CATEGORY: MEN’S HEALTH
Estrogen delivered through skin patches controlled locally advanced prostate cancer as well as the standard hormone injections in a randomized UK trial of 1,360 men—87.1% of patch users versus 85.9% of injection users were alive with no cancer spread three years in—while the share of men troubled by hot flashes fell by half, from 89% to 44%.1
Switching Off Testosterone, Two Different Ways
Most prostate cancers grow on testosterone, so a mainstay of treatment is hormone therapy—medicine that shuts the hormone off. The standard version is an injection of an LHRH agonist, a drug that silences the gland in the brain that tells the testes to make testosterone, given every one to three months. The trial tested a very different route to the same destination: patches of estradiol, the main form of estrogen, worn on the skin—typically four at a time, swapped for fresh ones twice a week—which quiet the same brain signal. Both routes worked: by one year, 85% of the men in each group had testosterone suppressed to the very low level the treatment aims for.1
Fifteen Years of Enrolling, One Direct Comparison
Between 2007 and 2022, researchers at 75 UK hospitals enrolled 1,360 men, at a median age of 72, whose cancer had grown locally or reached nearby lymph nodes but had not spread to distant parts of the body. Each man was assigned by chance to the patches or to the injections; because a patch on the skin cannot be disguised as an injection, everyone knew which treatment they were on, but the outcomes counted—cancer spread and death—leave little room for wishful reading. The study asked a deliberately conservative question: not whether patches beat injections, but whether they were at least as good, within a pre-set margin. They were. At three years, 87.1% of patch users and 85.9% of injection users were alive without distant spread, and at five years 81.1% and 79.2% were still living—no sign the patches gave anything away.1
The Estrogen Pill’s Old Failure, Retried Through the Skin
Estrogen is not a new idea in prostate cancer—pills of it controlled the disease back in the 1960s, and were abandoned because estrogen swallowed by mouth passes first through the liver, where it stirs up clotting factors that caused strokes, clots and heart deaths. The researchers’ bet, stated from the program’s start, was that skin delivery would sidestep exactly that: a patch—the same kind of adhesive square used for nicotine replacement or menopause hormones—feeds estradiol directly into the bloodstream, skipping the liver’s first pass. Long-term safety results from the same trial program bore the bet out, finding cardiovascular event rates similar in the two groups.2
Half the Hot Flashes, Fewer Fractures, More Breast Tenderness
The two treatments parted ways on side effects. Hot flashes—often the most wearing part of hormone therapy—affected 44% of patch users versus 89% of injection users, and the more severe kind affected 8% versus 37%. Because estrogen protects bone while standard hormone therapy thins it, fractures over five years were also less common with patches: 2.8% versus 5.8%. The trade runs the other way on the chest: gynecomastia—swelling or tenderness of breast tissue—occurred in 85% of patch users versus 42% with injections, though it was usually mild. Severe adverse events overall were slightly less common with the patches, 16% versus 19%. One practical note: the patches are applied at home rather than at appointments, but they are not yet licensed for prostate cancer—doctors can currently prescribe them only off-label while the trial team pursues regulatory approval.1
Key Takeaways
- In a randomized UK trial of 1,360 men with locally advanced prostate cancer, estrogen skin patches matched standard hormone injections—87.1% versus 85.9% were alive without cancer spread at three years, with five-year survival also similar.
- Patch users had far fewer hot flashes (44% versus 89%) and fewer fractures over five years (2.8% versus 5.8%), but much more breast swelling or tenderness (85% versus 42%).
- Long-term results from the same trial program found similar cardiovascular event rates in both groups—the heart harm that ended estrogen pills for prostate cancer in the last century did not appear with skin delivery.
- Estradiol patches are not yet licensed for prostate cancer; the treatment is currently available only by off-label prescription while approval is sought.
References
- Langley RE, Gilbert DC, Mangar S, et al. Transdermal Estradiol Patches in Locally Advanced Prostate Cancer. New England Journal of Medicine. 2026;394(16):1595–1607. link
- Langley RE, Gilbert DC, Duong T, et al. Transdermal oestradiol for androgen suppression in prostate cancer: long-term cardiovascular outcomes from the randomised Prostate Adenocarcinoma Transcutaneous Hormone (PATCH) trial programme. The Lancet. 2021;397(10274):581–591. link