Estrogen vs ADT?

[janebob99]

I've read 5 recent papers that discuss the use of estrogen as an alternative treatment to ADT (Lupron, etc.). The new data looks very favorable.

A bit of history. Huggins discovered this effect around 1941-44, and he found that high doses of estrogen (estradiol) efficiently castrated men, which, in turn, reduced prostate cancer. Soon after that, they prescribed DES, which, indeed, castrated men. But, it had bad side effects, primarily blood clots and other CV effects. So, it fell into disfavor.

Recently, in the last 10 years, researchers have used three, different estrogen sources: (1) estradiol phosphate (IM), (2) transdermal estrogen (estradiol E2) patch, and (3) a contraceptive pill with estetrol (E4), a different form of estrogen. Since none of these new sources are oral, they don't pass through the liver, which prevents the bad CV effects from happening.

The new estrogen sources have no difference in PCa mortality rates, according to one paper. Importantly, side effects are much less than ADT, including, but not limited to, reduced CV side effects, reduced hot flashes, reduced bone loss, reduced fatigue, improved libido, and improved Quality of Life (QoL). In most cases, bone mineral density stayed the same or increased over time with estrogen treatment.

The only downside of estrogen treatment is increased gynecomastia (breast enlargement) and increased nipple sensitivity.

If you send me your email address, I will send you .pdfs of the papers (one from 2023).

Bob

[Tall_Allen]

We are awaiting the results of the PATCH/STAMPEDE trial of estrogen patches vs GnRH agonists.

[janebob99 in reply to Tall_Allen]

Yes. It will be very exciting to see what they find.

[Nusch in reply to Tall_Allen]

When will the results be published?

[Tall_Allen in reply to Nusch]

IDK

[Nusch in reply to Tall_Allen]

Please help with IDK.

[Tall_Allen in reply to Nusch]

IDK=I don't know

[janebob99 in reply to Nusch]

I was told that the results of the Phase-III PATCH study comparing estrogen to Lupron will be published this Spring. It's been going on for 10 years now.

[Nusch in reply to janebob99]

wry interesting, let’s watch out.

[manbreast]

do you have breast growth now i have large breasts from estrogen induced gynecomastia

[janebob99 in reply to manbreast]

Yes, that would be a negative side effect of estrogen patch therapy.

Do you take estrogen supplements? What form?

[Lizzo30]

What about phytoestrogens ?

[janebob99]

Good question! I think they couldn't hurt. But, I worry that the dosage would not be high enough, compared to a transdermal patch or IM injection.

[Lizzo30 in reply to janebob99]

There are some very potent phytoestrogens Aguaje for example but it is not easy to source genuine aguaje

[Lost_Sheep]

I am not sure how to send a message to you, but I would like to have links to the 5 studies you mentioned. My prostatectomy October 2023 showed positive margins and I have a fairly aggressive cancer and now every medico I see is suggesting radiation and hormone therapy (Androgen deprivation). I do not like the side effects (SE) of ADT and have read (so far) that the SE of transdermal estrogen patches are much less. In two weeks, I should have my 90 day PSA results and want to be ready with my own thoughts on treatment options.

[janebob99 in reply to Lost_Sheep]

If you reply to me with your email, I will send you 10 papers on estrogen patch/gel therapy. It's very exciting. It's an excellent substitute for Lupron, etc. but without most of the side effects (you will still have muscle loss). I've talked with a Professor of Biology in British Columbia who has been taking estrogen gel (Estrogel) for 20 years instead of Lupron, etc, and he swears by it. When I eventually do SBRT radiation therapy, I will choose the estrogen route rather than Lupron ,etc. Most docs are not up to speed on this...so, give them a copy or two of the papers (especially the ones from 2024). If you end up doing traditional ADT, you might want to use Orogovyx (Relugolix) instead. It removers testosterone much faster than Lupron after you quit using it. Plus, it's a pill, which is more convenient.

Bob

[moon1878]

id love to see these studies as Im stopping ADT (Eligard ) after 6 months as the SE are having major mental negative impacts on me (suicidal thoughts - been there before) - trying maybe IADT but if need to go back on it really need an alternate .

[janebob99 in reply to moon1878]

Send me a private chat message with your email address and I will send you lots of papers on estrogen patch therapy. It's as effective as ADT, without the side effects.

I've also been suicidal in the past (but due to discontinuing anti-depressants). Doing well now on Abilify (a dopimine agonist).

You may want to consider starting testosterone replacement therapy (TRT) after your testosterone starts to recover somewhat.

I've been on TRT for over 20 years due to hypogonadism. It's safe for prostate cancer (see papers by A. Morgentaler at Harvard).

Hang in there. It will get better.

Bob

[janebob99]

Here's a plot of estrogen, testosterone and PSA versus time after starting estrogen patch therapy. You can see that estrogen therapy effectively castrates men (very low testosterone). PSA also drops rapidly after 3 months

Show this plot to your doctor.

Bob

Hormones versus time for estrogen patch therapy

[Lost_Sheep]

Which of the papers you refer to have those graphs, please? You sent me the 10 papers in .pdf format a few weeks ago.

Incidentally, my PSAs have been

13.3 the day before prostatectomy ( Oct 23, 2023)

1.33 5-6 weeks after surgery

1.79 Jan 16, 2024

2.1 Feb 3 2024

2.49 Feb 13, 2024

Either Orgovyx (Standard of Care) or Estrogen (if I can convince my doctors - which is uncertain)

[janebob99]

Ugh...meant to say "rise" not "rest".