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I am very happy to allow this discussion, because it is an important one. I am sure that calm heads will prevail:-) - after all they do MOST of the time! As far as I know the liver by-pass you mention is an important element in the use of estradiol patches.
I'd just like to add my two cents/tuppence worth.
1. Although you say I'm presently on a vacation from Lupron/Casodex and know that sooner or later I will most likely go refractory on the ADT2 that ain't neccessarily so. There are many (anecdotal) examples of men, especially those on an intermittent therapy who never go hormone refractory. You know, there are 'medical beliefs' sometimes which run contrary to observed outcomes. This is often because the doctors rely on s cientific studies and there is little financial reason to produce a study to show that intermittent therapy can be better than continuous therapy.
2. Dr Fernand Premoli in Argentina has done a good deal of work with estradiol patches. He finds it extremely frustrating that he cannot get the results of his studies published in the US - and again one cannot help but wonder if the reasons for this are financial. I am sure he will be happy to respond to you if you mail him. His address is fernandopremoli@argentina.com Be aware of the fact that English is not his first language, although he is pretty fluent in it.
I've dropped him a line inviting him to see this post, but he is a very busy man and I do not expect him to have the time to monitor Forums such as these.
I talked to Dr. Premoli way back and glad I did. Patches or estradiol gel can be effective and looks like less risk maybe. (exception as always in PCa)- I knew of a guy Harryakrie forum name whom got a DVT using patches, so nothing is guaranteed. However, his risk factors for blood clots might have been totally ignored by his doc, I am not sure he got an INR Pro-time coagulation blood test and maybe I think he did not use aspirin or coumadin, either. One of the leaders of UsToo is on year 5+ on estradiol useage. You will love this compared to LHRH or casodex...side effects.
Don't forget about emcyt (estramustine), Dr. Fred Lee has been using this one for along time and is 27 yrs. PCa survivor. Dr. Bob Baladament his friend (surgeon guy) says Dr. Lee is 25 yrs. with know PCa spread (mets), he said at a seminar meeting, I had him repeat that message to be clear on that statement. Results are priceless.
How about anyone interested coming up with some questions and I can then ask Dr Premoli to provide answers when he has time and I can post the resultant answers in the ADT section of the site.
So....over to you blokes. Post your questions here.
1) Does the Gleason score affect the dose required ?
2) Does the Gleason score affect the length of time the treatment might be effective for ?
In other words: Is this more successful with lower Gleason grades or is there little difference ?
3) Does the original staging affect results ?
Do those with bone mets or lymph involvement for example, expect much poorer results ?
4) Do younger men ( say 50 - 65 ) have equal expected response to the treatment. Or is this more successful for the elderly cases, where the natural testosterone production may have decreased ?
5) I understand that the patches remove the danger of thrombosis due to by-passing metabolism by the liver; but I wondered if any liver function changes or other reactions have been observed ?
6) Does the history of PSA doubling time affect the outcome or durability of the treatment ?
7) Is there a role for using the patches as part of Intermittent Hormone Treatment using testosterone blockers etc.? For use on the Off-period when LHRH and/or anti-androgens such as Casodex are discontinued for a while.
8) When is the optimum time in the normal progression of treatments for prostate cancer to initiate the patches ? Earlier the better or as a second or third line treatment ?
9) This treatment best before chemotherapy or better results afterwards ?
10) I understand that the patches may also be effective for what is called androgen independent P.Ca.( or androgen resistant). Is this verified by any of your findings ?
I have seen other men use: climara or vivelle brands
I don't claim to know alot on this, I have talked to Dr. Premoli in the past and have seen others get results using patches or gel. Side effects should be minimal, I have used DES 1-mg for years, sometime intermittent and still using it...since is has outperformed my ADT3 with psa results and side effects, since these are in the estrogenic family...should be some overlapp. It will cancel side effects of Lupron, like hot flashes and sweats, it did so in me within like 10 days or so way back in 2004 era.
Example of costs in USA dollars but bought from Canada:
Climara generic version 50 mcg 8 patches= $30
Vivelle .025/24hr. 40 count= $150
Could be twice that in USA, insurance might pay for all of it anyway.
