Why Guideline Support Is Key to Estradiol Adoption in Prostate Cancer

For men on long-term prostate cancer therapy, quality of life matters. In the final installment in a 5-part series, Richard Wassersug, PhD, and Paul F. Schellhammer, MD, FACS, discuss strategies for establishing transdermal estradiol as a recognized therapy for men undergoing androgen deprivation therapy (ADT) for prostate cancer. They emphasize the need to present compelling evidence to patients, physicians, payers, and licensing authorities, highlighting that no pharmaceutical companies currently produce estradiol products specifically licensed for men. Schellhammer shares his personal experience with intermittent estradiol therapy during clinical trials, noting its positive impact on quality of life compared with traditional LHRH analogues.

Both experts stress that physician adoption depends heavily on guideline recognition. They identify major oncology and urology organizations—including the National Comprehensive Cancer Network, American Society of Clinical Oncology, the American Urological Association, and the Society of Urologic Oncology—as key targets for guideline inclusion, which would legitimize transdermal estradiol as a viable therapeutic option and facilitate shared decision-making between patients and physicians. Publication of high-quality, evidence-based research is viewed as essential for this effort.

Wassersug reflects on their shared history, noting that both he and Schellhammer explored transdermal estradiol prior to definitive trial results. He describes preclinical work demonstrating estradiol’s benefits in castrated male rats, including improved REM sleep, reduced fatigue, and partial preservation of sexual interest—findings with potential relevance to patients’ well-being.

The conversation highlights the transformative potential of transdermal estradiol in prostate cancer therapy, contrasting it with existing ADT approaches and recent add-on treatments such as chemotherapy, immunotherapy, and receptor blockers. They note that estradiol could improve quality of life, maintain bone health, and reduce costs, representing a major shift in long-term prostate cancer management. Both conclude with a shared mission: to gain acceptance of transdermal estradiol as a standard-of-care option, emphasizing that their advocacy is motivated solely by patient benefit rather than financial interest.