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Old 03-06-2010, 11:01 AM   #1
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Lightbulb Hormonal therapy side effects: likelihood, seriousness, countermeasures

This is a response to Mitch's post under another thread, "First Lupron Shot - I welcome feedback." I thought it best to reply under a fresh thread as the response is long, it might clutter Tim E's thread, and the subject deserves prominence as Mitch raises many important concerns.

Hi Mitch and welcome to our club, especially to the hormonal blockade therapy section of the club!

I've been on intermittent hormonal blockade as my sole therapy for a challenging case since December 1999. Though I've never had any enrolled medical education, I've learned a lot about the disease and particularly about hormonal therapy. One thing I've learned is that there are several widely spread myths about hormonal therapy, in addition to many semi-informed doctors. I'll insert some thoughts in green in your immediately preceding post to Tim.


[QUOTE=Mitch128;4196720]Tim,

Since you've already started with LUPRON, just be aware of its possible side effects which are:

One of my pet peeves is that we typically get a poor picture of side effects from our doctors, something that is definitely the case with hormonal blockade therapy. Often a side effect is identified, as you have below, but we get no information about how long before it typically manifests itself ("onset"), its degree of severity for portions (percentages) of the patients taking it, its duration, and perhaps most important, countermeasures. Sometimes side effects are included that rarely occur, but they are listed right by the common side effects, making it hard for us patients to understand what is going on. For instance, if 30% of patients are experiencing bone and joint pain, with 26% experiencing mild pain and only 4% experiencing substantial pain, that also means that 70% are not experiencing this side effect, a hefty majority! We need to consider taking both the glass-half-empty and glass-half-full looks when we read such statistics. Often, we will see that our chances for handling the side effect with ease are great, especially after employing countermeasures to the side effect!

Some widely available sound information is in a book you should get that has the title "A Primer on Prostate Cancer - The Empowered Patient's Guide." It has one of the two best treatments of hormonal therapy I've ever seen, and that makes sense as the medical co-author, Dr. Stephen B. Strum, MD, is a an expert prostate cancer oncologist with outstanding knowledge of hormonal therapy. He and his then partner (before his semi-retirement), Dr. Mark Scholz, did a mini-study of the hormonal blockade patients in their own practice and came up with numbers regarding onset, severity and percentages with that severity, and some countermeasure information. Most of the summary numbers are on page 153 of the Primer. Other information, about impotence and bone density issues is located primarily on pages 151 and 142-143 respectively. Another source of information is the literature that comes with the shot, which is available on the FDA's website, a site we can mention on this board as it is Government sponsored. I'll make a few comments below.


Fatigue,

Not listed in the Primer, so probably not that common. The official literature does not list fatigue in the list of side effects affecting 5% or more of the approval trial patients. However, insomnia/sleep disorders was listed for one of the two trials, with 8.5% of patients affected, meaning that 92.5% of patients (in just that trial) were not so affected. I have experienced some sleep interruption in the first months after starting the drug, usually due to hot flashes and some muscle soreness; the soreness virtually disappeared within a month or two. I did experience occasional fatigue due to the sleep interruption, but it was not severe for me. A short nap usually fixed me right up.

An outstanding countermeasure for fatigue is both aerobic and strength exercise. I've not faced fatigue as a problem due to hormonal blockade, other than what I just described.


Flu-like symptoms,

This is not addressed in the Primer, so it's most likely quite minor. The official literature says that 12.2% of patients in one trial experienced those symptoms, but 0% in the other trial did. Even 12.2% is quite low, and I strongly suspect the symptoms were brief, probably just one time, even for those patients.

altered lipid levels,

This area - basically cholesterol and triglycerides - is definitely a significant concern for hormonal blockade patients. The Primer uses the word "hypercholesterolemia" - high cholesterol - to describe this, noting that 57% of blockade patients experience some symptoms, with 18% experiencing mild elevation and 34% more substantial elevation. Experts like the medical co-author of the Primer have been aware of this for many years (at least since 2002 when my edition of the Primer was published), but many other doctors have just been catching on in the past couple of years. For instance, the lipid area is not mentioned in the tables in the official literature. So often the doctors who just recently learn about one of these long-known "androgen deprivation syndrome" side effects overreact and mislead their patients about the seriousness of the side effect, in my opinion.

Fortunately, there is a very effective countermeasure to the lipid level side effect - the statin class of drugs. Given the other reasons for taking a statin, such as sharply reducing the risk of deadly prostate cancer, it makes good sense for those of us on blockade to take a statin. I take the generic drug simvastatin (which is generic Zocor), and it has been quite effective. In fact, with all the lifestyle nutritional and other tactics, my lipids are in great shape: total 198, LDL 101 (the bad cholesterol), HDL (the good cholesterol) a whopping 87, and trigs 49.


hot flashes,

This is a common side effect, affecting 48% of us per the Primer, but relatively mild in 23% and really bothersome in just 25%. Note that many of us, particularly older men (like you), get by with no or quite mild flashes and sweats. The official literature lists the percents as 46.9% in one study and only 8.3% in the other (probably used stricter standards for what was counted).

I've been on Lupron for three cycles (then off), and the flashes have gotten milder each time. I used to often use fans at work, in the car, and at night to decrease or prevent the flash/sweat, but in this third round they've been so mild that I rarely use the fans. My oncologist has offered a drug to eliminate the flashes, but they've been mild enough that I did not think it worthwhile to get the drug.

It's thought that soy helps (often advertised for women's hot flashes), but it is very clear that most men with serious flashes are greatly helped by several prescription drugs, such as Megace and Depot Provera. Often, one shot is all it takes, though some men get periodic shots.


numbness in extremities,

Where did you hear or see that? Numbness is not considered a side effect of hormonal therapy. It is not listed in the Primer, nor is it listed in the official literature. I have not experienced it and have not heard that any of my hormonal therapy buddies have experienced it.

mood swings,

This is a known side effect for some men on hormonal blockade. The Primer lists the total incidence as 17%, with 3% mild and 14% significant. (Remember that these numbers mean that 100% minus 17% means that 83% do not experience this side effect!)The official literature does not list it, but I suspect that is because it was not considered a significant, trackable issue at the time of the FDA approval trials for Lupron.

The experts I follow are convinced that regular exercise goes a long way in preventing mood and emotional problems. Mood swings have not been a problem for me, though my wife might differ with me on that. The experts also do not hesitate to prescribe anti-depressant drugs for the few men who need them.


joint pain,

The Primer lists the incidence at 30%, with 26% of that being mild and the remaining 4% significant. The official literature counted 16.3% with joint disorder in one study and 4.2% in the other, and 8.2% with myalgia (muscle pain) in one study and 0% in the other. I've experienced this a bit toward the beginning of cycles of Lupron, lasting for several weeks. It's probably due to the muscles getting used to a very low level of testosterone. Common pain killers are good countermeasures, and you can see that this is not much of a problem for most of us. My experience with three on-therapy cycles of blockade has been that this kind of discomfort goes away within the first few months.

weakness You did not mention this, but it is a fairly common side effect of hormonal blockade (the Primer listing it as 56% totl, with 51% mild and 5% substantial). It used to be thought that you could not build or maintain muscle while on blockade, and that you would become weaker. Well, I'm absolutely positive this does not have to be the case for some of us, as I have built muscle while on blockade, following the expercise countermeasure advice from the experts. Apparently, many of us are able to so benefit. It is harder to maintain and build muscle, but it can be done!


bone loss,

This one gets my dander up, because so many doctors carelessly mention it without informing us that there are outstanding countermeasures available! Yes, it's a very real issue, with the Primer noting that it is one of the most common side effects of hormonal therapy. It is really interesting that this common and potentially serious risk was not listed in the official literature. It has unfortunately taken many years for the most of the prostate cancer medical community to pick up on this threat. In sharp contrast, the experts have known about it and how to counter it for more than a decade. (For example, the Prostate Cancer Research Institute (PCRI) had an excellent article about bone density issues way back in the January 1999 issue of its PCRI Insights newsletter.)

You (if you have an orchiectomy) as well as men getting hormonal blockade therapy should have their bone mineral density assessed at the start of therapy and periodically (yearly for me), probably with a qCT scan in preference to the more common DEXA scan. If there is a problem, or as a preventative, a bisphosphonate drug (such as Fosamax, Boniva, Actonel, Aredia, or Zometa) plus calcium and quality vitamin D3 supplementation can pretty much take care of this concern. For men with well-advanced cases, especially with bone metastases, the most powerful bisphosphonate, Zometa, is the preferred drug. Not only is it great for bone density, but it is also helpful in counteracting bone mets, sometimes eliminating them completely!


anxiety,

This is not listed as a side effect in the Primer, nor is it in the official list. Just having prostate cancer is a cause of some anxiety for most of us, and, because hormonal blockade is normally used because the case is somewhat challenging, that anxiety could be heightened just because such patients know they have more challenging cases that may be life-threatening. It would probably be hard to tell what anxiety was due to the overall situation and what was due to taking the drug.

However, I'm convinced it helps to be aware of the highly encouraging reports from physicians expert in hormonal blockade. It helps to know that the myths are not true, such as the one about it only working for two or three years, and that survival after hormonal blockade stops working is short. The first myth actually was true for men with quite advanced cases involving multiple bone mets, but even in the early medical research papers it was recognized that men with less advanced cases did much better. Now, with bisphosphonate drugs, with radiation that can target and eliminate bone mets in men who have just a few, with potent hormonal blockade, such as triple blockade, that can also make some mets disappear and make it much harder for others to form, and with other advances, even the prospects for men with quite advanced disease are better..


blurry vision,

That's a new one to me. It's not listed in the Primer; I've never heard that it is a problem for anyone on blockade, and it's not listed in the official literature. Do you remember where you heard or saw that? Bottom line: I very much doubt that is a side effect of hormonal blockade.

memory loss,



The Primer's list shows that a total of 17% of men on hormonal blockade experienced some mental or emotional changes, with 3% being mild and 14% significantly bothersome. Some of this probably involved memory. While the official literature for Lupron omitted memory impact from the list of side effects experienced by 5% or more of patients, it did mention "confusion" in the list of rarer side effects.

Some of us do experience some degree of overall mental slip with hormonal blockade. Of course, many of us are older and getting even more older, a group which also, as a normal part of aging, is slipping a bit mentally, so it's hard to tell what part is due to the hormonal blockade. That said, researchers are working on this, and it does appear that there is some impact specifically on memory due to blockade, though the evidence is yet far from solid.

During the early months of my first round of blockade, at age 56 back in the spring of 2000 (started December 20, 1999), I was so concerned about difficulty in being able to handle all that was on my plate from home, work, and medically that I talked to my urologist about it. He advised me not to get overly concerned, saying that I indeed had a lot on my plate, especially with a challenging case, and that he thought I would shortly be feeling better about being able to handle everything. His talk helped, and he was right. I suspect many of us are in the same boat, especially in the early months on blockade.

Also, while hot flashes and sweats were not real bad, they did wake me up several times a night for at least ten minutes or longer. I learned to use a standing fan, on all night, in the bedroom back then, and that helped. On the second round the flashes/sweats were milder, and this third time they are a minor nuisance at most. Bottom line: interrupted sleep, until you get your routine down, can affect your mental sharpness.


increased risk of cardiovascular disease,

This has been recognized by the leading experts in hormonal blockade therapy for a long time, and was mentioned in my original edition Primer that was published in 2002, probably with this part written in 2001 or earlier. Unfortunately, many other doctors have only recently become aware of this risk, and some have overreacted by acting almost as if it were a show-stopper for those men considering hormonal blockade therapy. It should not be a show stopper. The official literature does not list it in the trials statistics, as the list includes only side effects experienced by 5% or more of men on Lupron; but the literature does list hypertension as one of the rare side effects affecting fewere than 5%. Of course, you get the question whether such a low percentage might have developed hypertension in the same period anyway, even if they had not received Lupron shots.

Effective countermeasures include statin drugs - no surprise there, to help with lipids, including cholesterol, and lifestyle tactics, including diet/nutrition/supplements, exercise (including aerobic and strength exercise), and stress reduction. I have a number of friends on hormonal blockade who are doing stunningly well in the cardio area, including myself. My own numbers, from my annual physical with a fasting test last year, were:

total cholesterol: 198 (high because of high good cholesterol)
HDL: 87 (the good cholesterol - a very high level)
LDL: 101
Ratio: 2.3 (fine)
Trigs: 49
My blood pressure and pulse are low, partly due to exercise. I take 20 mg of simvastatin (generic Zocor) daily.

I was really impressed with my HDL of 87 (so was my doctor, he looked at the lab report twice and said "Wow") , until I talked with a good friend also on hormonal blockade and doing the same countermeasures who had an HDL of 95!

The bottom line: cardiovascular concerns are a potentially serious threat, but they can and should be effectively countered!


decrease in hemoglobin,

Anemia is a recognized risk, but one I have not personally experienced. The Primer's table reports that about 45% of men on hormonal blockade experience some degree of anemia, though only 13% is at the level of substantial concern, while 32% is mild.

Fortunately, there are effective countermeasures. Lifestyle tactics can help, and if they do not do enough, medications are quite effective (Procrit for example; requires good medical management).

I'm going to break the discussion here and put the rest in another post under this thread in order to stay within the length limits. Jim (stay tuned)

 
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Old 03-06-2010, 11:28 AM   #2
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Re: Hormonal therapy side effects: likelihood, seriousness, countermeasures

CONTINUED FROM INITIAL POST

male breast enlargement,

A substantial proportion of us experience some mild breast enlargement, including me, though it's mild enough that I can pass it off as well developed pectoral muscles (at least that's what I tell myself ). The Primer's table pegs the total percentage at 38%, about evenly split between mild (18%) and more substantial and bothersome (19%). The official literature does not list this in the records from the clinical trials.

This is much more of a problem with the anti-androgen drugs (such as Casodex, flutamide) used alone and not with the LHRH-agonist clase (such as Lupron, Zoladex, Viadur, Trelstar, etc.). The anti-androgens used alone often also cause tenderness and soreness in the breast. The usually recommended way to counter this is to get a short course of radiation to the breast up front, before the anti-androgen has been used for very long. However, while most doctors are comfortable with such radiation, Dr. Charles "Snuffy" Myers, one of the great experts in prostate cancer and especially hormonal therapy, is concerned that there could potentially be an increase in breast cancer downstream due to the radiation; I have not looked into research on this.


elevated blood pressure,

This is not addressed in either the Primer or the official table of trial results, but I suspect it is a side effect for at least a few patients. It is mentioned in the official literature as a rare side effect reported by fewer than 5% of patients. I'm also convinced that it can be countered with lifestyle countermeasures (diet/nutrition/supplements, exercise, and stress reduction). Of course, blood pressure medication can also be used.

I like to get my blood pressure checked because it always comes out good, in contrast to my initial PSA result. For instance, in January a year ago I was at 110/70 with a pulse of 60, not bad for a then 65 year old man, not on blood pressure medication, on hormonal blockade therapy for several months at that time. I'm convinced a lot of us can achieve such results.


and weight gain.

Oh yes, quite common - most of us will gain five pounds or more. It's a struggle to keep weight down, especially around the middle, as our metabolisms slow down on blockade. Also, carbohydrate foods, such as bread, appear to foster weight gain for those on blockade. I am fairly religious about exercising and diet, but I'm convinced I could drop the five pounds I've gained if I were even more diligent about exercise. I've known some men on blockade who did not gain weight, and they were especially diligent exercisers who also stuck to a diet.

Based on my research, Androgen Deprivation therapy normally precedes removal of the prostate and,

Actually, while that sometimes happens, it is not common. Some doctors do use advance ADT to shrink the prostate before surgery, and perhaps the doctor who advises you is in that group.

with any such treatment, may evolve to a point where it becomes refractory.

Okay, major soapbox time. In fact, give me a minute while I build the soapbox higher. ()

Your point is true: it appears that most men relying on hormonal blockade will eventually have the cancer develop so that it is able to grow despite a very low level of testosterone and DHT, but: typically, that takes many years, may never happen, and survival after that point is substantial, all contrary to prevailing myth! I've been at this as a layman survivor for ten years now, and I've heard and communicated with many doctors and researchers about prostate cancer. I would say that most are under the gross misimpression that hormonal blockade is only effective for a short time, such as 18 to 24 months. The experts I follow, who have managed many men on intermittent hormonal blockade for many years, now believe that for most men on well-managed first line hormonal blockade (especially triple blockade) will control the cancer for either about ten to eleven years or indefinitely! Obviously I would like to be in the latter group, but I've now passed the ten year mark and should be able to go on a vacation off-therapy period for more than a year, before commencing another (fourth) round of hormonal blockade; that should put me well beyond the eleven year point.

The myth about short survival after hormonal blockade no longer works well is that the average survival is around twenty months. Well, that's based on men who entered trials mostly over a decade ago, prior to many advances, and it counts survival from trial entry date rather than from the time the blockade no longer worked, a key difference! Some doctors associated with Case Western Reserve University looked into that, and they found that additional, post-blockade survival averaged 40 months (well over three years) if men had bone mets at the time, and 68 months if they did not have such mets! That's approaching six years! When I first learned this, I added up the conservative figure of eleven years survival on triple blockade plus the five plus years for post first-line blockade survival, getting sixteen plus years, which boosted my morale! We also need to keep in mind that even that encouraging study was based on men being treated essentially in the 1990s, well before many of the advances in therapy and case management that we now enjoy. I can provide details including citations of the medical research, but those are the high points.

So yes, bottom line, the cancer is likely to work a way around hormonal blockade, but for most of us diagnosed in the modern era - before cases become far advanced, that is likely to take a long, long time.

And a post script to that bottom line: second line hormonal therapy often works very well for years for those who have eventually failed first line therapy. After that there is chemo, and likely Provenge (now pending FDA approval, probably on or by May 1 this year (2010).


I recommend you discuss this approach with your physician for a better understanding of the treatment sequence.

Such discussion is sometimes helpful, but frankly and bluntly, so many physicians using hormonal therapy for prostate cancer are ill informed that there is a good chance of getting poor advice. I strongly recommend the Primer, the book by Dr. Myers "Beating Prostate Cancer - Hormonal Therapy & Diet," and publications of the Prostate Cancer Research Institute, including its newsletter, "PCRI Insights." Many issues of Dr. Myers' own newsletter, "Prostate Forum", are invaluable for those of us on hormonal blockade. Leading doctors whose work regarding hormonal blockade that I follow closely include Stephen B. Strum, Mark Scholz, Richard Lam, Charles Myers, and Robert Leibowitz. In my opinion, they are about a decade ahead of conventional medicine regarding blockade therapy. There are other experts (including several Canadians who have made great contributions), but these are the ones I've paid most attention to. As a rule, for most of us, they are fond of using intermittent blockade rather than continuous therapy.

BTW, I'm fighting the same battle as you and have, as the result of LUPRON research, decided on Orchiectomy (scheduled 3/15/2010) because of fewer, more manageable, side effects and some assurance of continuing a certain quality of life. I am 71.

Mitch, you need to look at this again! An orchiectomy will cut off testosterone at least as effectively as drugs, and it's the virtual absence of testosterone that basically causes the side effects. You will have pretty much the same risks, as I understand it. What side effect risks do you think you will be avoiding? Those of us who know hormonal blockade can help you understand what will be going on after an orchiectomy. There's nothing wrong with that approach, except that it requires synthetic testosterone if you want to later take a vacation from the therapy; often, taking testosterone when you have succeeded in knocking the testosterone way down for a period is not a substantial problem in controlling the cancer.

Ultimately it comes down to an informed personal decision for us all.

You bet!

Best of luck in your physician guided decisions.

As I said above, I'm a strong believer in patient empowerment in the hormonal blockade area. Actually, in my own oncologist's practice, in my local support group, I've been able to provide key information to the doctors, as well as learning from them.

Before closing, I would like to mention two other rather common side effects that mitch is not concerned about, perhaps due to his age of 71.

Decrease in libido - Quite common. Countermeasures may help.

Decrease in erectile function - Also quite common, and again, countermeasures may help.


Mitch

To all - take care and may you have low PSAs.

To Mitch, please be active on the board, and again, welcome! Your first post provided a lot of food for thought on some topics the board has not seen for a while.

Jim

PS - Mart16 raised the issue of
insulin resistance in her post. That's an important side effect that has fairly recently received more attention. I've given a response about that and countermeasures in post #6, today.

[/QUOTE]

Last edited by IADT3since2000; 03-10-2010 at 03:20 PM. Reason: Adding comment on insulin resistance as a PS

 
Old 03-06-2010, 09:46 PM   #3
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Re: Hormonal therapy side effects: likelihood, seriousness, countermeasures

Jim-
Thank you for taking the time for such detailed information. My husband will be starting his first round of hormone therapy soon also and I will have him read your post.

I do have one question that maybe you could answer. My husband is diabetic and we have been warned the HT will make him more insulin resistant. It is one reason he has not started on HT as of yet. Have you come across anything regarding diabetics and HT.

Thanks- Molu

 
Old 03-07-2010, 10:47 AM   #4
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Re: Hormonal therapy side effects: likelihood, seriousness, countermeasures

Jim,

Thanks so much for your input on the effects of Hormonal Therapy. Prior to my posting I had read a number of yours and was (and am) impressed with your knowledge and willingness to completely share your treatment experiences. You are the stalwart of this forum and I'm sure every member is just as appreciative of your involvement as I am.

As to the possible side-effects of LUPRON (which I regard as poison), I'd like to add the following: loss of body hair, brittle nails and thinning skin. You should know my list represents a compilation of actual side-effects as posted on several PCa forums; they have not come from any digest, book or medical journal.

As to my particular situation, I am well aware there could be side-effects of Orchiectomy such as hot flashes, swelling of breasts, weight gain/redistribution, loss of muscle mass and thinning of/or brittle bones. By comparison to LUPRON which, because I am largely intolerant of medications especially statins and steriods, this is a condition I am prepared to come to grips with Hormonal Blockade via bisphosphonate therapy, D3 supplements, calcium, Zometa, Avodart or Boniva. Besides my age, 71, the fact that I have acute recurring Epididymis (pronounced testicular growths) with accompanying inflamation and discomfort made the decision easier - remove four for the price of two as it were.

Mitch

Last edited by Mitch128; 03-07-2010 at 10:48 AM.

 
Old 03-07-2010, 07:14 PM   #5
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Re: Hormonal therapy side effects: likelihood, seriousness, countermeasures

The beauty of this forum is to put your situation out there, and see what people in the same position think- any ideas they have- and anything they can add to my toolbox in fighting this. I think everyone who is in this position, benefits from the education gained- or the suggestions given from this forum. And I think everyone gains when Jim gets on his soapbox.

I am going to be preparing for my next appointment as a final exam in college. There are so many things that I need to add to what I am already doing. Based on the research I have been doing- and the reading, I knew to add calcium and vitamin d3 with the Zometa, the doctor didn't mention anything. You bring up so many important points which I need to reread and get it right. I am still 2 months into my first lupron shot- and no side effects that I am aware of. I am working 2 jobs at the moment- and living a normal life. Thank god I went in for my physical a year ago- if I didnt- the 2 tiny spots on my ribs would have been plenty more, and I never had one symptom.

Thanks to all.

 
Old 03-10-2010, 02:15 PM   #6
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Re: Hormonal therapy side effects: likelihood, seriousness, countermeasures

Hi Molu,

Thanks for your kind words but also for your fine question. Insulin resistance is a topic that has recently been getting a lot more attention among hormonal blockade therapy experts. I should have included it, but that shows the patterns of thought you can get into when you've been at something a long time and you are not focusing on important fresh information. I really do empathize with those doctors who struggle to keep up with their rapidly developing fields. I'll put some comments in green in an excerpt of your post, below.


Quote:
Originally Posted by Mart16 View Post
... My husband is diabetic and we have been warned the HT will make him more insulin resistant. It is one reason he has not started on HT as of yet. Have you come across anything regarding diabetics and HT.

Thanks- Molu
It is possible that having HT would make your diabetic husband more insulin resistant; on the other hand, there are some countermeasures that might do the job.

Dr. Charles "Snuffy" Myers, MD, one of the handful of true experts in hormonal blockade therapy for prostate cancer (as well as other aspects of the disease), wrote about this recently in his Prostate Forum subscription newsletter: "Reader Questions, November 2009," Volume 11, Number 7. His summary point in the list leading off the issue was: "Men who have their testosterone levels suppressed in the treatment of prostate cancer commonly develop insulin resistance." He discusses it in an answer about CoQ10, starting on page 3. His key comment is "I covered the management of these issues in great detail in Prostate Forum [Volume] 10 #11 and [Volume] 11#2. However, the key elements are exercise, the Mediterranean diet, controlling your carbohydrate intake, and portion size. Fish consumption and fish oil are very effective in reducing elevated triglycerides and lessening the damage done by insulin resistance...."

His main point in Vol. 11#2 is that he strongly prefers intermittent hormonal to continuous blockade, where possible, to cut down on the side effect burden. Intermittent rather than continuous blockade is a key part of my own approach.

In Vol. 10#11, his summary point is that "Both systolic hypertension and insulin-resistance steadily worsen the longer a man is on androgen withdrawal." He notes on page 2, "In men on adnrogen withdrawal, insulin resistance is often quite apparent. Men start to crave carbohydrates and often gain 5-20 pounds during treatment...." He cites nine medical research references for this section, including three that specifically mention insulin in the title. (These can be researched, starting with abstracts you can get for free at www.pubmed.gov, a site we can mention on this board because it is Government sponsored. I just got 35 hits with this search string on PubMed: " prostate cancer AND insulin resistance AND androgen deprivation therapy " (without the quotation marks).

He goes on to address "Controlling Excess Carbohydrate Intake," which is the key to development of insulin resistance. He talks about using the Zone Diet (Dr. Barry Sears) and the Mediterranean diet to control carbohydrate intake. He makes specific recommendations about such diets, especially regarding breakfast. He also emphasized that exercise was very important together with the diet.

One point he makes about exercise is that "Exercise helps reverse [the shift of calories to fat rather than muscle] and shift[s] incoming calories to muscle rather than fat. In study after study, daily exercise helps lessen insulin resistance." He also cites eight medical research references for this section.

I'm confident I've been doing very well myself in counteracting a tendency toward insulin resistance and diabetes while on hormonal blockade. I've been generally doing the things Dr. Myers recommends, and my test results are good evidence that I'm doing okay. Still, I've gained about five pounds, and every once in a while I slip up and put on a few more. I can empathize with those craving extra carbs; I have to limit the amount of bread I eat.

Back copies of the Prostate Forum issues are available, and you might be able to find the copies discussed in sets kept by some prostate cancer support groups.

I'm going to edit my second post in this thread and mention insulin resistance. Thanks again for bringing it up.

Good luck to you and to your husband in dealing with the combined challenge of diabetes and prostate cancer. I believe that many couples have found a way to meet this challenge, but it will take commitment and work.

Take care,

Jim

 
Old 03-10-2010, 04:57 PM   #7
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Re: Hormonal therapy side effects: likelihood, seriousness, countermeasures

Hi Mitch,

Thanks for your nice words. I'm putting some comments in green into an excerpt of your post #4, which raised some questions.


Quote:
Originally Posted by Mitch128 View Post
Jim,

Thanks so much for your input on the effects of Hormonal Therapy. ...

As to the possible side-effects of LUPRON (which I regard as poison),

Shortly after starting therapy with Lupron I came across publications from a group calling itself something like the Lupron Victims Group. Their statements were alarmist, exaggerated, sometimes wrong, and generally misleading. But I did not realize that at the time, and they sure got my attention for a while. Like many powerful and effective medications, Lupron has some side effects. But weighing the risks, as reduced by countermeasures, and the benefits, I consider it a welcome drug.

I'd like to add the following: loss of body hair,

My experience and what I've learned is that that is pretty much true. Guys who treasure their chest hair are in for a disappointment. You keep your scalp hair and pubic hair, but much of the rest nearly disappears. But what's the big deal here? To me, this is a "who cares" issue.

brittle nails

I don't see brittle nails as a side effect, and many fellow hormonal blockade guys have not mentioned it when I've communicated with them.

and thinning skin.

I'm not sure how we would know if the skin is thinning, but again I haven't heard that this is a side effect. Dry skin may be a side effect; it's certainly something I have to cope with during the cold weather months. Advanced formula Lubriderm and I are great friends. Sticky skin can also be a nuisance. Dr. Myers has recommended vaseline for it, but to me it has not been worth the trouble.

You should know my list represents a compilation of actual side-effects as posted on several PCa forums; they have not come from any digest, book or medical journal.

There's some good information out there, but also a lot of poor information.

As to my particular situation, I am well aware there could be side-effects of Orchiectomy such as hot flashes, swelling of breasts, weight gain/redistribution, loss of muscle mass and thinning of/or brittle bones.

Plus the other side effects of hormonal blockade that I've mentioned. Be sure you are familiar with the countermeasures.

By comparison to LUPRON which, because I am largely intolerant of medications especially statins and steriods, this is a condition I am prepared to come to grips with Hormonal Blockade via bisphosphonate therapy, D3 supplements, calcium, Zometa, Avodart or Boniva. Besides my age, 71, the fact that I have acute recurring Epididymis (pronounced testicular growths) with accompanying inflamation and discomfort made the decision easier - remove four for the price of two as it were.

That makes good sense to me.

Mitch
Take care and good luck,

Jim

 
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