Do IADT Risks Outweigh Benefits?

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Mitch128
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Date Joined Aug 2010
Total Posts : 83
   Posted 9/14/2010 7:58 PM (GMT -6)   

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Of real concern to me and, perhaps, others here is the following recently released article. Since Intermittent Androgen Deprivation Therapy (IADT) is the next planned treatment in my PCa journey, I would appreciate ANY comments/feedback

"A new report published in the American Cancer Society journal, CA: A Cancer Journal for Clinicians, and in the American Heart Association journal, Circulation, reveals that androgen-deprivation therapy (ADT), a type of prostate cancer treatment, can increase heart risk factors and possibly lead to heart attack or cardiac death.

A writing group of experts from the American Heart Association, the American Cancer Society, the American Urological Association, and the American Society for Therapeutic Radiology and Oncology published their findings that indicate that ADT leads to increased fat mass, increased low-density lipoprotein (LDL) cholesterol, the "bad" form of cholesterol, and blood sugar abnormalities.

The goal of ADT is to reduce male hormonal levels in order to decrease the rate at which cancer cells grow and spread in the prostate. By limiting the two primary male androgens - testosterone and dihydrotestosterone - Western medicine theory purports that prostate cancer can be better combated. The American Cancer Society, however, admits that ADT and other forms of hormone therapy do not actually cure prostate cancer (this is a known - remission is the goal. Mitch).

The advisory panel that oversaw the study noted that, while ADT does seem to increase one's risk of having future cardiovascular problems, the patient should evaluate whether the alleged benefits of ADT are worth it in comparison. The group also stressed its belief that prostate cancer patients should consult only the physician who is actually treating the cancer for help in making the decision, without referral to any other outside specialists.

Interestingly, studies pertaining to the effects of low testosterone levels in men have determined that the condition, known as hypogonadism, leads to cardiovascular disease and death. Low serum testosterone levels are also known to increase a man's risk of developing diabetes, metabolic syndrome, and dyslipidemia. Men who undergo ADT experience the same increased risk factors due to their testosterone levels being artificially reduced.

Many men who have undergone ADT also experience long-term difficulty achieving proper testosterone levels following the treatment. Many have reported that they are unable to sustain proper male hormonal levels at all following ADT, summoning them to a life of illness and premature death.

If ADT does not cure prostate cancer and permanently blocks male hormones from properly circulating in the body, why would anyone endorse such a treatment? There does not seem to be any logical answer to this question other than that it is recommended by mainstream cancer experts to assist in treatment; therefore, many simply jump on the bandwagon."

Thanks, Mitch
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Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 9/14/2010 8:14 PM (GMT -6)   
Mitch, I am not well-versed in HT, so I cannot comment in detail; however, I do believe it is more than "jumping on the bandwagon." You did say that you understood it does not cure PC; it's purpose is to control PC.

My wife recently took a drug that had 3.5 pages of side effects and warnings listed. They were bulleted (one effect/warning per bullet), single spaced, and 8.5"x11" paper. Bottom line: more good than harm (hopefully).
 
 
added as edit:  The point is, I believe, that if one needs to consider other health concerns before taking this or any drug/medication...there is no one-size-fits-all solution.  Lots of older men have PC; lots of older men also have heart conditions.  HT might not be the best for everyone.  As Dr Myers says, "Prostate cancer is like golf.  You need to play it as it lies.  Because the disease is variable, each treatment solution requires a unique strategy."

Post Edited (Casey59) : 9/14/2010 7:22:26 PM (GMT-6)


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 9/14/2010 8:17 PM (GMT -6)   
The electric chair or the gallows ?

I have seen too many men on here gain valuable years with a good qol to believe that the risk of heart attack or some other potential future malady isn't worth it. If ADT is my last course of action, I will risk it, if I can have a few more years maybe even months with my family.

Plus, my odds of heart attack are probably already pretty good just being a 59 year old male who hasn't always followed a heart healthy diet.
Goodlife
 
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01
1 year psa (364 days) .01
15 month PSA <.01

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3892
   Posted 9/14/2010 8:57 PM (GMT -6)   
Mitch, are you aware of the survival chances for men with metastatic disease? Walsh's book, page 474...

Few men live long enough for bone loss and cardiac problems to matter much... The handful that DO survive 10 years or more undoubtedly need to take special precautions to guard against these conditions..

Good Luck to you brother...Welcome to the forum...

(Surviving Prostate Cancer by Dr. Patrick Walsh)

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3996
   Posted 9/14/2010 9:02 PM (GMT -6)   
wow. here we go again!  sounds like whoever wrote that article doesn't know what the hell he's talking about.
 
ed
age: 55
PSA on 12/09: 6.8
no symptoms, no prostate enlargement
12/12 cores positive....gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10

Aprilsunny
New Member


Date Joined Jan 2010
Total Posts : 15
   Posted 9/14/2010 9:08 PM (GMT -6)   
If you want to read the article in Circulation, it is available here. (Found through a Pubmed search). The summary seems less conclusive than the text you quote.

The writing group thus believes at this time that it is appropriate to state that there may be a relationship between ADT and cardiovascular risk. Future clinical trials of ADT should prospectively assess cardiovascular risk factors before and after ADT is begun and should prospectively monitor patients for adverse cardiovascular events and mortality.

A recent Swedish study concludes:

Because ET is currently the only effective treatment for metastatic disease and the ARDs were rather small, our findings indicate that CVD risk should be considered when prescribing ET but should not constitute a contraindication when the expected gain is tangible. (ET = endocrine therapy, aka hormone therapy)

D***ed if you do, etc.

Good luck!

Post Edited (Aprilsunny) : 9/14/2010 8:11:35 PM (GMT-6)


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 9/14/2010 9:29 PM (GMT -6)   
According to Dr Scholz the risk of cardiac issues comes from the weight gain associated with HT and not HT itself. If you control your diet and excercise, including weight training the risks diappear.
JT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 9/14/2010 11:01 PM (GMT -6)   
Mitch, hello and welcome.

For starters, HT is not meant to be a curative means to PC. At best, it can control the growth, slow things down, and even mask the PSA buying time for the patient.

Your only curative means in these times, are surgery or radiation, and sometimes HT is mixed in with those choices.

If you have already used up your curative cards, and still have the cancer, then looking at HT, side effects and risks, takes on a whole other look. Some men here are in that boat, and this subject weighs heavy on their minds and hearts.

Not as cut and dry as your original post.

If you are in the advanced PC ranks, and have no cure hopes left, the risk of having a heart attack or being too fat, would be the least of your troubles.

We have some good folks here with first hand experience on HT, I am no one, that would be glad to help you on it.

David in SC
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, on Catheter #21, will be having Ileal Conduit Surgery in Sept.

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 9/15/2010 7:42 AM (GMT -6)   
You might want to read Dr. Strum's book- A Primer on Prostate Cancer-The Empowered Patients Guide he talked about IADT and contiuous ADT and you can learn about plenty in his book, he is a leading oncologist specialist in PCa...has treated about every scenario in PCa possible, whereas Dr. Walsh-surgeon (although wise...has not treated these same patients or would have that background in totality, maybe he learned via book smarts or osmosis or such). Read all books in fairness to yourself. Then you can decide on those docs wisdom, get a well rounded education and even look at controversies...as this is the essence of PCa. AFTER reveiewing Dr. Walsh's book after this post (now editted) I see he has good information on this also, might be book smarts, but is good reading on this subject.

Not that you want to hear this, but long term useage of LHRH (Lupron etc.), causes bone density losses, in bad scenarios fractures possible(disabling?) and spinal compression, in spinal compression could also end up with fecal incontinence (it is on the internet). Also memory loss, LOL with both heads! (is another side effect). Also can be effective at controlling PCa so I am not saying don't use it, it is a decision and trade off, as is most all protocols. It gets more complex after failing control on any one drug. Sorry it is not pleasant subject matter, I presume we want full disclosure ideas. John Hopkins wrote an article about long term useage...in effect...helped PCa to morph to refractive and aggressive stages, more controversy to consider. Maybe consider IADT just for those reasons mentioned or look at future alternatives...even those that are considered controversial..too...they all are that.

Post Edited (zufus) : 9/18/2010 6:30:56 AM (GMT-6)


Baptista
Regular Member


Date Joined Aug 2010
Total Posts : 84
   Posted 9/15/2010 10:27 AM (GMT -6)   
Hi Mitch

 

Your post touches my “wound” deeply. I am on that way and will be jumping into that bandwagon soon.

However, when considering other types of treatment as substitutes of HT we come with empty hands. In ten years of survival I haven’t seen anything new that could assure me a remission. More yet, I actually see more guys caring for the treatment of the side effects than to the treatment of the cancer itself.

Treatment Protocols start having a certain sense in me. After RP, then RT and now HT, that makes just part of it. If lucky of surviving any cardiovascular problem or metabolic syndrome, I might consider then a dose of chemo too, just to extend the days under the sun. Let’s be careful and be prepared in advance for what it may come.

 

Wishing you the best in your advents.

Baptista


Age: 50 at Dx on May/2000; PSA=22.4;
Asymptomatic; Negative DRE and MRI & Bone scan
6x cores biopsy positive; Gleason (2+3)=5
RP surgery performed Aug/2000 Dr Komatsu, Toranomon, Tokyo
Voluminous tumor; seminal vesicles & pelvic lymph nodes (9) negative; capsular penetration
Adenocarcinoma, well-differentiated; pT3apN0
Post-op lowest PSA=0.18 on Oct/2000;
Mar/2001 PSA=0.42 Biochemical Failure; Classified as Micro Metastasis
Watchful Waiting until PSA=3.55 on Sep/2005 (doubling average of14 months)
Nov/2006 SRT (3D IMRT; 68Gy in 37 fractions) Dr G. Vieira, CRMN, Portugal
Post RT PSA=2.28 on Jan/2007
Feb/2008 lowest nPSA=0.05
Aug/2008 MRI negative to metastasis
May/2009 Biochemical recurrence PSA=0.26
Aug/2010 PSA=0.79 (doubling time of 8 months)
Ten years Asymptomatic ; never incontinent
ED since RP; Anorectic symptoms during first year after SRT

Mitch128
Regular Member


Date Joined Aug 2010
Total Posts : 83
   Posted 9/15/2010 4:39 PM (GMT -6)   
Very comprehensive and well researched reply to my same post from Jim (IADTsince2000) on HealthBoards. If my post shows zero replies, refresh your browser.
 
I am, based on Jim's reply and after reading Dr. Snuffy Myers book "Beating Prostate Cancer: Hormonal Therapy & Diet", proceeding cautiously with IADT.
 
My first appointment is next Tuesday, with Dr. Gary Spitzer, who is a Medical Oncologist here Greenville, South Carolina. I made it clear when making the appointment that the purpose is for information gathering and free exchange of information only.
 
Thanks for everyone's comments, Mitch

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 9/15/2010 4:57 PM (GMT -6)   
Mitch, you grabbed my attention? Are you living in Upstate SC also? I know Dr. Spitzer, met him once before, has a good reputation. I live in Easley, just west of G-ville.

David in SC
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, on Catheter #21, will be having Ileal Conduit Surgery in Sept.

Mitch128
Regular Member


Date Joined Aug 2010
Total Posts : 83
   Posted 9/16/2010 6:55 AM (GMT -6)   
<< Mitch, you grabbed my attention? Are you living in Upstate SC also? I know Dr. Spitzer, met him once before, has a good reputation. I live in Easley, just west of G-ville. David in SC >>
 
David,
 
Yes, we live in Country Lakes near the Southern Oaks Golf Course - about 8 miles from Easley .
 
Thanks for the comments re: Dr. Spitzer - my anxiety level just went down a tad  confused
 
Mitch  

Red Nighthawk
Regular Member


Date Joined Oct 2009
Total Posts : 289
   Posted 9/17/2010 4:07 PM (GMT -6)   
Mitch, the person you referenced (IADTsince 2000), Jim from another board is the most knowledgable person on all things related to PCa and could probably get a Phd in the subject if there was one. The guy helped me immeasurably during those first few months after being diagnosed with his advice and council. Unfortunately, I was banned from that site for 'being too religious' so screw them! lol This board is far superior and I'm grateful I found it out of necessity.
Age: 63
Gleason grade: 3+4=7, present in both lobes, pT2c NX MX
Robotic RP: Sept. 15th, 2009
PSA's: .04, .03, .02, .05 (darn)
ED: Improvement slow but there are positive signs. No incontinent issues.
Surgery: Dr. Jim Hu. Dana-Farber/Brigham and Women's, Boston

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 9/17/2010 4:10 PM (GMT -6)   
Mitch, we have another brother here that lives close by, perhaps we should have a 3 way get together soon, perhaps when i am out of the hospital soon.
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, on Catheter #21, will be having Ileal Conduit Surgery in Sept.
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