Dr. Samadi "Androgen deprivation therapy is overused, and now may be even more dangerous than..

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BobCape
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Date Joined Jun 2010
Total Posts : 416
   Posted 12/8/2010 6:01 PM (GMT -6)   
I know many trust this Doctor, so I wanted to share the article.. 
 
"Additionally, the length of time patients received the hormone therapy increased their risk of developing colorectal cancer."
 
 
Good wishes to you all tonight.
 
Bob on Cape Cod.

Purgatory
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Date Joined Oct 2008
Total Posts : 25380
   Posted 12/8/2010 6:08 PM (GMT -6)   
Interesting, but how many people use HT as a primary treatment for any level of PC.

But he also said from your article:

"Not many patients realize that there is usually a 40 percent upgrading of the disease after the prostate is removed, which is also a strong argument against radiation as the primary treatment for prostate cancer," he said.

That won't make the fans of radiation as a primary treatment very happy.

David
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 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

Fairwind
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Date Joined Jul 2010
Total Posts : 3742
   Posted 12/8/2010 7:02 PM (GMT -6)   
The Urology profession needs to get together and clean up their act, before the rest of the medical profession regards them all as a bunch of quacks, giving their patients poor and conflicting advice, "experts" expounding completely different recommendations based on questionable research and studies.. Primary Care physicians will have a hard time getting their patients to make an appointment with a urologist if those doctors continue to lose credibility and books like "Invasion Of The Prostate Snatchers" sell millions of copies..

Julietinthewoods
Regular Member


Date Joined Sep 2010
Total Posts : 309
   Posted 12/8/2010 7:15 PM (GMT -6)   
Do many men use HT in conjunction with primary radiation treatment? I thought it was more commonly combined with radiation as secondary therapy after surgical failure.

Which also makes me wonder...just what are the statistics regarding the percentage of men who must seek further treatment after surgery?

I also wonder if the focus shouldn't be more on dealing with weight gain that leads to the diabetes. Apparently, HT does prolong lives.

There just are no easy answers for anyone. Wishing that each therapy could be perfected for the benefit of each different patient....

Juliet

Fairwind
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   Posted 12/8/2010 7:27 PM (GMT -6)   
As far as Urologists are concerned, if their patients die of heart attacks, isn't that a "positive outcome"??

BobCape
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Date Joined Jun 2010
Total Posts : 416
   Posted 12/8/2010 7:27 PM (GMT -6)   
I agree with you Fairwind. It really is unfortunate how so much conflicting information is out there. For example, the way the doctors talk about it, my upcoming radiation treatment is "just cleaning up the leftover cancer cells" that remained after RRP. Yet I see it as "darn, had the surgery, psa rose again, radiation (yuk) is my next best hope, and then i'm left with Hormone stuff..? Then you look at the stats.. I dont know if I'm looking at 5 years or 15, or 30.. It's like a friggen merry go round, the whole thing.

If my urologist has done 2,000 RRP surgeries, and it looks like 10%+- who have pca die from it each year, then he's lost hundreds of prostate patients.. so I guess I shouldn't expect any special urgency or concern about my personal situation. I dunno.

F8
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Date Joined Feb 2010
Total Posts : 3800
   Posted 12/8/2010 7:36 PM (GMT -6)   
>>That won't make the fans of radiation as a primary treatment very happy.<<
 
or the guys who experience BR after surgery who are then forced into SRT in a glandless prostate bed which isn't as effective and can produce serious side effect -- ED, incontinence -- than if they opted for a combined radiation treatment in the first place.  the 40% thing is also pretty common knowledge.
 
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

BobCape
Regular Member


Date Joined Jun 2010
Total Posts : 416
   Posted 12/8/2010 7:44 PM (GMT -6)   
"Not many patients realize that there is usually a 40 percent upgrading of the disease after the prostate is removed, which is also a strong argument against radiation as the primary treatment for prostate cancer,"

Again, I dont understand. My drs told me that they would have done radiation instead of surgery had they known the pca had escaped the prostate.

Sounds like there's a good reason to head for the hills no matter what they tell you.

F8
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Date Joined Feb 2010
Total Posts : 3800
   Posted 12/8/2010 7:51 PM (GMT -6)   
my urologist is a very accomlpished open prostate surgeon.  his partner is a very accomplished da vinci surgeon.  my urologist said i was not a good candidate for surgery because i had a 60% chance that the disease was out of the capsule and a good chance it was still local (if it had escaped).
 
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

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 12/8/2010 8:14 PM (GMT -6)   
bob, one of my standard arguments: if the experts and doctors can't even agree, what chance other than luck/chance do we patients really have in our decisions

ed: sounds like you had a good uro, not all of them steer people into surgery as the conspiracy theory guys think.
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 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

142
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Date Joined Jan 2010
Total Posts : 6947
   Posted 12/8/2010 9:50 PM (GMT -6)   
Juliet,
 
In my case, visiting with the Rad. Oncologist, they expected to use HT for a couple of months before starting RT if I did it as a primary treatment.
 
I chose DaVinci surgery, but the post-op pathology was such that adjuvant radiation was a given. For that, the Rad. Oncologist wanted to do HT first, but my uro/surgeon was not in complete agreement. We elected to not do the HT.

John T
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Date Joined Nov 2008
Total Posts : 4226
   Posted 12/9/2010 12:19 PM (GMT -6)   
Questionsaboutit.
I can't speak for Fairwind but I have had a total of 7 urologists; 5 before my DX and 2 after and I would grade their knowledge of prostate cancer about a 5 on a scale of 1-10. (I would also grade my 2 radiologist about the same). They know a lot about one aspect of PC well, and that is surgery. When it comes to diagnosing and staging their knowledge is poor and when discussing alternate treatments such as radiation or hormone therapy the information is very poor and many times totally wrong. I don't think that this is a conspiricy or anything, but they are involved in many types of urological problems and are usually not experts in all the facets of prostate cancer.
Samadi is a surgeon, not a medical oncologist who has been trained in the biological aspects of cancer. The affects of HT cause weight gain and this weight gain leads to the other diseases, not the HT itself. Every major oncologist recommends a strict diet and excercise program in order for HT patients to keep from gaining weight and those that maintain a healty lifestyle can avoid the issues Samidi refers to. This is just another case of a Doctor going beyond his field of expertise and giving faulty and conflicting advice. It is also a good reason for anyone undergoing HT be monitored by an oncologist who can spot problems and reduce side affects. It is unquestonalbe that HT has extended the lives of many advanced PC patients and as any other treatment it has side affects which can be minimized by using only the best experts in the field.
JohnT
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

STW
Regular Member


Date Joined Jun 2009
Total Posts : 292
   Posted 12/9/2010 12:31 PM (GMT -6)   
I've been down this road once before with a brain tumor. I realized then that every doctor has a particular type of hammer that he wants to use on your specific nail. The surgery I was scheduled for then needed an ENT to burrow partway in after which a neurosurgeon would remove the tumor itself. It was only at my last pre-surgery consult that the neurosurgeon suggested an alternative gamma knife treatment with the words, "I don't care. I get paid either way." Radiation sure cut the ENT out of the loop.
When I was diagnosed with PCa my uro insisted a schedule an appointment with a radiation oncologist to learn my local options. The ultimate decision was mine. I noticed, again, that oncologists seemed to favor radiation and surgeons favored surgery. Why would anyone be surprised by that?
I asked an oncologist friend when you make the transition to his services with PCa. "Hopefully never" seems to cover it. However, if my next PSA tests confirms biochemical failure it's on to the radiation oncologist and if that doesn't work then my friend told me he feels another oncologist is the best doctor of any specialty in the hospital. (I hope I never know.)

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 12/9/2010 1:55 PM (GMT -6)   
Ancient Chinese saying  (lol):
 
Trust but veryify!
Question everything and all the time, people are making alot of money on your woes!
 
You may be surprized that your 'expert' was not as expert as you first,  believed!
 
 Difference between agenda and expertise, is your ability to decipher this difference.
 
Fool me once, shame on you, fool me twice and get tongue twisted like George W. did when saying this same line. (lol)
 
 

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 12/9/2010 3:56 PM (GMT -6)   
questions:

your long post above is very good. you have said in one post what i have tried to say in many over the past 2 years. i grow weary of the anti doctor in general and anti urologists in particular rants and conspiracy theories. i think most doctors are good and honest and good at what they do, there are always bad apples in any profession.

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 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

mycroft
Regular Member


Date Joined Oct 2010
Total Posts : 54
   Posted 12/9/2010 4:07 PM (GMT -6)   
BobCape said...
"Not many patients realize that there is usually a 40 percent upgrading of the disease after the prostate is removed, which is also a strong argument against radiation as the primary treatment for prostate cancer,"

Again, I dont understand. My drs told me that they would have done radiation instead of surgery had they known the pca had escaped the prostate.


When I mentioned the absence of uniformity in PCa tx aka no one agrees with anyone, my cardiologist, who always asks about my PCa status, smiled and said, "Welcome to medicine!"

Re: the medics who said that they would have done RT if they had known the PCa had escaped the prostate, did they say why? Or, more important, just what they would have treated with RT? RT is a local tx.

Are they real cancer specialists or urologists?

mycroft
Regular Member


Date Joined Oct 2010
Total Posts : 54
   Posted 12/9/2010 4:12 PM (GMT -6)   
questionsaboutit said...

The only people I think are greedy and dishonest in cancer treatments are those that pander to fear and push easy solutions like diet and supplements as treatments to scared and confused cancer patients. They have to know that eating habenero peppers or swallowing handfuls of supplements will not cure cancer yet they sell their snake oil. At least until their customers gets mets.


Well said, but if you want to be insulted, just tell that to the True Believers.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 12/9/2010 5:41 PM (GMT -6)   
well said, mycroft.
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 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

BobCape
Regular Member


Date Joined Jun 2010
Total Posts : 416
   Posted 12/9/2010 6:15 PM (GMT -6)   
mcroft, as I understand it, and as it ended up, there were two different (unassociated) urologists, and 3 different (unassociated) radiation oncologists.. all told me the same thing. Collectively, they indicated to me the reason was, since the cancer escaped the prostate, radiation was likely anyway. And surgury was just putting the patient through two nightmares. Of course, it's very difficult to know if the cancer has left the prostate ntil after RRP.

That said, I have no question but that these are each honorable and caring doctors, who have my interest in mind.. 2 of the mentioned met me knowing they would NOT be providing and treatment to me.

So, it makes some sense to me that there would be a stanrdard thinking that if the pca has escaped the prostate, then radiation is typically the 1st method of treatment. I can understand that.

My questioning of the "40% upgrading of the disease after the prostate is removed" has to do with the suggestion he goes on to make "which is also a strong argument against radiation as a primary treatment". I DONT GET THAT.

If "Upgrading" includes it having escaped the prostate, then radiation would appear to trump surgery, which would not solve the problem. DOES HE SIMPLY MEAN FOR EXAMPLE, that a Gleason 6 on biopsy would be treated as such with radiation, but 40% of the time that G6 is a G7 or worse, and without RRP and ONLY using Radiation, one would never know?

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4226
   Posted 12/9/2010 6:20 PM (GMT -6)   
David,
I don't see anyone being anti doctor or advocating conspiracy theories. I think that most doctors don't have a very good knowledge of all the aspects of prostate cancer, especially when they talk about treatments outside of their field of speciality. I think we should recognize these limitations and get 2nd and 3rd opinions.
I do think that it is a conflict of interest for urologists to own radiology centers and imaging centers.
I think it is just common sense to question any recommendations and weigh all alternatives, and above all do your own research and be your own advocate. Taking everything your doctor says at face value will not fair you well in the PC world.
JT
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 12/9/2010 7:29 PM (GMT -6)   
John, I certainly wasn't even thinking of your with my post. I consider you well learned on the subject of PC, and your own unique journey led you through a lot of doctors. I could name names, but that would be flaming, but we have at least 2-3 here on a regular basis that try to plant the seed of doubt with doctors and urologists in general, and they seem to target newcomers here. I think that does a terrible dis-service to someone seeking help and support.

People need to find doctors they can trust, and then they need to ask questions, lots of questions, and then be compliant with their doctors. Nothing worse than a know-it-all patient, that goes to doctors, then never listens to their advice.

I am not comfortable of any urologist that has a direct or in-direct interest in radiology centers, fully agree with you, its the old conflict of interest things in simplest of terms.

Second opinions should be encouraged, no argument there. I don't think my course of action would have been changed with my situation, but if I were re-doing my PC journey, I would have like to at least had my initial slides looked at by some higher level source, as my suspicion tells me that it was worse then first reported, not better. Just guessing in hindsight.

David in SC

P.S. I have been through some serious medical matters since age 28, without much break between them, and along the way, I have had a lot of deep caring, brilliant doctors that saved my axx, and for that I am thankful.
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 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3800
   Posted 12/9/2010 8:40 PM (GMT -6)   
 >>Or, more important, just what they would have treated with RT? RT is a local tx.<<
 
RT and to a lesser extent BT treats the prostate bed.  SRT is administered after the prostate is removed.  my doctor said he would usually advise against surgery if there is a high probability the cancer is out of the capsule.  so in my case we went with a combination treatment that zaps both the gland and prostate bed.
 
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
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