Transdermal estradiol for prostate cancer: how do patients compare it to other options for androgen deprivation therapy?

Carly Sears¹, Richard Wassersug^2,*, Eric Brown³, Paul Schellhammer⁴, Robert Watson⁵
1 University of Calgary, Calgary, AB, Canada
2 Faculty of Medicine, Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, BC, Canada
3 Simon Fraser University, Vancouver, BC, Canada
4 Macon and Joan Brock Virginia Health Sciences, Eastern Virginia Medical School, Norfolk, VA, USA
5 Sandia National Laboratories (Ret.), Albuquerque, NM, USA
* Corresponding Author: Richard Wassersug. Email: email

Canadian Journal of Urology https://doi.org/10.32604/cju.2026.075285

Received 29 October 2025; Accepted 01 April 2026; Published online 09 May 2026

Abstract

Backgrounds: The PATCH/STAMPEDE trial [NCT00303784] in the UK has established that transdermal estradiol (tE2) offers equally effective cancer control for systemic prostate cancer (PCa) as standard androgen deprivation therapy (ADT) with luteinizing hormone-releasing hormone agonists alone or combined with androgen receptor pathway inhibitors. ADT with tE2 provides significantly better quality of life. However, there are no tE2 products specifically licensed for PCa patients and little evidence on whether PCa patients would be interested in using tE2 for ADT compared to other ADT options. Given that background, we used an online survey to explore PCa patients’ reservations versus enthusiasm for tE2 as an option for ADT compared to standard ADT. We also assessed patient preferences for various forms of tE2 administration. The objective of this exploratory study was therefore to assess PCa patients’ interest in and concerns about alternative forms of ADT. Methods: From 13 March–26 May 2025, we conducted a cross-sectional online survey of men diagnosed with PCa, who were accrued via PCa support organizations in Canada and the USA. The survey included both multiple-choice and an open-ended question. Results: Eight hundred and twenty-seven PCa patients completed the survey: 45% from the USA, 41% from Canada, 14% from outside North America. Overall, interest in tE2 was high, with >95% of patients wanting tE2 to be a standard of care option for ADT in their country. In terms of positive versus negative comments on ADT, out of 86 comments on standard ADT, 80% were negative. In contrast, out of 23 comments on tE2, none was negative. The great majority (72%) of participants were willing to pay for tE2 off-label and even more (76%) said they would be willing to consult with more than one physician for an off-label prescription. The highest interest in tE2 came from PCa patients who have never been on ADT. Older patients had significantly less concern about gynecomastia, but this did not predict interest in tE2. About 2.8 times more men reported a preference for daily topical tE2 cream/gel products versus multiple tE2 patches changed twice a week. Conclusions: Our survey establishes that men with PCa believe that tE2 products should be among the standard of care options for ADT and that tE2 side effects are more manageable than those of standard ADT drugs. For administering E2, patients preferred daily topical application of a gel or cream to wearing multiple patches.