tE2 and ARSI vs. LHRHa and ARSI

[PCaWarrior]

We have results.

Transdermal Estradiol Plus ARPIs Demonstrate Comparable PSA Response to LHRHa in Metastatic Prostate Cancer

onclive.com/view/transderma...

[Adendino]

Still learning... what is the primary benefit (besides cost) of using tE2 instead of traditional ADT like Lupron or Orgovyx? Is it a reduction in side effects? My understanding is the suppression of T is what causes the side effects as opposed to ADT itself. For those who really struggle with the side effects of ADT such as brain fog, muscle wasting, low energy, bone density issues, is tE2 a viable alternative to ADT?

[PCaWarrior in reply to Adendino]

Estrogen Therapy (e.g., Transdermal Estradiol)

o Previously used but abandoned due to heart-related side effects with oral estrogen.

o Transdermal estradiol (PATCH trial) is being reconsidered as a safer option with potential benefits for bone and metabolic health.

o Patches achieve better PSA and testosterone control. They also reverse bone loss in many cases. Lupron and other ADT options result in osteoporosis risk. Lupron has an inferior cardiac risk profile. Men using estrogen patches report superior libido and sexual function than men on Lupron. The downside to estrogen patches is a marked increase in the number of cases of gynecomastia.

I did tE2 for my 4 1/2 months of ADT. Bone density increased (I can't prove it was due to tE2. It might have been due to subsequent therapies).

I had brain fog, zero libido, muscle wasting, and started developing gyno at the end. My energy seemed ok. Might have been my diet and exercise that kept that up.

[janebob99 in reply to Adendino]

Good questions.

Suppression of T causes suppression of E2, and low E2 causes many bad side effects. The PATCH phase I, II, and III trials showed that, relative to Lupron ADT, transdermal estradiol (tE2) ADT has the following advantages:

1. Reduced or eliminated osteoporosis;

2. Reduced or eliminated hot flashes;

3. Lower blood glucose levels;

4. Lower bad cholesterol levels;

5. Greater good cholesterol levels;

6. Less fatigue;

7. Greater libido; and

8. Significantly lower costs...as much as 1000 X cheaper than Lupron/Orgovyx ADT.

Disavantages of tE2 for ADT are increased breast gynecomastia and breast mastalgia.

The 14-year survival probabilities for tE2 were essentially identical to those for LHRH ADT, thus demonstrating non-inferiority. Also, they found no increased incidence of blood clots or CVE's in the PATCH trials. This shows that tE2 is a safe and effective alternative to LHRH ADT.

[EdBar]

I’ve been using a single patch twice a week together with Lupron and Xtandi for the past 11 years. Snuffy Myers at one point had me using the 3 patches twice a week for a while to try and heal the sclerotic areas in my bones after my PSA went undetectable. My current oncologist! Dr Sartor said even the one patch may contribute to my overall cancer treatment as well as the original purpose of mitigating SEs.

Ed

[dhccpa in reply to EdBar]

What dose is the single patch you use? And what does your estradiol level run typically, if you measure.

Thanks

[EdBar in reply to dhccpa]

0.1. I don’t know what estradiol runs, haven’t had that tested in a long time.

Ed

[dhccpa in reply to EdBar]

Are the patches pricey? Or do you run them through drug plan?

[PCaWarrior in reply to dhccpa]

$32 a month for 0.06 mg/day. I only need 0.05 mg/day. You might need the same or more.

goodrx.com/climara?label_ov...

[EdBar in reply to dhccpa]

Drug plan

[dhccpa]

I'm going to bring that in to my MO. Haven't made him sweat since December when I brought him the earlier non-metastatic studies.

[PCaWarrior in reply to dhccpa]

Sweating can be good for people. You're doing him a favor.

[podsart]

my Dr said he has Dr Myers patients who came to him on the patch that had cardio issues, so stopped their use

[dhccpa in reply to podsart]

First I've heard that. Caused by the patches?

[podsart in reply to dhccpa]

thats what I heard

[PCaWarrior in reply to podsart]

Snuffy was using DES. Are you certain the men were using patches? Some guys have cardiac issues due to low T. Some just plain have cardiac issues - obesity or whatever. Patches have been rather conclusively shown to have no added cardiac risks vs. Lupron. I'd estimate the evidence is 99.9%. PATCH trial and now STAMPEDE.

[podsart in reply to PCaWarrior]

interesting; think blood clots were the issue with those patches

[dhccpa in reply to podsart]

Sounds like what my doctor tried to put past me. I immediately pointed to the paper I had just given him. He hasn't given in-yet. He's just rigid in his thinking.

[PCaWarrior in reply to dhccpa]

50+? If so he was taught that estrogen causes cardiac issues. My MO is in her 40s and she was not indoctrinated in the old school thinking.

[dhccpa in reply to PCaWarrior]

Yes, he's over 50.

[podsart in reply to dhccpa]

ok good luck

[PCaWarrior in reply to podsart]

Blood clots from patches? You're certain they used patches? We have high level proof + theories + real world experience that if E2 is delivered transdermally it does not cause blood clots more than Lupron or any other ADT drug. It actually appears to do the opposite.

Oral DES was used for decades and indeed does cause blood clots. That's why it's use was stopped. Lupron was introduced in the 80s.

[podsart in reply to PCaWarrior]

sorry thats all i heard about that