Hormone patches are as effective as injections for treating non-metastatic prostate cancer
26 Mar 2026
Prostate cancer is the most common cancer among men. Worldwide, about 1.4 million men were diagnosed with prostate cancer in 2020, and many of them had advanced prostate cancer.
Prostate cancer needs the male hormone testosterone to grow. Patients whose prostate cancer has spread beyond the prostate or is at high risk of doing so receive treatments to lower testosterone. This is called hormone therapy or androgen deprivation therapy.
The most common way of lowering testosterone is with LHRH analogues (LHRHa) injections. These drugs lower both testosterone and oestrogen levels, causing several side effects. Low levels of testosterone cause impotence and muscle weakness. Low levels of oestrogen cause hot flushes, bone problems and increase risk factors for heart disease.
An alternative approach to hormone therapy is oestradiol patches. They lower testosterone but avoid the side-effects caused by low oestrogen levels.
The PATCH and STAMPEDE trial networks worked together to find out whether oestradiol patches were as good as LHRHa injections, in terms of how long people lived without their prostate cancer spreading, and compared the side-effect profiles.
The results published yesterday in The New England Journal of Medicine include a total of 1,360 men with non-metastatic prostate cancer. Participants were randomly assigned to start hormone therapy with either one of two treatments:
- 639 were given the current standard-of-care LHRHa injections
- 721 were given transdermal oestradiol patches
As part of their treatment, some participants also received radiotherapy to the prostate and chemotherapy using the drug docetaxel in addition to hormone therapy.
After following all participants for at least three years, and some for more than 15 years, the study found that oestradiol patches were as good as LHRHa injections at treating non-metastatic prostate cancer.
After three years, 91% of those started on oestradiol patches were alive, with 87% alive without their cancer spreading. Among those started on LHRHa injections, 90% were alive after three years, and 86% alive without their cancer spreading.
Hot flushes were much less common among those using patches; 44% reported them compared to 89% in the injection group. However, breast tissue swelling (gynaecomastia) was more frequent with patches, affecting 85% of participants compared to 42% of those on injections. The number of patients experiencing bone fractures 5 years after entering the trial was 2.8% in those who had oestradiol patches, versus 5.8% of those who had LHRHa injections.
Previous studies comparing oestradiol patches to LHRHa have shown that overall quality of life scores are better in men receiving the patches compared to the injections, and there is no increase in heart or blood clotting problems with the patches.
These results provide patients with a choice about their approach to hormone therapy, both in terms of the expected range of side-effects and how the treatment is delivered.
The oestradiol patches used in the trial are the same as those used in hormone replacement therapy to treat menopause symptoms in women. These patches are currently not licensed to treat prostate cancer, meaning they need to be prescribed “off-label” (i.e., outside approved use). Some healthcare providers may be reluctant to do this.
For these patches to be approved as treatment for prostate cancer, a manufacturer would need to apply for a license covering this new use. An easier and faster option is for a company that already sells oestradiol patches for another purpose to extend its existing license so that it also covers prostate cancer treatment.
The participants in this study were recruited between 2007 and 2022 from 75 centres in the UK. The study was sponsored initially by Imperial College London and then University College London and funded by Cancer Research UK and the UKRI Medical Research Council (MRC) Clinical Trials Unit.
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