John, no there is not a lot of data that support your post. And you forgot one big question:
Is treating prostate cancer with a therapy that has a potentially higher risk of mortality than the disease itself a good plan to control biochemical relapse rates in prostate cancer?
I have seen Leibowitz state it at our UsTOO groups, but he is very clear that more work needs to be done to compare the efficacy of the regimen to the morbidities. This release by the FDA just may make his approach to do so a liability he may need to contend with.
You know where I come from by now on prostate cancer studies. Dr. Bob and his practice is not a study, and certainly I am not interested in any short term studies on the use of front line HT as a primary therapy except in intermediate or high risk cases. What studies that we do see have consistently shown front line HT to not perform as well as other options and we do have some pretty long ones.
John T said <my comments are in brackets>:
1. For localized PC has cure rates similar to other therapies.
<there is no study that shows this anywhere, in fact I can produce many that disagree entirely with this statement including the CaPSURE database. HT is not a cure for prostate cancer. Controlling PSA may work well for some patients, but that doe not make it a cure. HT does not offer the same cure rates of any generally accepted front line therapy>
2. All side affects are reversible once stopped.
<This is just plain false, in fact the release by the FDA indicates that many very serious side effects may linger forever and remain life threatening when the cancer never was>
3. Is not an invasive treatment
<Again this is entirely false. HT is a highly invasive systemic chemical therapy. The affected areas may and likely will include any of the following: the nervous system, endocrine system, cardiovascular system, and cause diabetes, cause severe depression and so much more. I can't imagine a more invasive therapy than a systemic therapy like this one. You must be thinking in terms of localized morbidities but with experience in three therapies, HT was by far the most invasive life altering one I was on>
4. Good option for patients that refuse surgery or radiation for personal reasons. <This one I agree with depending on the patients expectations. If a person is not well enough for surgical therapies or radiation then the use of HT as a front line therapy is reasonable. As long as he understands all the risk factors>
I agree with the negatives you posted. I will add a few that I personally witnessed:
5. Depression. Caused by low T levels, this one can affect your ability to maintain a good work out regimen that will bring all of the other SE's into play.
6. Many men suffer from severe respiratory ailments and are forced to stop the therapy. These ailments can lead to allergic reactions and even death.
7. Many men who go on HT even for a short time suffer from hypogonadism forever (low T levels). Typically the use of androgen replacement therapy is common.
I'm sure I can add more. I am not down on Lupron or any of it's competition and recognize that some can indeed do well on it as a front line therapy. But to tell people that have localized or locally spread prostate cancer that HT works just as good as other local therapies, all side effects go away, or it is not invasive is not a good representation of the facts that we do have. But HT does have it's place in our disease. And for those of us unlucky enough to qualify for it, we end up being thankful it is an option.
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas
Blog : www.caringbridge.org/visit/tonycrispino
Post Edited (TC-LasVegas) : 10/27/2010 5:04:15 PM (GMT-6)