Europe, where **polyestradiol phosphate** has been used as an alternative to ADT. Some studies suggest comparable efficacy to ADT in terms of testosterone suppression and cancer control, with a potentially better side effect profile than oral estrogen.
- **Patches vs. Injections**: The choice between patches and injections may depend on patient preference, tolerance, and access. Patches offer lower thromboembolic risk, while injections provide greater convenience.
| **Estrogen Injections** | Moderate | Moderate | Every 3-6 months | Common | Protective |
If you’re considering estrogen therapy for prostate cancer, discuss these options with your healthcare team to determine the best choice based on your individual risk factors, preferences, and treatment goals. Each form has its pros and cons, and the decision should be tailored to your specific situation.
And did you switch from traditional ADT? If so anything of note in how you feel in comparison? Keeping an eye on this as it seems to be better for the bones.
Just did. Feel free to answer privately if needed, but having been on ADT for years and having Mets, how difficult was it to talk your doctor(s) into letting you try estrogen and drop ADT?
When I said "us," I meant the forum (if you choose). By "privately," I mean through a message directly to me (again, if you choose). Didn't mean to be mysterious. We're here to share info, if we choose to do so
Previously used oral estrogen for treating PCa caused an increased risk of blood clots and CVE's. Modern use of transdermal estradiol (patches, gels, creams, pellets, injections, sprays, etc._) do not take a first pass through the liver (like oral pills), and, hence, have no increased risk of blood clots and CVE's when compared head-to-head with Lupron LHRH ADT (Ref: PATCH study papers). ChatGPT is out of date.
I wasn't able to get my MO to prescribe estradiol for ADT, but my PCP prescribed it after I showed him some PATCH study papers.
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