Hi wford and welcome to this board! We are a good group and are happy for your company.
Originally Posted by wford
I have been on 50mg X 2 Androcur since may 5 and 10.6 zoladex since wed 19 may, I am suffering depression and intense grief, am I going nuts or is this a "normal" side effect?
No you are not going nuts, but you did draw one of the short straws odds wise. Both Androcur and Zoladex can cause depression in a minority of men. There's a book titled "A Primer on Prostate Cancer - The Empowered Patient's Guide," Dr. Stephen B. Strum, MD and Donna Pogliano, 2005 edition, that lists most of the main side effects of combined blockade therapy. The chart in Table 13, page 153 (of my older edition) is based on a study done in one leading practice that specializes just in prostate cancer and that uses a lot of hormonal therapy. The chart shows the typical onset time for a side effect as well as it's percentage of occurence and degree of severity using standard severity numbers (mild 0-1; stronger 2-3, with 3 typically requiring medication). The authors note that the numbers are likely underestimates due to the reluctance of many male patients to discuss their symptoms.
For "Mental/Emotional Changes", the category that would include depression, the onset is 1 to 2 or more months. A total of 17% of patients experience this (about 1 in 6), with 3% of the patients experiencing mild changes and 14% experiencing more burdensome effects. You can find out more about depression and hormonal therapy if you go to a www.pubmed.gov, a site we can mention on this board because it is Government sponsored, and search for something like " prostate cancer AND hormonal therapy AND depression NOT (suramin OR cryo OR estrogen OR spinal) ". I just did that and got five hits (did the tailoring with the NOTs to get rid of papers that looked less promising). By clicking on the hypertext titles, you can view any abstract if there is one.
I'm a ten year veteran of intermittent triple hormonal blockade therapy (Lupron, 50 mg Casodex - similar effects to Androcur, and 10 mg finasteride). I did not experience these effects, except for feeling low for most days during the first couple of months, probably due to the life-wrenching adjustment to being diagnosed with a challenging case of prostate cancer. I have talked to fellow survivors who did experience significant depression.
Dr. Charles "Snuffy" Myers, MD, an eminent medical oncologist with a practice dedicated to prostate cancer, one of the leading medical oncologists dealing with the disease, and a survivor of a challenging case himself, has been writing a monthly subscription newsletter since 1996 known as the Prostate Forum (also the name of a very active PC support group in Southern California). He touches on depression from time to time, but he devoted the December 1999 (published July 2000 - delayed due to his own diagnosis and response) issue to "Simultaneous Treatment of Hot Flashes and Depression". He made many good points, including the points that "Anxiety often complicates treatment of depression in men with prostate cancer," and "Antidepressants can treat depression and anxiety at the same time." He discussed a number of key drugs and their advantages and disadvantages. He noted that Paxil, Zoloft, and Effexor are antidepressants that decrease the frequency and severity of hot flashes."
You would probably benefit if you obtained a back copy. They are still for sale with rapid delivery, but a nearby support group may have a full set that you could look at.
Keep in mind that this information is now a decade old. For instance, though he made a fairly neutral comment about St. Johns Wort, he later made unfavorable comments based on later research. His practice is accepting new patients and is convenient to the airport for Charlottesville, VA, but I believe he also does phone consultation, should you be interested.
If you are in Canada, would you mind saying where? There are some outstanding prostate cancer centers in Canada. (I'm guessing your location based on the use of Androcur. It's not approved for use in the US due to its cardiovascular risks.) The ones that I know about are in Vancouver, Toronto and Laval University, Quebec, but I'm confident there are other highly expert centers too. An important point: if you decide to stop Androcur, make sure you talk to your doctor about tapering off. I've had no enrolled medical education, so keep that grain of salt handy when considering the leads I've provided.
One final point, Drs. Strum and Mark Scholz became particularly expert in dealing with side effects of hormonal therapy. Dr. Strum has moved and semi retired, but Drs. Scholz and Richard Lam are carrying on in Marina del Rey (spelling?), on the coast by Los Angeles. Their practice has published a paper on the side effects of hormonal therapy and how to avoid or minimize them. They emphasize the role of exercise - aerobic as well as strength - for decreasing a number of side effects, and depression is one of them!
May I ask if you were diagnosed recently? Do you think your depression stems mainly from the medications or from the prospects of the cancer? If the latter, there are key facts that may cheer you up.
I hope you get some relief.
Take care and keep in touch,
Last edited by IADT3since2000; 05-24-2010 at 10:05 AM.
Reason: Added a semi-final paragraph shortly after posting.
Jim, thanks for the information, I was diagnosed April 12, gleason of 9, psa of 3, and a T2c tumour, 8 out of 12 biopsies were 9.
I had no symptoms whatsoever and it was just a routine DRE that started the nightmare, there are only 3 days supply of Androcur to go, the emotional swings are difficult, mostly intense grief/saddness.
I am Australian, from Brisbane, the braccytherapy HDT is in July followed by 5 weeks of EBRT.
Exercise does help, I am a martial arts instructor and in the gym the focus and workout certainly lifts me up out of the black clouds, I do this 4 nights per week, tho' some tiredness is starting to make it a struggle
It's coming up to three months on Zoladex and will be due for the next shot. The side effects continue unabated, dreadfull sadness and tearfulness continues, joint pain in hips and shoulders, walk like an old man and at times have to use a cane, some mental fogginess and short term memory loss, general feeling of weakness, zero libido and E.D, troubles sleeping and to top it off itching of my lower shins that gets me when trying to sleep. Have had bracytherapy and now receiving EBRT, is there anyone else out there having these side effects?
Last edited by wford; 08-09-2010 at 04:28 AM.
Reason: poor spelling
I'm so sorry you continue to suffer these side effects. I have gotten off so lightly in comparison that I cannot offer you much from personal experience. I'll insert a few thoughts in green.
Originally Posted by wford
It's coming up to three months on Zoladex and will be due for the next shot. The side effects continue unabated, dreadfull sadness and tearfulness continues,
There is an old Prostate Forum issue that addresses depression and prostate cancer, discussing drugs to help combat it. It looks like your concern is more mood swings than depression, but it would probably be worth checking with a doctor to see if anti-depressant medication would help. The issue is Volume 4, Number 12, "Simultaneous Treatment of Hot Flashes and Depression," and it was published in July 2000 ("dated" December 1999" - the month I was diagnosed, by the way).The author is one of the most respected specialists in prostate cancer, especially in hormonal blockade for prostate cancer, and he went the extra mile by becoming a patient with an advanced case himself, giving him added insight to what we go through. He discusses a number of drugs by name and their use for prostate cancer patients.
joint pain in hips and shoulders, walk like an old man and at times have to use a cane,
For many of us, the joint soreness eases or disappears after several months on therapy; that has been the case for me the three times I've been on triple blockade, which included Lupron, an equivalent to Zoladex. I use glucosamine too for better joint action; it is fine for us, but chondroitin is not wise for prostate cancer patients. Do over-the-counter pain remedies help?At times I've used NSAIDs, such as buffered aspirin.
A practice known as Prostate Oncology Specialists has a number of publications for men on hormonal blockade. One of them, on side effects, says this: "... The joint pain that occurs with TIP responds well to over-the-counter preparation like Glucosamine, MSM, and Super oxide dismutase (SOD). Typical non-steroidal anti-inflammatory drugs like Motrin®, Celebrex®, and Bextra® are also quite effective. There is some soft evidence that Chondroiten, another popular over the counter preparation for treatment of the joint is not a good idea for men with prostate cancer. It is possible (not proven) that chondroiten may accelerate the growth of prostate cancer." Bextra is no longer available in the US.
some mental fogginess and short term memory loss,
During my first few months I experienced that to the point I asked my doctor about it. He reminded me that I had a lot on my mind at the time, and he thought I would do better shortly. I did. These are symptoms of hormonal blockade though. A little more coffee might help. The foregoing publication comments on this and the other side effects you mention as well.
general feeling of weakness,
Is your gym work continuing to help? It's likely you will be well below your peak while on blockade, but I'm thinking you will be able to maintain an impressive level of strength as long as you continue to exercise. Be sure to keep up your protein intake. I believe that consuming a lot of water (in green tea, mostly) has helped me. I get at least a half ounce per pound of body weight daily, usually closer to 2/3 ounce per pound. I built up to that gradually. Some of the fitness supplements help some of us, partly depending on our genetics.
zero libido and E.D,
One of the leading practices recommends imagery and exercise to maintain what you can. It's not easy, but I'm convinced those practices can help some of us.
troubles sleeping and to top it off itching of my lower shins that gets me when trying to sleep.
Are hot flashes a problem at night? Fans can help. Your sleeping may improve as time passes. Melatonin, 3 mg, was recommended to me, to be taken about six hours before bed time. I believe it's helping some. Usually I sleep well, but I believe I'm doing even better with the melatonin.
Dry skin (and sticky skin) can be "minor" but irritating issues with hormonal therapy. A skin ointment may help. One leading doctor recommends vaseline.
Have had bracytherapy and now receiving EBRT, is there anyone else out there having these side effects?
I wish I were able to be of more help. Perhaps someone else will post who has overcome highly bothersome side effects while on hormonal therapy.
Jim, thanks for all the free education you have given, it is seriously appreciated.
Side affects are something I am begining to tolerate, I guess you just get used to living with a stone in your shoe, one interesting side effect I THINK I have had is the absence of migraines, I would get one of these things about every 4-6 weeks, haven't had a one since starting hormone treatment, that alone almost makes it worthwhile...LOL
A question I have is what about Estrogenic drugs to treat PC? is there anything known about this? studies, trials etc.
Your observation about the migraines is the first I've heard of that. Who would have thought it?
You also wrote:
"A question I have is what about Estrogenic drugs to treat PC? is there anything known about this? studies, trials etc."
That's a definite yes. In fact, that's the way hormonal therapy started; the drug was known as DES. It's inexpensive and effective, but there were some side effect issues so it is not used very much in the US at present. It commonly enlarges the breasts a lot, which is awkward for us guys. However, it also was causing substantially increased cardiac risks.
Now, estrogen can be delivered safely by patches on the skin (transdermal patches) instead of orally. That has made a great difference in the cardio aspect.
You can use PubMed to check what's been done with patches; I just did that using the string " prostate cancer AND transdermal estrogen " and got 24 hits. You will see abstracts of the studies, if the study has an abstract, if you click on the hypertext titles. Some of the doctors who publicly communicate frequently with patients have written about transdermal estrogen. For instance, Dr. Myers wrote about it in his book "Beating Prostate Cancer: Hormonal Therapy & Diet." He has also written about it in his newsletter.
My husband was diagnosed in May and started Zoladex In June in preparation for IGRT. The plan for him is a total of 6 shots. 2 before 2 during & 2 after radiation. He is coming up on his third shot and dreading it.
He is suffering some the side effects that you list E.D. hot flashes, low energy, sleep disturbance and especially depression and grief.
I don't know if this would be an option for you but last week his GP prescribed Velafaxine 25mg twice daily that's a starter dose apparently. It seems to have helped some with the hot flashes but it's hard to say if they are helping with the other symptoms. He may have to ramp up, we'll see, it's early days yet.
Hi pollyell, I have just had my second Zoladex implant, what I can say from my own experience about the depression and grief is that I have had some better control over it, this isn't to say it doesn't happen but there are times when it starts and I can prevent it from becoming a full bore sobbing session, and these are not as frequent as they used to be.
Love him comfort him and empathise with him, it will lessen.
The best news I have just had, my oncologist told me that in 18 more EBRT treatments I will be in remission!!
Thanks for the encouragement he doesn't read the board but he does listen to the stuff I glean from it, to a point. He's only 55 and had no symptoms, routine PSA. He has not been sick in well over 30 yrs so it's especially hard that the "cure" is so toxic to him.
p.s. Well done on "only 18 more" & remission!
Last edited by PollyEll; 08-19-2010 at 08:23 PM.
Reason: add a p.s.