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Old 01-14-2008, 04:52 PM   #1
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when are hormone shots necessary in the treatment of prostate cancer

when are hormone shots necessary in the treatment of prostate cancer

 
Old 01-14-2008, 07:40 PM   #2
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Re: when are hormone shots necessary in the treatment of prostate cancer

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Originally Posted by butch121 View Post
when are hormone shots necessary in the treatment of prostate cancer
Butch,

You used the word "necessary," but I would like to expand that slightly to desirable, and when you wrote "hormone shots," I would like to expand that to "hormone therapy" since some hormonal blockade therapy is delivered by an implant in the arm and not a shot (for example, Viadur is delivered that way). I'm not going to describe use of hormonal blockade as the primary therapy for low-risk patients, because that is an optional and not "necessary" use and is not clearly more desirable than other therapy options; in fact, it has a much shorter and less researched track record as primary therapy. (It still looks highly promising to me.)

Basically, hormonal blockade therapy, usually with an LHRH-agonist drug that stops the production of testosterone as the foundation, is necessary when prostate cancer is recognized as being systemic, meaning it is no longer localized in and immediately around the prostate, and also is beyond the likely range of radiation therapy. Usually systemic disease is thought of as being spread out in the body, but sometimes it is located in only one or a few places.

Hormonal therapy is also typically at least part of treatment when a man develops metastatic prostate cancer. It can be remarkably effective against metastases for a while.

Another use that I would class as desirable but almost necessary is to support radiation therapy. For cases that are somewhat challenging, patients getting radiation often do much better if they also get some hormonal blockade therapy, and there is evidence that several years of blockade is better than just a few months. There is a little evidence that hormonal therapy may also help boost effectiveness of surgery for some men, but that is controversial.

There are other options to the shots and implants, and they work basically by blocking testosterone and its relatives from docking with the cancer cell, which is necessary for growth. Some therapies just use antiandrogen drugs, like Casodex or flutamide, perhaps with either finasteride or Avodart. Those drugs do not stop the production of testosterone, and therefore they don't cause the side effects that stopping testosterone often causes to some degree (which can be fairly well managed for most of us). However, the antiandrogens often have some side effects of their own, and the antiandrogens are not as good as controlling the cancer for most of us. But, that said, I've heard one leading doctor say that this approach works for some patients as it delivers 80% of the benefits but only 20% of the side effect burden. Choosing this antiandrogen option depends on the balance between controlling the cancer and quality of life. For example, for a man in his 70s with low-risk, slow growing disease or a mild recurrence after surgery or radiation, this approach might work well. New research involving estrogen patches is showing some promise as another alternative.

I have been on intermittent hormonal blockade therapy for just over eight years for my challenging case of prostate cancer, and I am doing very well. For most of the time I have been on therapy, it has been the triple hormonal blockade version with Lupron, Casodex and finasteride, with Fosamax or Boniva in support of bone density. I am a fellow survivor and have never had any enrolled medical education.

I hope this long answer to your short question is not overwhelming, and I hope you get to see some other viewpoints.

Take care,

Jim

 
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Old 01-15-2008, 07:24 PM   #3
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Re: when are hormone shots necessary in the treatment of prostate cancer

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when are hormone shots necessary in the treatment of prostate cancer
Hormone therapy is the most effective treatment for men with metastatic prostate cancer. The effectiveness of treatment is evaluated by serial assessment of symptoms, scans and PSA. Nearly all men initially benefit from treatment and most will continue to benefit for at least 18 months before additional treatment is necessary.
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Old 01-16-2008, 09:20 AM   #4
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Re: when are hormone shots necessary in the treatment of prostate cancer

Quote:
Originally Posted by able5 View Post
... Nearly all men initially benefit from treatment and most will continue to benefit for at least 18 months before additional treatment is necessary.
I can really understand where able5 is coming from, and he includes the words "at least" in the statement, which makes it correct and optimistic, which is appropriate. But so many people focus on the "18 months" that they have a severly warped, pessimistic concept of the effectiveness of blockade, and I want to address that.

There is some very good news for anyone who is under the impression that the benefit of hormonal blockade treatment is limited to 18 months. Bottom line: it is a MYTH; blockade is effective for far longer for the vast majority of us, with the exception being those with widespread (and especially, if painful) metastases to the bone when the hormonal blockade drugs are started. As Mona Lisa Vito responded in the movie My Cousin Vinnie when asked if her explanation of that tell-tale photograph of tire tread marks was just a theory, the statement that the 18 to 24 months view is a myth is not just a theory, "It's a fact!"

As a veteran of eight years of intermittent triple hormonal blockade and a survivor-representative participant in a number of cancer research medical conferences, research proposal reviews and FDA hearings, I have heard that figure or a variation, 18 to 24 months, stated a number of times, usually without able5's "at least", sometimes by some highly respected physicians, though none of them experts in hormonal blockade. I've heard the figures stated confidently about both patients who were detectably metastatic and those, like me and the vast majority of us, who were not. Those figures also figured prominently in the initial prognoses of five years survival (three good quality of life, two declining) that I received from two respected physicians. So if I seem to be on a soapbox, I am! (By the way, I'm not the only one on this soapbox. This myth also drives the expert blockade doctors nuts who hear it frequently from their physician colleagues who are not well-versed in blockade treatment (but who frequently are managing their patients on blockade), and it also includes fellow survivors like myself who have had to learn the ins and outs of blockade for their own well being and even survival.)

First, the short-effectiveness view is obviously not true of my own challenging case, featuring an initial PSA of 113.6, GS 4+3=7, all biopsy cores positive, most cores 100% cancer, perineural invasion, and staging T3 with suspected seminal vesicle involvement, though CT, bone and ProstaScint scans were essentially negative. I have been on hormonal blockade intermittently since December 1999, and in the last phase of both full therapy periods my PSA nadir was less than 0.01 using an ultrasensitive PSA test (spring/summer 2002 and December 2006). That proves hormonal blockade has been effective for me.

I have also been in close touch with fellow survivors on continuous and intermittent hormonal blockade as well as several doctors who are expert in that therapy, and their experience is also that hormonal blockade is highly effective for many years for the vast majority of us. It does tend to be less effective for the total group of men with detectable metastases, but it still generally works far longer than 18 to 24 months for those with milder metastatic disease, and the outlook is improving even for patients with more serious metastases.

But so far this evidence is just my own case and personal contacts. While that is hopefully somewhat useful to those trying to learn about hormonal blockade, the best evidence requires rising above our own personal experiences and contacts and looking at scientific evidence. Without that, we are essentially mired in the low-level evidence of anecdotes, which may be fine for mutual, supportive commiseration, but does not get you where you need to be in order to make the best choices involving issues of quality of life and life itself. Anyway, that's my story, and I'm sticking with it.

Here's one piece of the key science for those who really want to know and are willing to invest some effort in looking at it.

A key early paper, and apparently an unintentional source for the myth, is "A controlled trial of leuprolide with and without flutamide in prostatic carcinoma. Crawford ED, Eisenberger MA, McLeod DG, Spaulding JT, Benson R, Dorr FA, Blumenstein BA, Davis MA, Goodman PJ. N Engl J Med. 1989 Aug 17;321(7):419-24. PMID: 2503724 (The authors list has some of the major names in prostate cancer research.) Dr. Charles Myers gave us a summary of the results, which involved not just a few men but 603 men, in a presentation at the National Conference on Prostate Cancer 2005, speaking about the average time from starting hormonal therapy until the disease progressed to resistance to that therapy. Here are the key facts:

For men with wide spread bone mets + pain -- 8 months

For men with wide spread bone mets but without pain -- 18 months

For men with few bone mets in the hip and spine -- 4 to 5 years
(30 to 40% still responding to hormonal blockade at 9 years!)

This study only involved men with stage D2 cancer, which means metastasis to distant lymph nodes, or metastasis to bone or visceral organs. It's not hard to realize that men without detectable disease would generally do much better. Also, the trial involved giving the men the equivalent of Lupron or Zoladex with or without flutamide. To me it is virtually certain that they would have done even better with more modern approaches, such as triple blockade with a bone density medication and associated supplements in support. (While I'm writing confidently, please keep in mind that I am a fellow survivor who has studied this for some time but have never had any enrolled medical education.)

You can see the 18 month figure, and bear in mind that in 1989 many men were first diagnosed at a stage where they were already metastatic. In other words, such men were typical. Unfortunately, many physicians and researchers seem to have latched on to 18 to 24 months for the "typical" prostate cancer patient without realizing that patients being diagnosed or recurring today have far, far superior case characteristics. When I go to medical conferences, I take copies of some of this data and show it to researchers who have the wrong information. They are usually quite surprised because the "18 to 24 months" figures are so firmly imbedded in the conventional wisdom.

You can see from the data in the paper that we should be thinking of the effectiveness of hormonal blockade in terms of a minimum of years of effectiveness except for very advanced patients, and even some of them are doing very well today, as a percentage were even in 1989 with the much less advanced treatments then available.

Other research has produced results that generally confirm this much more upbeat view of hormonal blockade. One of the experts in hormonal blockade therapy, Dr. Mark Scholz, says that it typically works for 10 to 11 years if not indefinitely. The "indefinitely" part especially applies to very low risk patients.

Okay, time to get down from my soap box and get some lunch.

Thanks for bringing this issue up.

Jim

 
Old 01-16-2008, 09:55 AM   #5
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Re: when are hormone shots necessary in the treatment of prostate cancer

Quote:
Originally Posted by IADT3since2000 View Post
I can really understand where able5 is coming from, and he includes the words "at least" in the statement, which makes it correct and optimistic, which is appropriate. But so many people focus on the "18 months" that they have a severly warped, pessimistic concept of the effectiveness of blockade, and I want to address that.

There is some very good news for anyone who is under the impression that the benefit of hormonal blockade treatment is limited to 18 months. Bottom line: it is a MYTH; blockade is effective for far longer for the vast majority of us, with the exception being those with widespread (and especially, if painful) metastases to the bone when the hormonal blockade drugs are started. As Mona Lisa Vito responded in the movie My Cousin Vinnie when asked if her explanation of that tell-tale photograph of tire tread marks was just a theory, the statement that the 18 to 24 months view is a myth is not just a theory, "It's a fact!"

As a veteran of eight years of intermittent triple hormonal blockade and a survivor-representative participant in a number of cancer research medical conferences, research proposal reviews and FDA hearings, I have heard that figure or a variation, 18 to 24 months, stated a number of times, usually without able5's "at least", sometimes by some highly respected physicians, though none of them experts in hormonal blockade. I've heard the figures stated confidently about both patients who were detectably metastatic and those, like me and the vast majority of us, who were not. Those figures also figured prominently in the initial prognoses of five years survival (three good quality of life, two declining) that I received from two respected physicians. So if I seem to be on a soapbox, I am! (By the way, I'm not the only one on this soapbox. This myth also drives the expert blockade doctors nuts who hear it frequently from their physician colleagues who are not well-versed in blockade treatment (but who frequently are managing their patients on blockade), and it also includes fellow survivors like myself who have had to learn the ins and outs of blockade for their own well being and even survival.)

First, the short-effectiveness view is obviously not true of my own challenging case, featuring an initial PSA of 113.6, GS 4+3=7, all biopsy cores positive, most cores 100% cancer, perineural invasion, and staging T3 with suspected seminal vesicle involvement, though CT, bone and ProstaScint scans were essentially negative. I have been on hormonal blockade intermittently since December 1999, and in the last phase of both full therapy periods my PSA nadir was less than 0.01 using an ultrasensitive PSA test (spring/summer 2002 and December 2006). That proves hormonal blockade has been effective for me.

I have also been in close touch with fellow survivors on continuous and intermittent hormonal blockade as well as several doctors who are expert in that therapy, and their experience is also that hormonal blockade is highly effective for many years for the vast majority of us. It does tend to be less effective for the total group of men with detectable metastases, but it still generally works far longer than 18 to 24 months for those with milder metastatic disease, and the outlook is improving even for patients with more serious metastases.

But so far this evidence is just my own case and personal contacts. While that is hopefully somewhat useful to those trying to learn about hormonal blockade, the best evidence requires rising above our own personal experiences and contacts and looking at scientific evidence. Without that, we are essentially mired in the low-level evidence of anecdotes, which may be fine for mutual, supportive commiseration, but does not get you where you need to be in order to make the best choices involving issues of quality of life and life itself. Anyway, that's my story, and I'm sticking with it.

Here's one piece of the key science for those who really want to know and are willing to invest some effort in looking at it.

A key early paper, and apparently an unintentional source for the myth, is "A controlled trial of leuprolide with and without flutamide in prostatic carcinoma. Crawford ED, Eisenberger MA, McLeod DG, Spaulding JT, Benson R, Dorr FA, Blumenstein BA, Davis MA, Goodman PJ. N Engl J Med. 1989 Aug 17;321(7):419-24. PMID: 2503724 (The authors list has some of the major names in prostate cancer research.) Dr. Charles Myers gave us a summary of the results, which involved not just a few men but 603 men, in a presentation at the National Conference on Prostate Cancer 2005, speaking about the average time from starting hormonal therapy until the disease progressed to resistance to that therapy. Here are the key facts:

For men with wide spread bone mets + pain -- 8 months

For men with wide spread bone mets but without pain -- 18 months

For men with few bone mets in the hip and spine -- 4 to 5 years
(30 to 40% still responding to hormonal blockade at 9 years!)

This study only involved men with stage D2 cancer, which means metastasis to distant lymph nodes, or metastasis to bone or visceral organs. It's not hard to realize that men without detectable disease would generally do much better. Also, the trial involved giving the men the equivalent of Lupron or Zoladex with or without flutamide. To me it is virtually certain that they would have done even better with more modern approaches, such as triple blockade with a bone density medication and associated supplements in support. (While I'm writing confidently, please keep in mind that I am a fellow survivor who has studied this for some time but have never had any enrolled medical education.)

You can see the 18 month figure, and bear in mind that in 1989 many men were first diagnosed at a stage where they were already metastatic. In other words, such men were typical. Unfortunately, many physicians and researchers seem to have latched on to 18 to 24 months for the "typical" prostate cancer patient without realizing that patients being diagnosed or recurring today have far, far superior case characteristics. When I go to medical conferences, I take copies of some of this data and show it to researchers who have the wrong information. They are usually quite surprised because the "18 to 24 months" figures are so firmly imbedded in the conventional wisdom.

You can see from the data in the paper that we should be thinking of the effectiveness of hormonal blockade in terms of a minimum of years of effectiveness except for very advanced patients, and even some of them are doing very well today, as a percentage were even in 1989 with the much less advanced treatments then available.

Other research has produced results that generally confirm this much more upbeat view of hormonal blockade. One of the experts in hormonal blockade therapy, Dr. Mark Scholz, says that it typically works for 10 to 11 years if not indefinitely. The "indefinitely" part especially applies to very low risk patients.

Okay, time to get down from my soap box and get some lunch.

Thanks for bringing this issue up.

Jim
Not a problem, it was my pleasure!
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Last edited by able5; 01-16-2008 at 09:56 AM.

 
Old 01-16-2008, 09:58 AM   #6
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Re: when are hormone shots necessary in the treatment of prostate cancer

Quote:
Originally Posted by IADT3since2000 View Post
I can really understand where able5 is coming from, and he includes the words "at least" in the statement, which makes it correct and optimistic, which is appropriate. But so many people focus on the "18 months" that they have a severly warped, pessimistic concept of the effectiveness of blockade, and I want to address that.

There is some very good news for anyone who is under the impression that the benefit of hormonal blockade treatment is limited to 18 months. Bottom line: it is a MYTH; blockade is effective for far longer for the vast majority of us, with the exception being those with widespread (and especially, if painful) metastases to the bone when the hormonal blockade drugs are started. As Mona Lisa Vito responded in the movie My Cousin Vinnie when asked if her explanation of that tell-tale photograph of tire tread marks was just a theory, the statement that the 18 to 24 months view is a myth is not just a theory, "It's a fact!"

As a veteran of eight years of intermittent triple hormonal blockade and a survivor-representative participant in a number of cancer research medical conferences, research proposal reviews and FDA hearings, I have heard that figure or a variation, 18 to 24 months, stated a number of times, usually without able5's "at least", sometimes by some highly respected physicians, though none of them experts in hormonal blockade. I've heard the figures stated confidently about both patients who were detectably metastatic and those, like me and the vast majority of us, who were not. Those figures also figured prominently in the initial prognoses of five years survival (three good quality of life, two declining) that I received from two respected physicians. So if I seem to be on a soapbox, I am! (By the way, I'm not the only one on this soapbox. This myth also drives the expert blockade doctors nuts who hear it frequently from their physician colleagues who are not well-versed in blockade treatment (but who frequently are managing their patients on blockade), and it also includes fellow survivors like myself who have had to learn the ins and outs of blockade for their own well being and even survival.)

First, the short-effectiveness view is obviously not true of my own challenging case, featuring an initial PSA of 113.6, GS 4+3=7, all biopsy cores positive, most cores 100% cancer, perineural invasion, and staging T3 with suspected seminal vesicle involvement, though CT, bone and ProstaScint scans were essentially negative. I have been on hormonal blockade intermittently since December 1999, and in the last phase of both full therapy periods my PSA nadir was less than 0.01 using an ultrasensitive PSA test (spring/summer 2002 and December 2006). That proves hormonal blockade has been effective for me.

I have also been in close touch with fellow survivors on continuous and intermittent hormonal blockade as well as several doctors who are expert in that therapy, and their experience is also that hormonal blockade is highly effective for many years for the vast majority of us. It does tend to be less effective for the total group of men with detectable metastases, but it still generally works far longer than 18 to 24 months for those with milder metastatic disease, and the outlook is improving even for patients with more serious metastases.

But so far this evidence is just my own case and personal contacts. While that is hopefully somewhat useful to those trying to learn about hormonal blockade, the best evidence requires rising above our own personal experiences and contacts and looking at scientific evidence. Without that, we are essentially mired in the low-level evidence of anecdotes, which may be fine for mutual, supportive commiseration, but does not get you where you need to be in order to make the best choices involving issues of quality of life and life itself. Anyway, that's my story, and I'm sticking with it.

Here's one piece of the key science for those who really want to know and are willing to invest some effort in looking at it.

A key early paper, and apparently an unintentional source for the myth, is "A controlled trial of leuprolide with and without flutamide in prostatic carcinoma. Crawford ED, Eisenberger MA, McLeod DG, Spaulding JT, Benson R, Dorr FA, Blumenstein BA, Davis MA, Goodman PJ. N Engl J Med. 1989 Aug 17;321(7):419-24. PMID: 2503724 (The authors list has some of the major names in prostate cancer research.) Dr. Charles Myers gave us a summary of the results, which involved not just a few men but 603 men, in a presentation at the National Conference on Prostate Cancer 2005, speaking about the average time from starting hormonal therapy until the disease progressed to resistance to that therapy. Here are the key facts:

For men with wide spread bone mets + pain -- 8 months

For men with wide spread bone mets but without pain -- 18 months

For men with few bone mets in the hip and spine -- 4 to 5 years
(30 to 40% still responding to hormonal blockade at 9 years!)

This study only involved men with stage D2 cancer, which means metastasis to distant lymph nodes, or metastasis to bone or visceral organs. It's not hard to realize that men without detectable disease would generally do much better. Also, the trial involved giving the men the equivalent of Lupron or Zoladex with or without flutamide. To me it is virtually certain that they would have done even better with more modern approaches, such as triple blockade with a bone density medication and associated supplements in support. (While I'm writing confidently, please keep in mind that I am a fellow survivor who has studied this for some time but have never had any enrolled medical education.)

You can see the 18 month figure, and bear in mind that in 1989 many men were first diagnosed at a stage where they were already metastatic. In other words, such men were typical. Unfortunately, many physicians and researchers seem to have latched on to 18 to 24 months for the "typical" prostate cancer patient without realizing that patients being diagnosed or recurring today have far, far superior case characteristics. When I go to medical conferences, I take copies of some of this data and show it to researchers who have the wrong information. They are usually quite surprised because the "18 to 24 months" figures are so firmly imbedded in the conventional wisdom.

You can see from the data in the paper that we should be thinking of the effectiveness of hormonal blockade in terms of a minimum of years of effectiveness except for very advanced patients, and even some of them are doing very well today, as a percentage were even in 1989 with the much less advanced treatments then available.

Other research has produced results that generally confirm this much more upbeat view of hormonal blockade. One of the experts in hormonal blockade therapy, Dr. Mark Scholz, says that it typically works for 10 to 11 years if not indefinitely. The "indefinitely" part especially applies to very low risk patients.

Okay, time to get down from my soap box and get some lunch.

Thanks for bringing this issue up.

Jim
BTW...
I especially like the remark, "The "indefinitely" part especially applies to very low risk patients."
Thanks again!
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Old 01-17-2008, 04:57 AM   #7
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Re: when are hormone shots necessary in the treatment of prostate cancer

Quote:
Originally Posted by IADT3since2000 View Post
I can really understand where able5 is coming from, and he includes the words "at least" in the statement, which makes it correct and optimistic, which is appropriate. But so many people focus on the "18 months" that they have a severly warped, pessimistic concept of the effectiveness of blockade, and I want to address that.

There is some very good news for anyone who is under the impression that the benefit of hormonal blockade treatment is limited to 18 months. Bottom line: it is a MYTH; blockade is effective for far longer for the vast majority of us, with the exception being those with widespread (and especially, if painful) metastases to the bone when the hormonal blockade drugs are started. As Mona Lisa Vito responded in the movie My Cousin Vinnie when asked if her explanation of that tell-tale photograph of tire tread marks was just a theory, the statement that the 18 to 24 months view is a myth is not just a theory, "It's a fact!"

As a veteran of eight years of intermittent triple hormonal blockade and a survivor-representative participant in a number of cancer research medical conferences, research proposal reviews and FDA hearings, I have heard that figure or a variation, 18 to 24 months, stated a number of times, usually without able5's "at least", sometimes by some highly respected physicians, though none of them experts in hormonal blockade. I've heard the figures stated confidently about both patients who were detectably metastatic and those, like me and the vast majority of us, who were not. Those figures also figured prominently in the initial prognoses of five years survival (three good quality of life, two declining) that I received from two respected physicians. So if I seem to be on a soapbox, I am! (By the way, I'm not the only one on this soapbox. This myth also drives the expert blockade doctors nuts who hear it frequently from their physician colleagues who are not well-versed in blockade treatment (but who frequently are managing their patients on blockade), and it also includes fellow survivors like myself who have had to learn the ins and outs of blockade for their own well being and even survival.)

First, the short-effectiveness view is obviously not true of my own challenging case, featuring an initial PSA of 113.6, GS 4+3=7, all biopsy cores positive, most cores 100% cancer, perineural invasion, and staging T3 with suspected seminal vesicle involvement, though CT, bone and ProstaScint scans were essentially negative. I have been on hormonal blockade intermittently since December 1999, and in the last phase of both full therapy periods my PSA nadir was less than 0.01 using an ultrasensitive PSA test (spring/summer 2002 and December 2006). That proves hormonal blockade has been effective for me.

I have also been in close touch with fellow survivors on continuous and intermittent hormonal blockade as well as several doctors who are expert in that therapy, and their experience is also that hormonal blockade is highly effective for many years for the vast majority of us. It does tend to be less effective for the total group of men with detectable metastases, but it still generally works far longer than 18 to 24 months for those with milder metastatic disease, and the outlook is improving even for patients with more serious metastases.

But so far this evidence is just my own case and personal contacts. While that is hopefully somewhat useful to those trying to learn about hormonal blockade, the best evidence requires rising above our own personal experiences and contacts and looking at scientific evidence. Without that, we are essentially mired in the low-level evidence of anecdotes, which may be fine for mutual, supportive commiseration, but does not get you where you need to be in order to make the best choices involving issues of quality of life and life itself. Anyway, that's my story, and I'm sticking with it.

Here's one piece of the key science for those who really want to know and are willing to invest some effort in looking at it.

A key early paper, and apparently an unintentional source for the myth, is "A controlled trial of leuprolide with and without flutamide in prostatic carcinoma. Crawford ED, Eisenberger MA, McLeod DG, Spaulding JT, Benson R, Dorr FA, Blumenstein BA, Davis MA, Goodman PJ. N Engl J Med. 1989 Aug 17;321(7):419-24. PMID: 2503724 (The authors list has some of the major names in prostate cancer research.) Dr. Charles Myers gave us a summary of the results, which involved not just a few men but 603 men, in a presentation at the National Conference on Prostate Cancer 2005, speaking about the average time from starting hormonal therapy until the disease progressed to resistance to that therapy. Here are the key facts:

For men with wide spread bone mets + pain -- 8 months

For men with wide spread bone mets but without pain -- 18 months

For men with few bone mets in the hip and spine -- 4 to 5 years
(30 to 40% still responding to hormonal blockade at 9 years!)

This study only involved men with stage D2 cancer, which means metastasis to distant lymph nodes, or metastasis to bone or visceral organs. It's not hard to realize that men without detectable disease would generally do much better. Also, the trial involved giving the men the equivalent of Lupron or Zoladex with or without flutamide. To me it is virtually certain that they would have done even better with more modern approaches, such as triple blockade with a bone density medication and associated supplements in support. (While I'm writing confidently, please keep in mind that I am a fellow survivor who has studied this for some time but have never had any enrolled medical education.)

You can see the 18 month figure, and bear in mind that in 1989 many men were first diagnosed at a stage where they were already metastatic. In other words, such men were typical. Unfortunately, many physicians and researchers seem to have latched on to 18 to 24 months for the "typical" prostate cancer patient without realizing that patients being diagnosed or recurring today have far, far superior case characteristics. When I go to medical conferences, I take copies of some of this data and show it to researchers who have the wrong information. They are usually quite surprised because the "18 to 24 months" figures are so firmly imbedded in the conventional wisdom.

You can see from the data in the paper that we should be thinking of the effectiveness of hormonal blockade in terms of a minimum of years of effectiveness except for very advanced patients, and even some of them are doing very well today, as a percentage were even in 1989 with the much less advanced treatments then available.

Other research has produced results that generally confirm this much more upbeat view of hormonal blockade. One of the experts in hormonal blockade therapy, Dr. Mark Scholz, says that it typically works for 10 to 11 years if not indefinitely. The "indefinitely" part especially applies to very low risk patients.

Okay, time to get down from my soap box and get some lunch.

Thanks for bringing this issue up.

Jim
My brother had radiation therapy and is now on the hormone shots. He has had four so far. He is having emotional problems from the shots. Feels very tired and depressed. Has anyone taken anti-depressants while taking the hormone shots?
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Old 01-17-2008, 08:47 AM   #8
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Thumbs up Re: when are hormone shots necessary in the treatment of prostate cancer

Quote:
Originally Posted by able5 View Post
My brother had radiation therapy and is now on the hormone shots. He has had four so far. He is having emotional problems from the shots. Feels very tired and depressed. Has anyone taken anti-depressants while taking the hormone shots?
I wish I could give you a first hand account about the drugs, as this is the kind of issue where that can really help, and I hope you get some first hand stories about the drugs. Fortunately for me, I have never had a problem with either tiredness or depression while on the shots, though I did take more naps in my first half year during early 2000. That was mainly because my night's sleep was somewhat disturbed from hot flashes. (The flashes were tolerable, but they were a nuisance.) The tiredness wasn't chronic or continuous through the day. For me it was the kind of tiredness you get from being a little short of sleep, and a half hours nap is all you need to recover. I can tell you about exercise from first hand experience, and drugs from what I've learned, to help with these problems, plus another idea or two.

Tiredness and emotional issues are fairly common for men on blockade. The book "A Primer on Prostate Cancer - The Empowered Patient's Guide," states on page 11: "... Stress and depression are common consequences of dealing with the diagnosis, the treatment decision, the treatment itself, and the side effects of treatment...." The Primer has a table of common side effects of blockade on page 153 that includes "Mental/Emotional Changes," based on experience with 77 men in one leading practice. It shows that these side effects typically begin from 1 to 2 months after starting blockade, but sometimes later. About 3% of blockade patients had a mild degree of such side effects (up to occasional and mild), and 14% had frequent/bothersome such side effects, or serious enough to require drug treatment. That's only a total of 17%, indicating that 83% had no noticeable problems with mental/emotional changes, but these figures aren't so comforting if you are in that 14% group!

I believe there is a way to decrease tiredness and emotional problems without additional drugs while on the shots, and there's a lot of medical research to back that up. When I went to the Government site [url]www.pubmed.gov[/url] and searched for " exercise AND prostate cancer ", I got 243 hits this morning. For instance, the third hit is a paper with Monga as the lead author entitled "Exercise prevents fatigue and improves quality of life in prostate cancer patients undergoing radiotherapy." Both aerobic and strength forms of exercise are important. Unfortunately, when we need to exercise to gain these and other benefits it is probably not at all appealing, but we need to do it anyway, and the more we do the easier it becomes.

It is possible to work with weights even when reducing testosterone to a castrate level. In fact, it is possible (not easy) to build muscles, even upper body muscles, with a castrate testosterone level. I didn't fully believe that when I first heard it from Dr. Mark Scholz, a leading doctor/researcher using hormonal blockade, but I proved it for myself during my second round of blockade therapy. Exercise, especially strength exercise, has several important benefits for patients on blockade. Many prostate cancer books have sections on exercise.

Fortunately, in addition to decreasing or eliminating fatigue, exercise also helps with depression. I just searched [url]www.pubmed.gov[/url] for " depression AND prostate cancer AND exercise " and got 11 hits, including this one: Ann Oncol. 2007 Dec;18(12):1957-62. Epub 2007 Sep 5 Cancer treatment-induced alterations in muscular fitness and quality of life: the role of exercise training.Schneider CM, Hsieh CC, Sprod LK, Carter SD, Hayward R. It documented numerous favorable effects of exercise for cancer patients in a trial, including a 25.6% decrease in depression.

Dr. Charles Myers, a leading doctor working with hormonal blockade, has recommended the use of anti-depressants for blockade patients who experience depression, of course after talking to their own doctors about them. Dr. Myers faced sleeplessness and anxiety for his own challenging case of prostate cancer back in early 1999, for which he had a combination of triple hormonal blockade and an aggressive course of both external beam radiation and seeds, with removal of lymph nodes in a dangerous area of a metastasis also thrown in, so he is one of the prostate cancer doctors who have experienced these issues first hand.

I'm looking at something he wrote in 1999, quite a while ago, and also at something he wrote recently. In 1999 he noted that "Paxil, Zoloft and Effexor are antidepressants that decrease the frequency and severity of hot flashes," thereby giving a double benefit. He noted that "... antidepressants that work only by increasing the effectiveness of serotonin often lower sex drive," but that usually will make little difference to someone while he is on hormonal blockade. He also stated that "Some antidepressants lower sex drive and others do not. Those antidepressants that do not lower sex drive work by enhancing dopamine and or norepinephrine. Examples are Wellbutrin and Effexor." He also had a caution about St. Johns Wort, a supplement, but commented that "Valerian helps induce sleep and lessens anxiety, is not addicting, and seems very safe." He also mentioned comfort he got from two of his kittens; pets are friends we often forget in our anti-depression strategy. Perhaps my dog and cat helped me prevent depression.

However, I just was glancing at the first chapter of his 2006 book "Beating Prostate Cancer: Hormonal Therapy & Diet," and noticed these sentences: "I have had considerable success with both Welbutrin and Lexapro as treatment for the depression that commonly develops when men are on hormonal therapy. You also need to be aware that exercise can markedly lessen depression in many people.... vitamin D and sunlight exposure which greatly influence the positive impact of a well-planned hormonal therapy regimen. It has long been known that exposure to sunlight can lessen depression in many people. Now it appears that a good deal of that is due to vitamin D."

Of course, some depression is not so much caused by our biology as by our thoughts about the disease. Dr. Myers' first chapter is mostly on the importance of optimism rather than on medical details. He also includes inspiring cases of success with extremely challenging cases involving men with PSAs in the thousands. I find these reassuring because these men had cases far more advanced than mine but yet are doing well. Learning about such cases in this and other books can help decrease depression.

I also believe that spiritual help and support can play a key role for our mental outlook generally and particularly when facing prostate cancer. They have for me.

It also helps to know that we are not alone. Survivor Don Kaltenbach is one of several of us (or our wives) who have written books that also deal with these subjects. So the library or bookstore can be worth a visit. Along that line, support groups (including this board) can be a big help.

It may also help for your brother to start thinking of himself as a prostate cancer warrior rather than a prostate cancer victim. I know that has helped many of us.

I'm not trying to give a comprehensive review, just to show that there are resources out there to combat depression, including drugs to help that doctors dealing with prostate cancer feel are a wise step for those who need them.

I hope this helps,

Jim

 
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