Mel and Casey,
Alluding to Casey's point about
"man pain years". Clearly androgen deprivation, and estrogenic supplementation were very instrumental in changing the course of prostate cancer therapy. Men lived very much longer, and pain was very reduced and pain free years were a huge finding. But to make it even more fascinating, all you need to do is read and analyze the first paragraph. Men on average were only living a year when the disease was discovered. Now think about
that. How advanced would prostate cancer have to be that the average diagnosis was so late that men only lived a year?
You have to consider how pioneering this was...
1> PAP, discovered in the late 30's, was the first test that could identify metastatic tumors outside the prostate. So it is that when men had metastatic lesions until PAP they had no idea it was prostate cancer without actually dissecting the prostate in an "exploratory surgical procedure". Eventually they knew what the metastatic pattern looked like in men, but that was done often after life.
2> There was no PSA, Gleason Score, or imaging that could identify the disease. So they may have had pain, but the source was unknown and there was no treatment other than pain medication. Probably high amounts of opiate based drugs. These guys would likely have had PSA's in the thousands.
3> Still with all that, Huggins et. al. discovered how to make these men live years with very improved QoL.
When Huggins wrote about
"fuel on the fire" he was referring to men with aggressive, advanced Stage IV cancer that were castrated and experiencing disease control that was never seen before. It was not a myth. It was a fact that adding testosterone was counter productive.
Only in recent years have treated men been given androgen replacement therapy, as written by Morgantaler in the article above. But the tools are drastically different and the cases much earlier detected due to PSA, and aggressiveness is also a factor and that wasn't even charted by Gleason until 1968 and put into standard pathology until the eighties. So I think that it would not be proper to call Huggins work in the 40's 50's and 60's a myth given that all cases were so advanced, no PSA test existed, and no-one knew how to grade aggressiveness. Still Huggins was reviewing the possibility that once disease was brought under control, could men be given androgen replacement to try to improve QoL even further? He apparently decided that it wasn't worth the risk/reward.
Fascinating indeed and worthy of a Nobel. But it is true today that technology has made it possible to consider giving a man testosterone replacement but it is highly controversial even still in high Gleason cases as well as stage 3+ cases. I don't think the "myth" has been fully dispelled.
Bluebird123 gives us a great example of a man that probably had no chance of 17 years of survival before Huggins et al. And after being on HT for 17 years that case probably is so used to being on HT that he does not have "SE's" he would notice out of what he's used to.
Another point...Men living without testosterone is a centuries old game plan... Eunichs and Castrato's are men that were castrated by torture or by choice dating back a millennium. There is data that these castrated men lived an average of 16 years longer than normal men.
I'm curious what role not getting prostate cancer played in that if any...
Advanced Prostate Cancer at age 44 (I am 50 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7
Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.