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Cancer: Prostate Message Board


Cancer: Prostate Board Index


[COLOR="DarkGreen"]CONTINUED FROM INITIAL POST[/COLOR]

male breast enlargement,

[COLOR="darkgreen"]A substantial proportion of us experience some mild breast enlargement, including me, though it's mild enough that I can pass it off as well developed pectoral muscles (at least that's what I tell myself ;)). The Primer's table pegs the total percentage at 38%, about evenly split between mild (18%) and more substantial and bothersome (19%). The official literature does not list this in the records from the clinical trials.

This is much more of a problem with the anti-androgen drugs (such as Casodex, flutamide) used alone and not with the LHRH-agonist clase (such as Lupron, Zoladex, Viadur, Trelstar, etc.). The anti-androgens used alone often also cause tenderness and soreness in the breast. The usually recommended way to counter this is to get a short course of radiation to the breast up front, before the anti-androgen has been used for very long. However, while most doctors are comfortable with such radiation, Dr. Charles "Snuffy" Myers, one of the great experts in prostate cancer and especially hormonal therapy, is concerned that there could potentially be an increase in breast cancer downstream due to the radiation; I have not looked into research on this.[/COLOR]

[I]elevated blood pressure[/I],

[COLOR="darkgreen"]This is not addressed in either the Primer or the official table of trial results, but I suspect it is a side effect for at least a few patients. It is mentioned in the official literature as a rare side effect reported by fewer than 5% of patients. I'm also convinced that it can be countered with lifestyle countermeasures (diet/nutrition/supplements, exercise, and stress reduction). Of course, blood pressure medication can also be used.

I like to get my blood pressure checked because it always comes out good, in contrast to my initial PSA result. For instance, in January a year ago I was at 110/70 with a pulse of 60, not bad for a then 65 year old man, not on blood pressure medication, on hormonal blockade therapy for several months at that time. I'm convinced a lot of us can achieve such results.[/COLOR]

and [I]weight gain[/I].

[COLOR="darkgreen"]Oh yes, quite common - most of us will gain five pounds or more. It's a struggle to keep weight down, especially around the middle, as our metabolisms slow down on blockade. Also, carbohydrate foods, such as bread, appear to foster weight gain for those on blockade. I am fairly religious about exercising and diet, but I'm convinced I could drop the five pounds I've gained if I were even more diligent about exercise. I've known some men on blockade who did not gain weight, and they were especially diligent exercisers who also stuck to a diet.[/COLOR]

Based on my research, Androgen Deprivation therapy normally [I]precedes[/I] removal of the prostate and,

[COLOR="darkgreen"]Actually, while that sometimes happens, it is not common. Some doctors do use advance ADT to shrink the prostate before surgery, and perhaps the doctor who advises you is in that group.[/COLOR]

with any such treatment, [I]may [/I]evolve to a point where it becomes refractory.

[COLOR="darkgreen"]Okay, major soapbox time. :( In fact, give me a minute while I build the soapbox higher. :mad: (;))

Your point is true: it appears that most men relying on hormonal blockade [I]will [U]eventually[/U][/I] have the cancer develop so that it is able to grow despite a very low level of testosterone and DHT, [B][I][U]but: typically, that takes many years, may never happen, and survival after that point is substantial, all contrary to prevailing myth![/U][/I][/B] I've been at this as a layman survivor for ten years now, and I've heard and communicated with many doctors and researchers about prostate cancer. I would say that most are under the gross misimpression that hormonal blockade is only effective for a short time, such as 18 to 24 months. The experts I follow, who have managed many men on intermittent hormonal blockade for many years, now believe that for most men on well-managed first line hormonal blockade (especially triple blockade) [B][I][U]will control the cancer for either about ten to eleven years or indefinitely![/U][/I][/B] :D Obviously I would like to be in the latter group, but I've now passed the ten year mark and should be able to go on a vacation off-therapy period for more than a year, before commencing another (fourth) round of hormonal blockade; that should put me well beyond the eleven year point. :D

The myth about short survival after hormonal blockade no longer works well is that the average survival is around twenty months. Well, that's based on men who entered trials mostly over a decade ago, prior to many advances, and it counts survival from trial entry date rather than from the time the blockade no longer worked, a key difference! Some doctors associated with Case Western Reserve University looked into that, and they found that additional, post-blockade survival averaged 40 months (well over three years) if men had bone mets at the time, and [I][U]68 months if they did not have such mets! That's approaching six years! :D[/U][/I] When I first learned this, I added up the conservative figure of eleven years survival on triple blockade plus the five plus years for post first-line blockade survival, getting sixteen plus years, which boosted my morale! :jester: We also need to keep in mind that even that encouraging study was based on men being treated essentially in the 1990s, well before many of the advances in therapy and case management that we now enjoy. I can provide details including citations of the medical research, but those are the high points.

So yes, bottom line, the cancer is likely to work a way around hormonal blockade, but for most of us diagnosed in the modern era - before cases become far advanced, that is likely to take a long, long time.

And a post script to that bottom line: second line hormonal therapy often works very well for years for those who have eventually failed first line therapy. After that there is chemo, and likely Provenge (now pending FDA approval, probably on or by May 1 this year (2010).[/COLOR]

I recommend you discuss this approach with your physician for a better understanding of the treatment sequence.

[COLOR="darkgreen"]Such discussion is sometimes helpful, but frankly and bluntly, so many physicians using hormonal therapy for prostate cancer are ill informed that there is a good chance of getting poor advice. :( I strongly recommend the Primer, the book by Dr. Myers "Beating Prostate Cancer - Hormonal Therapy & Diet," and publications of the Prostate Cancer Research Institute, including its newsletter, "PCRI Insights." Many issues of Dr. Myers' own newsletter, "Prostate Forum", are invaluable for those of us on hormonal blockade. Leading doctors whose work regarding hormonal blockade that I follow closely include Stephen B. Strum, Mark Scholz, Richard Lam, Charles Myers, and Robert Leibowitz. In my opinion, they are about a decade ahead of conventional medicine regarding blockade therapy. There are other experts (including several Canadians who have made great contributions), but these are the ones I've paid most attention to. As a rule, for most of us, they are fond of using intermittent blockade rather than continuous therapy.[/COLOR]

BTW, I'm fighting the same battle as you and have, as the result of LUPRON research, decided on Orchiectomy (scheduled 3/15/2010) because of fewer, more manageable, side effects and some assurance of continuing a certain quality of life. I am 71.

[COLOR="darkgreen"]Mitch, you need to look at this again! An orchiectomy will cut off testosterone at least as effectively as drugs, and it's the virtual absence of testosterone that basically causes the side effects. You will have pretty much the same risks, as I understand it. What side effect risks do you think you will be avoiding? Those of us who know hormonal blockade can help you understand what will be going on after an orchiectomy. There's nothing wrong with that approach, except that it requires synthetic testosterone if you want to later take a vacation from the therapy; often, taking testosterone when you have succeeded in knocking the testosterone way down for a period is not a substantial problem in controlling the cancer.[/COLOR]

Ultimately it comes down to an informed personal decision for us all.

[COLOR="darkgreen"]You bet![/COLOR]

Best of luck in your physician guided decisions.

[COLOR="darkgreen"]As I said above, I'm a strong believer in patient empowerment in the hormonal blockade area. Actually, in my own oncologist's practice, in my local support group, I've been able to provide key information to the doctors, as well as learning from them.

Before closing, I would like to mention two other rather common side effects that mitch is not concerned about, perhaps due to his age of 71.

Decrease in libido - Quite common. Countermeasures may help.

Decrease in erectile function - Also quite common, and again, countermeasures may help.[/COLOR]

Mitch

[COLOR="darkgreen"]To all - take care and may you have low PSAs.

To Mitch, please be active on the board, and again, welcome! Your first post provided a lot of food for thought on some topics the board has not seen for a while.

Jim :wave:

PS - Mart16 raised the issue of
[U]insulin resistance[/U] in her post. That's an important side effect that has fairly recently received more attention. I've given a response about that and countermeasures in post #6, today.

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