A what if question, looking for serious input.

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Purgatory
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   Posted 12/22/2010 12:20 PM (GMT -6)   

This just meant to be a "what if" question. I am curious, but do not have a clue to an answer. Assume the PC patient has had surgery, the surgery failed, the patient then goes through Salvage Radiation, and the radiation fails, and the PSA starts to rise slowly with a doubling time of six months.

If the patient never pursued HT or Chemo, how long would it take the PSA to rise high enough to definitely cause bone mets, (some will give higher numbers than others, but I always think of Sonny with a positive met situation with a low post surgery/RT number)?

Second question, and I know this would vary for a lot of reasons, if the same patient chose to do nothing at this point, what would be the average time to death directly from PC? And of course, this assumes the patient doesn't have any other critically pressing medical conditions.

Looking for any answers or possibilties to these questions.

David in SC


John T
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   Posted 12/22/2010 12:32 PM (GMT -6)   
It takes about 40 multiples for a cancer to casue death. This is pretty consistant with all cancers, not just PC. So starting from zero with a 6 months doubling time it would take 20 years. In this case you are not starting with zero, because you already have millions of cells multiplying already in order to generate any psa. In this case, to take a guess, I would say about 10 years.
JohnT

Ed C. (Old67)
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   Posted 12/22/2010 1:11 PM (GMT -6)   
David,
You asked the question that many of us would like to know the answer to. With a Gleason 8, I'm always wondering if and when my cancer will show its head again. I'll be willing to do RT if that happens but, at my age (I'm 69 now) I would be reluctant to do HT. So like you, I would like to know how many more years will HT buy me vs the quality of life that it takes away. I'm sure that the answer will vary for each individual.

James C.
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   Posted 12/22/2010 1:22 PM (GMT -6)   
Something we tend to forget here, because it carries such a cring factor, is there is an alternative to the side effects of HT, that being casteration. Now, I know tha'ts something men will automatically reject, but with advancing age, loss of sexual abilities, the threat of bone mets, painful suffering and early death, this option begins to make more sense. I'd rather contribute them to the fight than to proceed with the suffering of bone mets if I did decide not to take HT from fear of the side effects. Just my opinion.........
James C. Age 63
Gonna Make Myself A Better Man tinyurl.com/28e8qcg
4/07: PSA 7.6, 7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS6
9/07: Nerve Sparing open RRP, Path: pT2c, 110 gms., all clear except:
Probable microscopic involvement of the left apical margin -GS6
3 Years: PSA's .04 each test until 04/10-.06, 09/10-.09- Uh-Oh, next in Jan & Feb.
ED-total-Bimix 30cc

Ed C. (Old67)
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   Posted 12/22/2010 1:36 PM (GMT -6)   
James,I have complete ED since the nerve bundles were removed. trimix is the only option for me and in general that left me and my wife with little desire for sex. My question is, why is castration better than HT in terms of side effect and pain from mets?
Age: 67 at Dx on 12/30/08 PSA 3.8
2 cores out of 12 were positive Gleason (4+4)
Davinci surgery 2/9/09 Gleason 4+4 EPE,
Margins clear, nerve bundles removed
Prostate weighed 57 grams 10-20% involved
all PSA tests since (2, 5, 8, 11, 15, 18 months) undetectable
Latest PSA test (21 months) .005

James C.
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Date Joined Aug 2007
Total Posts : 4462
   Posted 12/22/2010 1:39 PM (GMT -6)   
Hormone Therapy is the deprivation of testosterone to the body. Testosterone feeds prostate cancer cells. HT in reality is just chemical castration, suppressing the production of testosterone but with a high dollar cost and many nasty side effects to some/most people who take it. Surgical castration does the same thing, without the nasty chemical side effects. Removes the manufacutre of testosterone from the body. Different approach's, same end result.
James C. Age 63
Gonna Make Myself A Better Man tinyurl.com/28e8qcg
4/07: PSA 7.6, 7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS6
9/07: Nerve Sparing open RRP, Path: pT2c, 110 gms., all clear except:
Probable microscopic involvement of the left apical margin -GS6
3 Years: PSA's .04 each test until 04/10-.06, 09/10-.09- Uh-Oh, next in Jan & Feb.
ED-total-Bimix 30cc

Post Edited (James C.) : 12/22/2010 11:42:46 AM (GMT-7)


zufus
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   Posted 12/22/2010 2:28 PM (GMT -6)   
Rule #1 in PCa....there are no Rules that can be written in stone. It varies alot and from patient to patient, to many variables with all the variant PCa types (docs probably have little clue which one you have), the DNA ploidy types, volume of cancer and Gleasons found and then the patients immune system and overall health. But if you needed a generality, like John T was mentioning....people with known mets and even with excellent drug protocols fall into around 10 year slot and that is perhaps on the best scenarios, now as you mentioned no chemo or HT should shorten that by alot.
 
 Then there is small cell PCa variant, you could literally die in 1-3 yrs(or less). perhaps, one gal posted her husband was just diagnosed (years ago now), perhaps he was diagnosed way late...but he died within 2 weeks thereafter as she reposted soon on the update. I have to presume he was diagosed late and then died within 2 weeks...still it was unreal to hear about.

Then there is the exception- Dr. Fred Lee failed cure 25 yrs. years ago and had node envolvement or micro mets known of....he was diagnosed 27 yrs. ago...still alive at age 80 and working still. Of course he said fubar to using Lupron.....so he must be insane for using an estrogenic called emcyt...much to his long living and perhaps holds the record for longest living micro mets patient. I posted his internet website story from his author friend surgeon Dr. Bob B. whom is very impressed about this situation. See the spectrum alittle more now, keep looking, Howard Hansen recently passed away, his journey was 17 years overall and envolved many protocols, he helped educate alot of people on PCa.
Dx-2002 total urinary blockage, bPsa 46.6 12/12 biopsies all loaded 75-95% vol.; Gleasons scores 7,8,9's (2-sets), gland size 35, ct and bone scans look clear- ADT3 5 months prior to radiations neutron/photon 2-machines, cont'd. ADT3, quit after 2 yrs. switched to DES 1-mg, off 1+ yr., controlled well, resumed, used intermittently, resumed useage

Post Edited (zufus) : 12/22/2010 12:33:02 PM (GMT-7)


Ed C. (Old67)
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   Posted 12/22/2010 2:29 PM (GMT -6)   
Aside from the chemical side effects, does castration contribute to weight gain, man boobs, and of of the other symptons?

Piano
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Date Joined Apr 2008
Total Posts : 847
   Posted 12/22/2010 3:37 PM (GMT -6)   
I have a relative who was castrated about 10 years ago. Weight gain yes, but not man boobs, rather a man belly. Has had a broken hip so brittle bones is a side effect. Another side effect is old age -- he is now 91. :-)
No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4/12 cores
Non-nerve-sparing RRP 7 March 2008 age 63
Organ confined, neg margins. Gleason downgrade 4+4=8
Fully continent
Bimix worked well; now using just VED
PSA undetectable at first but now 0.3, doubling time 7 months
No radiation but ADT coming unless I can slow down the rise...

Ed C. (Old67)
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Date Joined Jan 2009
Total Posts : 2458
   Posted 12/22/2010 3:45 PM (GMT -6)   
Thank you guys. I don't know if I'm crazy but if my PCa comes back, I'll do the RT but if that fails I'm going for castration. Hopefully, that won't be needed and if it is, It is way into the future.
Age: 67 at Dx on 12/30/08 PSA 3.8
2 cores out of 12 were positive Gleason (4+4)
Davinci surgery 2/9/09 Gleason 4+4 EPE,
Margins clear, nerve bundles removed
Prostate weighed 57 grams 10-20% involved
all PSA tests since (2, 5, 8, 11, 15, 18 months) undetectable
Latest PSA test (21 months) .005

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 12/22/2010 4:20 PM (GMT -6)   
JohnT - good answer, what troubles me, when I asked the same general question at diff times to my GP, my Uro/Surgeon, and the Rad Oncologist, they all gave similar answers of 3-5 years. Wonder if they are reading the same source of info.

EdC - I am wondering the same thing as you, but I am 11 years younger than you. Trying to feel out the situation

James - aside from the cringing part, I just dont know if I could be physically castrated of my own free will

zufus - good input as expected, was compensating for all the variables, looking to see if there were a median time or some kind of average
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

proscapt
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Date Joined Aug 2010
Total Posts : 644
   Posted 12/22/2010 6:27 PM (GMT -6)   
David - another factor is that different grades of PC have different levels of PSA production as you know. At least some say this is so. So someone with a gleason 10 would probably have mets at a lower PSA than someone with a gleason 7.

I sincerely hope that all this remains in the hypothetical category for you.

Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 12/22/2010 6:49 PM (GMT -6)   
The fastest I have seen is less than 1 year. The slowest I have seen is still living at year 17. There are way too many factors to look at than the questions in general as they are.

Mets can hit the bones and not be terminal. Mets can also hit the liver and shut it down rather quickly. 3-5 years is probably on average.

Tony
Disease:
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

Treatments:
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.

Status:
"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

Jazzman1
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Date Joined Sep 2010
Total Posts : 1160
   Posted 12/22/2010 7:25 PM (GMT -6)   
I lost a testicle a few years ago due to a cancer scare. As surgeries go, that one wasn't too bad.

If I had to choose between HT and another surgery, I think I might go with the surgery. It's not a choice anybody would like to have to make, but from what little I know, the side effects of HT sound pretty bad.
Age 55
PSA: 8/09 2.69 -- 7/10 4.00 -- 8/10 4.11
--------------------------------------------------
Biopsy 8/10
Three of 14 cores positive: 10%, 60% & 80%
Stage T1C; Gleason 6
---------------------------------------------------------------
open radical prostatectomy at Cleveland Clinic 11/2/10
Post-surgical pathology: Gleason 7 (3+4)
Three positive margins; Stage T2c(+)
12/7/10 PSA: <.03

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 12/22/2010 7:43 PM (GMT -6)   
pro - your answer makes sense with the Gleason grade

tony - that perhaps why 3 different doctors gave me similar answers

jazz - ouch, that didnt sound like any fun. i am still having a lot of issues (personal) with the whole concept of HT
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

Piano
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Date Joined Apr 2008
Total Posts : 847
   Posted 12/22/2010 10:19 PM (GMT -6)   
David, you don't know how HT will work out for you until you try it. You may be one of the lucky ones where the effects are not nearly as severe as you expect. Compared to what you have been through, this may be a walk in the park.

Why not try it for a period and if the side effects are too bad, then quit? The side effects should be reversible.

That is the option I will take, and being forewarned, I will take vigorous steps to avoid weight gain and bone loss. Loss of libido is a certainty, but once that cuts in, then we don't care about that any more. I believe the mechanical ability for sex remains, so that might become a once-in-a-while "chore".

All this is from someone who has not had HT, so if I have some misconceptions there, someone please chime in and correct me.

Also, and I mention this at the risk of stirring up a hornet's nest: consider supplements (or diet changes). Like you, I don't believe in them, but there there are certainly enough suggestions that some some may work in some individuals. You should get fairly quick feedback via PSA tests whether any change is slowing down a rising PSA. Anything you can do to slow down the PSA rise adds to the time you can defer HT -- or whatever next treatment is in store for you.
No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4/12 cores
Non-nerve-sparing RRP 7 March 2008 age 63
Organ confined, neg margins. Gleason downgrade 4+4=8
Fully continent
Bimix worked well; now using just VED
PSA undetectable at first but now 0.3, doubling time 7 months
No radiation but ADT coming unless I can slow down the rise...

Fairwind
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Date Joined Jul 2010
Total Posts : 3787
   Posted 12/22/2010 10:51 PM (GMT -6)   
John T's post about doubling time measured by PSA is probably very accurate..High Gleason cancers tend to double rather quickly, low gleason PC tends to take it's time..Everyone is different...

James, when they put me on HT, Eligard, just another Lupron clone, I DEMANDED to know what the side-effects were from the drug alone, not from the loss of testosterone..The answer was virtually nothing..The intended effects of the drug will completely overpower any minor effects of the drug itself.. If it turns out I will need HT for the duration, I would chose castration over continued drugs simply because it WORKS BETTER!! Many times, these drugs have trouble lowering "T" to 20 or so..The docs say that's good enough..But physical castration can drop it to below 5, a big difference perhaps to cancer cells..Another factor, the medical establishment makes FAR more money off "medical castration" then they do off "surgical castration"...

Dave, have you read chapter 12 in Walsh's book?? He covers all this in fine detail...
Age 68.
PSA at age 55: 3.5, DRE normal. Advice, "Keep an eye on it".
age 58: 4.5
" 61: 5.2
" 64: 7.5, DRE "Abnormal"
" 65: 8.5, " normal", biopsy, 12 core, negative...
" 66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
" 67 4.5 DRE "normal"
" 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RRP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT, Dec

polfred
Regular Member


Date Joined Dec 2009
Total Posts : 62
   Posted 12/22/2010 11:03 PM (GMT -6)   
:-)  My husband has been on HT for over a year. Other than occasional ED, he has not had any side effects.  He initially had hot flashes but that only lasted six months. Blessings and Happy Holidays!
Jan
Age 59
PSA 9 on-08-09
Given antibiotics for 1 month/
PSA 10 on 10-09
Biopsy 11-18-09-Results 10 of 12 cores positive
CT and Bone scan negative
Diagnosed on 11-20-09
Lupron injection/ 7 dys of casodex on 11-20-09
Markers placed on 12-15-09
Planning scan scheduled 1-18-2010/ 8 wks radiation to follow
Treatments began 1-20-2010
Lupron injection-3-1-2010
Radiation treatments end (54)-3-26-2010
PSA undetectable/ 3-26-2010
 

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 12/22/2010 11:29 PM (GMT -6)   
piano, not saying you feel this way, but many assume i am concerned about the loss of the sex drive part, especially considering i have experienced zero ED through this entire bizzare journey. can honestly say my reservations have nothing to do with sex. a few years back, i needed to be on lexapro, and it essential took away all sexual desire, in fact, while it never stopped my ability, i just never gave it another thought. i am very prone historically to bad side effects in general, and that concerns me deeply. i dont want to end up a different person personality wise, don't want to get mean or aggitated towards my loved ones, etc. seems like a lot to go through, for some that eventually will cease to work, and knowing there is no curative hope at that point. of course, any of us could drop dead of a heart attack long before any cancer does its dirty deed.

fairwind, i have read the great walsh work many times cover to cover, i have read his opinions on the subject, and he does make some good points.

jan, i am glad to hear that news about your husband, hope he continues to do so well
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

maldugs
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Date Joined Jun 2007
Total Posts : 789
   Posted 12/23/2010 3:30 AM (GMT -6)   
Hi David, interesting question, in my case have had ED from the start, does not worry me one bit, or my wife, at the moment I am "stable" but I think at this stage, if my PSA starts to rise, don't think I want any more medication, I am 70, and who knows I may beat the cancer to the end, and die with it, not from it.

All the best David.

Mal.
age 67 PSA 5.8 DRE slightly firm Rt
Biopsy 2nd July 07 5 out of 12 positive
Gleason 3+4=7 right side tumour adenocarcinoma stage T2a
RP on 30th July,

Post op Pathology, tumour stage T3a 4+3=7, microcsopic evidence of capsular penetration, seminal vessels, bladder neck,are free of tumour, lymph nodes clear, no evidence of metastatic malignancy, tumour does not extend to the apical margins.

Post op PSA 0.5 26th Sept. Totally dry since catheter removed
PSA 23rd Oct.0.5 seeing Radiation Onocologist 31st Oct.
Started radiation treatment on 5th Dec, to continue until 24 Jan. 08.
Finished treatment, next PSA on 30th April.
PSA from 30th April 08, until now range- 0.5 to 0.6, I am now 70

JNF
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Date Joined Dec 2010
Total Posts : 3794
   Posted 12/23/2010 8:43 AM (GMT -6)   
I have been on Eligard and Jalyn since early October. I have experienced hot flashes regularly, primarily when I am sedentary. Over the last three weeks I have had two HDR brachytherapyprocedures and finised 26 IMRT sessions. During that time the flashes have been minimal. Probably due to the other meds I have been on for the HDR. So far no loss of libido or weight gain. I lost 15 pounds in anticipation of the HT by embracing the Snuffy Meyers diet and using my own common sense about diet and exercise that seems to have escaped me for decades!!!

I would consider physical castration more for the effectiveness with the cancer control, but I am not at that stage yet.

Regarding diet, numerous studies link land animal fat (meat and dairy), sugar, alcohol, peanuts (aflatoxin) and overweight with breast, prostate and colon cancer. I am not going to fight the studies. Snuffy Meyers was a pioneer in this area before he started treating patients. As to supplements I again go with Meyers and am taking C, D, E, selenium, lycopene, and fish oil in moderate amounts. I am not taking flaxseed oil for the same reasons.

I do not expect any of this to be curative. I do expect that it will contribute to me being more healthy and fit overall and present a less oportunistic environment for the cancer. With these changes over the last 100 days I feel better and have a better energy level despite the treatment I have undergone. That is evidence enough for me that the relartively minor changes have been wiorthwhile.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 12/23/2010 12:28 PM (GMT -6)   
mal, i respect your opinion and decision on the subject, if you are at peace with that line of thinking with your wife, then that is definitely the right way to look at it. we have to understand here, that there is a very personal side to our PC decisions, especially as one nears the end of their natural lives. I dont see any right or wrong, its in every person's heart and mind, what they want to do, or not want to do. i wish you many more years of quality life.

jnf - good luck in your approach too. hope you continue to do well
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

Ed C. (Old67)
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Date Joined Jan 2009
Total Posts : 2458
   Posted 12/23/2010 2:18 PM (GMT -6)   
I posed this question to my wife and she will support whatever decision I make. Because of our age (she is a little older than me), my total ED, sex has been on the back burner. If I get to where HT is the only option, I will opt for castration.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 12/23/2010 5:12 PM (GMT -6)   
Understood, Ed, even though that does make me cringe everytime I hear the word. But this is coming from a guy that now has a hole in his side to pee from, lol.
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 12/23/2010 5:54 PM (GMT -6)   
I've noted some posts that demonstrate incorrect understanding of the effects of castration, either chemical or physical.

I'll try to help.

An excellent start to understanding this aspect of PCa tx is this article on the comprehensive site of the Prostate Cancer Research Institute (PCRI): www.prostate-cancer.org/education/andind/Strum_ListeningToBiology.html
or
tinyurl.com/35vqqd

Overall, the physical results of chemical and surgical castration are the same. So are the side effects (SEs).

Those SEs can be and are mitigated when the medic, as is sometimes not the case, knows and cares about SEs of tx. Or, better yet, the patient does. Here are links to two excellent essays on the subject:

www.prostate-cancer.org/education/andind/Guess_TestosteroneSideEffects.html
or
tinyurl.com/2ymb8f

www.prostate-cancer.org/education/sidefx/Strum_ADS.html
or
tinyurl.com/g6fzp

The SEs are NOT caused by the LHRH agonists such as Trelstar, Zoladex or Lupron in its various guises. They are caused by the absence of testosterone.

Added html links so cites are clickable.

Post Edited By Moderator (James C.) : 12/24/2010 9:46:02 AM (GMT-7)

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