NewHere123, thank you for the link you posted...it is a good primer
for...as the title says.."The Treatment Challenges of Neuroendocrine Prostate Cancer.
It doesn't really sound like the first two respondents in this thread actually read the article...despite your request to "Please Read.” I think the article highlights important facts about
ADT that not everyone realizes. To me, the important point is NOT to say "full steam ahead with ADT no matter what," paraphrasing those first replies, but that everyone's individual case is more nuanced, and should be handled more nuanced care than "one size fits all."
Firstly, there is absolutely no suggestion in the article, and no suggestion elsewhere, that ADT causes
NET (I'll use this common abbreviation, NET, for neuroendocrine tumor). Rather, it highlights that for those very small percentage
of cases diagnosed with NET that ADT likely will
make the cancer worse.
Further, while the diagnosis of NET is reportedly only about
2% of cases, the actual incidence of PC cases with NET is most certainly higher because another biopsy while in the metastatic state...not commonly done. I know there’s some folks here who limit their knowledge to the “reported incidence” rates, but this is yet another instance where we know better.
Additionally, the report employs impactful statistics to highlight the very serious nature of NET cases: 2% of the reported diagnoses, but present in at least 25% of PC deaths...and again for reasons state above (another biopsy in metastatic state) it is likely much higher than 25%. No data behind this, but my gut says the vast majority of PC deaths are NET-related. Dr Willet Whitmore talked (decades ago) about
the PC that can be cured but probably doesn't need to be cured (common), and also about
the Starkly contrasting PC that needs to be cured and cannot be (rare)...in this second case, he was certainly talking largely about
NET (although decades ago, much, much less was known about
NET...it was just considered the small number of "bad" cases of PC).The article’s key takeaway
, in my view, is for those who are trending towards metastatic castration-resistant PC to be diligent with their oncologist about
possibly testing (biopsy) for NET because continued of ADT may do more harm than good...and the article suggests appropriate chemo regimen to transition to.
Good article...but ya gotta read it!
Post Edited (Blackjack) : 5/30/2019 12:13:10 PM (GMT-6)