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Dr. Tharun
Dr. Tharun, Urology Resident
Category: Urology
Satisfied Customers: 3550
Experience:  MBBS, DNB surgery and presently working as Urology resident towards the degree of Urologist.
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I have stage 4 prostate cancer and have been taking Bicalutamide

Resolved Question:

I have stage 4 prostate cancer and have been taking Bicalutamide 50mg for
past three months. No symptoms except sore back.
I am interested in a very new procedure ---Transdermal oestrogen patches.
Your thoughts please.
Submitted: 1 year ago.
Category: Urology
Expert:  Dr. Tharun replied 1 year ago.
Hello

Have you already tried leuprolide before trying bicalutamide?

What is your PSA level?

Have you been offered chemotherapy?

What did the bone scan show?

Please let me know

Dr.Tharun
Customer: replied 1 year ago.
PSA level now 700, was 1500.
I have only been on bicalutamide.
I am not interested in any invasive treatments or chemotherapy.
Bone scan showed spread of cancer throughout my skeleton.
Please tell me your thoughts on transdemal patches of oestrogen. Thank you. Peter
Expert:  Dr. Tharun replied 1 year ago.
HI Peter,

Usually bicalutamide is not given alone in cases of advanced prostate cancer.It is given along with other drugs especially leuprolide which is known as combined androgen blockade.Some studies have shown bicalutamide 150 mg alone as effective , but it is till not approved by the FDA.

So it is better to discuss with your doctor regarding the combination therapy rather than continuing the bicalutamide alone which is not the normal protocol in such scenarios.

Only if the combination therapy fails , we should be looking for novel therapies.Most of the patients do respond to the combination therapy and PSA drops to undetectable levels within 6- 8 weeks.

Regarding estrogen patches, estrogen is an antagonist to the testosterone and will act by opposing the action of testosterone.But it is not a complete block and PSA drop will not be as complete as the combination therapy.It should be considered as second or third line therapy for advanced prostate cancer.

I hope this answers your question and helps you take a decision.

Regards

Dr.Tharun
Customer: replied 1 year ago.
Still not clear to me Doctor.Estogen skin patch 1.25 to 2.5 mg three times per day is the route that now appears to me the best way to go. rather than injections of anything. Yes this is new but would you say no. Have you researched the subject or are just recommending the same old way? The Mayo Clinic is one of my sources. MNT medicalnewstoday.com another. Thank you. Peter Oakley
Expert:  Dr. Tharun replied 1 year ago.
HI

Injections (leuprolide) are given once every three months.Once given it is effective for 3 months.So within 3 shots or 6 months, the PSA drops to sub zero and the disease is controlled.The injections can be stopped once the PSA is sub zero till the PSA rises again.

It is definitely better than thrice daily patches for long time.Injections have patient compliance.Also estrogen are not without side effects.

Right now the consensus is start leuprolide as the first line therapy.Only if it fails estrogen can be used as second line or third line therapy.

Regards

Dr.Tharun
Customer: replied 1 year ago.
I quote LancetOncology---"The study dated 4th. March 2013 finds that HRT patches normally given to women to treat symptoms of menopause, lowered testosterone in men with prostate cancer to the same extent as LHRH injections."
They also state "current treatment relies on LHRHa to lower the amount of testosterone made by the testicles. BUT these can lead to serious side effects including osteoporosis, bone fractures and diabetes." Well Doctor, I repeat my question would you personally advise patches. If you haven't researched this subject recently please advise me. This is extremely important to me as you may imagine. Best wishes Peter
Expert:  Dr. Tharun replied 1 year ago.
Hi Peter,

Estrogen patches has revisited the lost interest of estrogen in prostate cancer.Earlier oral estrogen was used in prostate cancer but faded away due to the side effect profile it had.
Newer estrogen patches are supposed to avoid these side effects as they avoid the liver;and some studies has favorable results for these patches.These studies has shown lesser side effects as compared to LHRH agonists too.

But it is still too early to be included in any of cancer guidelines available today and cannot be considered as standard of care.But it can be taken in the setting of a clinical trial.I personally have very little experience with these patches and hence am slightly inclined against the usage of these patches for prostate cancer.But I would not dismiss it altogether.
Rest is your choice .You have the right to choose the best possible treatment available to you.

Dr.Tharun
Dr. Tharun, Urology Resident
Category: Urology
Satisfied Customers: 3550
Experience: MBBS, DNB surgery and presently working as Urology resident towards the degree of Urologist.
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