Great document, and thank you Tony for all your work on it.
One question, why is there nothing about quality of life related to all the long term ADT? I would think that prescribing venlafaxine for hot flashes/depression and diet to control the weight gain would be in the expert reccommendation category at this point?
I know some guys don't struggle with it too much, but over in the wives support group there are a LOT of suffering families. The really heartbreaking ones are the guys diagnosed with mets in their mid-40s who have kids in elementary school that don't understand why daddy is grumpy and won't play with them anymore.
That's a lot of great points. In our comments on evaluation there is this statement:Optimize pain control or other symptom support and encourage engagement with professional or community-based resources, including patient advocacy groups.
We know what to do to treat advanced prostate cancer with full understanding of the co-morbidities of treatment. But it is outside the scope of this document to get into the details of medical or complimentary and alternative medicinal approaches to easing the mental aguish that comes with it. But it certainly was discussed but it was not easy to put together a consensus statement. The need for anti-depressing drugs actually begins all the way back to prostate cancer diagnosis. Many do not deal with the "C" word well. But from my experiences outside of this panel I can say that every physician I have worked with has concerns about
the mental well being of their patients. Some are better than others but none ever felt good about
depression or side effects like hot flashes, weight gain, bone weakening, etc. Each patient is different and the science about
what to do as these situations arise is really weak. Physicians receive training about
co-morbidities caused by treatment and diagnosis but it is highly insufficient in my opinion. And it may be asking too much as well of them. Causes of depression may be strictly the diagnosis and treatment, but diagnosis and treatment may also act as amplifiers rather than cause. I was part of the decision to include the mention of community based resources, like HealingWell, to broaden thinking if the physician is challenged by what to do in these scenarios. I can tell you I get more done on this side of the discussion in the support groups than what the doctor can do in the examination room and I have been passionate about
that since coming here the first time in 2006. My anxiety was tremendously eased by talking to my peers, learning methods that worked for me on depression, hot flashes, etc. At one point I felt enough depression when my mother died of cancer while I was in ADT that I approached my physician about
taking an anti-depressant. He offered but also coached me, to work hard at knowing it was being enhanced by the ADT. And that was all I needed. But for others that's simply too simple.