Estrogen & PC

[B_Sprout]

This is my first post. I am 18 months out from a radical prostatectomy at U of Penn. Gleason 9, no mets, feeling great and currently monitoring PSA quarterly. PSA has risen from post surg 0.009 to current 0.063. Plan is to not intervene with ADT/RT unless PSA gets closer to 0.2. In addition to my urologist and consults with Med Onc and Rad Onc, I am seeing and integrative health MD to ensure optimal nutrition and overall health. Blood tests revealed abnormally high estradiol levels and the Genova Estronex Urine Profile revealed a very high level of the 4-0HE type of estrogen which apparently can contribute to increased cancer risk. My integrative health doc is concerned about the estrogen levels, but my urologist, MO and RO are not. I am concerned that if I lower estrogen that my testosterone will increase. Does anyone have any info on the relationship of estrogen to risk/progression of PC? Thanks.

[Hidden]

Patrick and Nal are the authorities in this but I can tell you what I have learned from my research. It is the ratio of T to E2 that is more important to the absolute value of E2 that the two aforementioned gentlemen like to maintain around 20. Slicing level of the order of 150:1, the higher the better, is my rule. But you will get more solid information from them.

[B_Sprout in reply to Hidden]

Thanks. I'll need to learn more about the T to E2 ratio.

[Tall_Allen]

Estrogen was the first medicine used against prostate cancer, and it is getting another look. It was abandoned because estrogen pills caused dangerous blood clots, but with the more even serum levels from transdermals, that is less of a problem. It may contribute to risk of some cancers (like breast cancer) but not to prostate cancer. If you take an aromatase inhibitor, like anastrozole, T and DHT levels may increase somewhat because you've blocked one of the metabolic pathways your body uses to get rid of excess T. If it's not bothering you (e.g., causing blood clots or gynecomastia), it's probably best to leave it alone.

[B_Sprout in reply to Tall_Allen]

Thanks. What you are saying is consistent with what I have heard from my Uro, RO and MO at U of Penn. Estrogen's relationship to prostate cancer cancer seems to be complex. The attached article also implicates estrogen as an agent contributing to the cause and progression of prostate cancer. With my estradiol level at 89 pg/mL and the normal high end of range being 42, my integrative health doc thinks this may be an issue. Perhaps a consult with an endocrinologist, as Stevecavill suggested would be good idea.

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

[Tall_Allen in reply to B_Sprout]

I agree that the relationship between all steroids (e.g., estrogen, testosterone, progesterone, corticosteroids, Vitamin D, etc.) and prostate cancer is complex and changes as the cancer evolves. That article only discusses lab studies, whereas, for you as a patient, it is only the clinical studies that really matter.

[B_Sprout in reply to Tall_Allen]

Good point, thanks.

[Stevecavill]

My fairly un-medical understanding is that oestrogen is actually made from testosterone. Lowering oestrogen shouldn’t raise testosterone. They’re not opposites. I always assumed the “menopause” like side-effects of adt were because we were reducing oestrogen as well as Testosterone.

A consult with a endocrinologist could be a good idea.

[B_Sprout]

thanks. perhaps consult with an endo would be a good idea.