N Engl J Med
Hormone patches go head-to-head with standard ADT in locally advanced prostate cancer
Clinical takeaway: For men with locally advanced prostate cancer, transdermal estradiol offers noninferior cancer control with fewer vasomotor symptoms, making it a reasonable ADT alternative to discuss when metabolic, bone, or quality-of-life issues are a concern.
In the phase 3 PATCH trial, 1,360 men with locally advanced, nonmetastatic prostate cancer were randomized to transdermal estradiol patches or standard luteinizing hormone-releasing hormone (LHRH) agonists. At 3 years, metastasis-free survival was 87.1% with estradiol vs. 85.9% with LHRH therapy, meeting prespecified criteria for noninferiority (hazard ratio, 0.96). Castrate testosterone levels (<1.7 nmol/L) were maintained in ~85% of patients in both groups during the first year. Five-year overall survival was also similar (81.1% vs. 79.2%). Adverse-effect profiles diverged: hot flashes were markedly less common with estradiol (44% vs. 89%; grade ≥2: 8% vs. 37%), while gynecomastia was more frequent (85% vs. 42%; grade ≥2: 37% vs. 9%). Cardiovascular outcomes were comparable, alleviating concerns from earlier oral estrogen studies.
Source:
Langley RE, et al; STAMPEDE-1 and PATCH Investigators. (2026, March 25). N Engl J Med. Transdermal Estradiol Patches in Locally Advanced Prostate Cancer. https://pubmed.ncbi.nlm.nih.gov/41880608/
