A new study led by researchers at UCL shows that hormone patches could be as effective as injections for controlling locally advanced prostate cancer. The research was published in The New England Journal of Medicine.
Men with prostate cancer that has spread just outside the prostate often need hormone therapy. This therapy lowers testosterone, a hormone that cancer cells use to grow. Usually, this is done with injections that block testosterone production. The new study tested whether hormone patches could offer the same benefits but with fewer side effects. The current injection requires mutliple hospital visits or GP visits, whereas oestradiol patches can be put on by patients at home. These patches release oestradiol, a form of estrogen, through the skin. Oestradiol reduces testosterone while adding estrogen to the body.
The study included 1,360 men with locally advanced, non-metastatic prostate cancer, meaning their cancer had not spread to other organs. They were randomly assigned to receive either the traditional injections or the oestradiol patches. After three or more years, the results showed that both treatments controlled the cancer equally well. About 87% of men using the patches were alive without cancer spreading. This was very similar to 86% in the injection group.
One key advantage of the patches is convenience. Injections often require repeated visits to hospitals or GP clinics. In contrast, patches can be applied at home by the patient. This reduces travel, clinic time, and stress. Side effects were also different between the two treatments. Injections lower both testosterone and estrogen levels. Low estrogen can cause hot flushes, bone weakness, and higher risks of heart problems, including high cholesterol, high blood pressure, and high blood sugar.
Patches add estrogen while lowering testosterone, so men experience fewer side effects from low estrogen. In the study, only 44% of men using patches reported hot flushes, compared to 89% in the injection group. However, some side effects were more common with patches. Breast tissue swelling, called gynaecomastia, affected 85% of patch users, while 42% of men on injections experienced this condition.
Bone health also improved with patches. Five years after starting treatment, 2.8% of men using patches had bone fractures, compared to 5.8% of men using injections. Previous research has shown that overall quality of life is better for men using patches. They feel more comfortable and experience fewer hormone-related symptoms.
Experts say this research could give men more choice in their treatment. Professor Ruth Langley, the lead author from the MRC Clinical Trials Unit at UCL, said, “Men should be able to choose the hormone therapy that suits them best. Some men are very affected by hot flushes. For them, patches could improve their quality of life significantly.”
Simon Grieveson, Assistant Director of Research at Prostate Cancer UK, commented, “Hormone therapy is common and effective, but it can cause serious side effects. The PATCH and STAMPEDE trials show that patches are just as effective as injections at delaying cancer progression. They also result in fewer hot flushes and are less invasive, giving men more choice in their care.”
Caroline Geraghty, senior specialist nurse manager at Cancer Research UK, added, “Prostate cancer is the most common cancer in men in the UK. Thanks to research, more than eight in ten men now survive 10 years or more after diagnosis. It is important not only to extend life but also to make treatments kinder. This trial shows that hormone patches can do both.”
Dr Duncan Gilbert, a consultant clinical oncologist from Sussex who recruited many patients to the study, said, “These results reflect years of hard work and the dedication of patients who took part. The easier administration and better side-effect profile make patches a real option for patients.”
Currently, oestradiol patches are only licensed for hormone replacement therapy in women, not for prostate cancer. This means doctors must prescribe them “off-label,” which some may hesitate to do. For the patches to be officially approved for prostate cancer, a manufacturer must apply for a license. In the UK, this is handled by the Medicines and Healthcare Products Regulatory Agency (MHRA), and in the US, by the Food and Drug Administration (FDA). Companies that already sell oestradiol patches could extend their license to include prostate cancer treatment.
The researchers hope that wider availability will give men more treatment options. Professor Langley said, “We want men to have a real choice in hormone therapy, improving both survival and quality of life.”
The participants in this study were recruited between 2007 and 2022 from 75 centers across the UK, as part of the UCL-led PATCH and STAMPEDE trials. The trial was sponsored initially by Imperial College London, then by UCL, and funded by Cancer Research UK and the UKRI Medical Research Council Clinical Trials Unit.
UCL’s commercial arm, UCL Business Ltd, is working with Professor Langley’s team to explore licensing options. Their goal is to make these patches widely available to men with prostate cancer. This study highlights that hormone patches could be a safer, simpler, and more convenient alternative to injections for men with locally advanced prostate cancer, offering effective cancer control with fewer disruptive side effects.
