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Old 11-22-2010, 06:53 PM   #1
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Smile Prostate Cancer Hormone Treatment

Just finished 7-1/2 weeks IMRT radiation.
now in the middle of 6 month hormone treatment.
2nd Trelstar injection has caused terrible problems with sleeping.
Anyone else had this problem?

 
Old 11-23-2010, 07:53 AM   #2
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Re: Prostate Cancer Hormone Treatment

Hi,ncobjim

I am not aware of Trelstar specific side effects aside from the usual of Ganodotrophin RH drugs. However, your sleeping problems may be caused not directly from Trelstar but from low testosterone.
In truth, low testosterone, less than 300 nanograms per deciliter of blood, cause symptoms including; low sex drive, erectile dysfunction, mood problems, fatigue, and sleep disturbances.
I read that fifty percent of patients with below-normal testosterone levels, report symptoms related to the above.

Wishing you the best
Baptista

Last edited by Baptista; 11-23-2010 at 07:54 AM.

 
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Old 11-26-2010, 01:56 PM   #3
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Re: Prostate Cancer Hormone Treatment

Hi Jim,

I'm an eleven year survivor of a challenging case of prostate cancer with hormonal therapy (intermittent triple blockade with finasteride continued during the vacation periods), and I have had similar though milder problems during the early months on blockade each time, though progressively milder on the second and third cycle. You wrote:


Quote:
Originally Posted by ncobjim View Post
Just finished 7-1/2 weeks IMRT radiation.
now in the middle of 6 month hormone treatment.
2nd Trelstar injection has caused terrible problems with sleeping.
Anyone else had this problem?
Is it hot flashes and sweats that are causing the sleep problems or something else? We are now fairly sure, based on accumulated research, that soy consumption/supplementation helps ease or eliminate the hot flashes and sweats. A fan in the bedroom at night can also help. However, there are a number of drugs available that are highly effective in dealing with flashes/sweats for most men.

It's also likely that the problem will ease as the months go on, and the problem should go away entirely within months of stopping the Trelstar.

Also, for many of us aerobic and strength exercise during hormonal therapy also helps with sleep and many other issues, including those mentioned by Baptista. The odds of having any of the specific common side effects are addressed in some good books, including "A Primer on Prostate Cancer -- The Empowered Patient's Guide," and the new book "Invasion of the Prostate Snatchers." Most side effects have an incidence well under 50%, and for most a substantial proportion of patients with the effect will have only mild symptoms. I am fully convinced that using countermeasures to the side effects is very important in order to achieve the best available quality of life while on hormonal therapy. Countermeasures won't completely resolve the issues for most of us, but they often make a huge difference!

Did your doctor explain the basis for just six months of adjuvant hormonal treatment? There may well be a good basis for that choice, but research has suggested that up to two years is superior to six months.

Take care,

Jim

 
Old 11-27-2010, 06:54 AM   #4
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Re: Prostate Cancer Hormone Treatment

Quote:
Originally Posted by IADT3since2000 View Post
Hi Jim,

I'm an eleven year survivor of a challenging case of prostate cancer with hormonal therapy (intermittent triple blockade with finasteride continued during the vacation periods), and I have had similar though milder problems during the early months on blockade each time, though progressively milder on the second and third cycle. You wrote:




Is it hot flashes and sweats that are causing the sleep problems or something else? We are now fairly sure, based on accumulated research, that soy consumption/supplementation helps ease or eliminate the hot flashes and sweats. A fan in the bedroom at night can also help. However, there are a number of drugs available that are highly effective in dealing with flashes/sweats for most men.

It's also likely that the problem will ease as the months go on, and the problem should go away entirely within months of stopping the Trelstar.

Also, for many of us aerobic and strength exercise during hormonal therapy also helps with sleep and many other issues, including those mentioned by Baptista. The odds of having any of the specific common side effects are addressed in some good books, including "A Primer on Prostate Cancer -- The Empowered Patient's Guide," and the new book "Invasion of the Prostate Snatchers." Most side effects have an incidence well under 50%, and for most a substantial proportion of patients with the effect will have only mild symptoms. I am fully convinced that using countermeasures to the side effects is very important in order to achieve the best available quality of life while on hormonal therapy. Countermeasures won't completely resolve the issues for most of us, but they often make a huge difference!

Did your doctor explain the basis for just six months of adjuvant hormonal treatment? There may well be a good basis for that choice, but research has suggested that up to two years is superior to six months.

Take care,

Jim

 
Old 11-27-2010, 07:19 AM   #5
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Re: Prostate Cancer Hormone Treatment

Thanks for the help.
Had radical proststectomy in 2006 after Gleason 3+4=7 Stage III (pT3b NO)
focally postive margin, and perineural and lymphatic invasion.
PSA wnt down to 0.05 after 4 weeks. Stayed at that until 2009. Went to 0.1
then 0.2 then 0.4. Decided on 8 weeks of IMRT radiation. Doctor advised starting
homonal therapy 2 weeks before radation to run for 6 months and then see how
it was responding. PSA after 5 weeks later was well below 0.0
Do not have a lot of problems with the hot flashes. Sleeping at night is the problem.
Either cannot get to sleep or when i do i wake up every hour or so and again have trouble getting back to sleep. It was after the 2nd 3 month shot that the problems started. I do a lot of Walking for exercise but not much else.
Hoping that the follow up PSA in March goes lower and we just have to keep an eye
on it. Hope yours contunues well for you.

 
Old 11-27-2010, 09:00 AM   #6
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Re: Prostate Cancer Hormone Treatment

Hi again Jim,

I'm responding to your latest post.

It could be that a lot of us in the early months of hormonal blockade therapy have the same problem with sleep, but it may be masked by problems with hot flashes and sweats.

Have you tried melatonin pills? I've tried several brands, but the one that works well for me is Schiff's. I sometimes take one pill just before bedtime.

Take care,

Jim

 
Old 11-27-2010, 12:42 PM   #7
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Re: Prostate Cancer Hormone Treatment

I tried the melatonin & did nothing.
I'll see if i can find Schiff's.
Thanks again

 
Old 11-28-2010, 03:44 AM   #8
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Re: Prostate Cancer Hormone Treatment

Hi ncobjim

I would think that your sleeping problem is due to a low testosterone in your body and therefore it will be gone once you recuperate to normal levels (probably at the fourth month from your last shot of Trelstar). However, stress, too much caffeine and depression, may be a cause of the problem too.

I experienced sleeping problems for 5/6 days after RT due to stress. I managed to solve the problem with a soft-walk (about 2Km) after dinner, and taking a very warm bath before bed time, done during one week.
Some people adjust the problem by changing some habits during the day and at bed time, like cutting in alcohol and coffee, until things get to normal.

Hormonal treatment done together with RT is a strategy to assure a higher success in the treatment. It is a RT protocol for cases where cancer is thought to be close to the bladder neck (area of seminal vesicles), where Gys are applied less intense, and so to avoid causing incontinence. The term “N0” in your pathological stage (pT3bN0), indicates the cancer has not spread to the lymph nodes. But the usual RT protocol includes attack to the areas of lymph nodes particularly those that were difficult to take in the RP, causing stress.

Surely your PSA will be in the two decimal digits (0.XX). I would recommend you to have it checked using a supersensitive assay that can be done at the same lab and at the same price.
My anticipated congratulations.

Wishing you the best,
Baptista

 
Old 11-28-2010, 10:24 AM   #9
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Re: Prostate Cancer Hormone Treatment

Hi Jim (and Baptista),

Bapbtista's suggestions about sleep make sense to me too, but I wanted to comment on one part:

Quote:
Originally Posted by Baptista View Post
Hi ncobjim

I would think that your sleeping problem is due to a low testosterone in your body and therefore it will be gone once you recuperate to normal levels (probably at the fourth month from your last shot of Trelstar).
I've been on hormonal blockade three times now (31 months, 19 months, and again 19 months), and each time I've had some difficulty sleeping during the early months when testosterone is plunging. I'm not sure exactly what causes the difficulty, but it may be the adjustment to decreasing levels of testosterone. In part hot flashes at night and sweats disturb sleep, and those are definitely related to the T level/estrogen balance.

However, after several months I do fine despite having very low testosterone. I have waked up enough to notice flashes/sweats several times a night, but the last two cycles these were just a minor nuisance, barely noticeable during the third cycle.

I have not had any trouble sleeping as testosterone gradually increases to normal after the Lupron shots have run their course.

Patients differ in the way they react to hormonal blockade, so my experience may not be what you will experience.

Take care,

Jim

 
Old 11-28-2010, 02:30 PM   #10
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Re: Prostate Cancer Hormone Treatment

Sir, I went through this 8 years ago Doc used Lupron as the injection. I had similar issuesI was on the Lupron 9 months then commenced radiation for 42 weeks once per week I have had no cancer issues since. Best of luck. Bill

 
Old 11-29-2010, 02:52 AM   #11
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Re: Prostate Cancer Hormone Treatment

Hi JimADT3

It seems that ncobJim case belongs to the group of HT guys (25 to 50%) reporting severe sleeping problems. On the other side of the spectrum there is the other group (50 to 75%) of guys not reporting, because they experience mild insomnias, (may be your case) or their bodies adapted well to low testosterone levels, or else.
This capability in humans of adaptation to environmental situations (gene-environment interaction), is also an affair behind the Refractory Prostate Cancer Cells. According to some hematologists studying facts, cancer cells learn to adapt to live of low testosterone supplies and still go further by transforming (mutation) themselves to adapt in feeding on anti-androgens.
I read some abstracts of scientists involved in similar studies who have identified a series of cells and enzymes that are the reason for that capability in adaptation to their environmental situation (maybe the roots of the evolution principle).

NcobJim could take something to increase testosterone in is body but that would spoil his present treatment involving the weakening of cancer cells with HT and the kill with RT. I would suggest him to try to adapt to the situation by simple follow a natural way as I mention in my post above.

Side effects from side effects are also a case to consider. When I started Cyproterone I experienced acute fatigue that it would made me to fall asleep just after dinning. I would then wake up at about 2am and would stand all night doing nothing. I adapt by taking dinner one hour later and getting me engaged in the exchange of e-mails before bed time (11pm).
The effects on low testosterone are also affecting me now but I am experiencing mild sleeping problems like you.

Wishing you a successful continuation of your intermittent hormonal therapy, for many more ON/OFFs periods.
Baptista

 
Old 11-29-2010, 04:36 AM   #12
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Re: Prostate Cancer Hormone Treatment

Doctors don’t know exactly why Provenge seems to work. Moreover, the combination of extended life with no improvement in any other clinical measure is basically unheard of in cancer research. Like going fishing, catching no fish, and still frying up a seafood dinner without a trip to the fishmonger. The issue of the New England Journal of Medicine announcing the modest success of the drug included an editorial wondering if the apparent positive effect was actually caused by some error in the experimental design.

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Old 11-29-2010, 05:47 AM   #13
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Re: Prostate Cancer Hormone Treatment

My doctor has suggested that maybe a mild sleeping pill could help with this situation. I said not at this time as i really do not want to rely on more medications at this time. May change later if this does not improve.

 
Old 11-29-2010, 01:44 PM   #14
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Re: Prostate Cancer Hormone Treatment

Hi kdavid30 and welcome to the board

I'm a bit puzzled by your post, and I'm not sure how it fits in this thread. You posted:


Quote:
Originally Posted by kdavid30 View Post
Doctors don’t know exactly why Provenge seems to work. Moreover, the combination of extended life with no improvement in any other clinical measure is basically unheard of in cancer research. Like going fishing, catching no fish, and still frying up a seafood dinner without a trip to the fishmonger. The issue of the New England Journal of Medicine announcing the modest success of the drug included an editorial wondering if the apparent positive effect was actually caused by some error in the experimental design.

< edited >
I'm wondering if you meant Provenge or some other drug, as some of what you posted does not line up well with what has happened regarding Provenge. For example, doctors actually know a lot about why Provenge works, and after a large (more than 500 patients) and rigorous clinical trial (double blind, randomized, placebo controlled) involving some of leading researchers in prostate cancer, with the results lining up very well with at least two previous clinical trials of Provenge, experts are confident the drug works, a higher degree of confidence than "seems to work".

The drug works because it first targets the cancer using the PAP molecule, after "training" the patient's immune system to recognize and target PAP, enabling the usual components of the patient's immune system to home in on the cancer.

I've gotten involved as a survivor (no enrolled medical education) in cancer research, and my impression is that improvement in survival without other objective measures of cancer improvement is not unprecedented. In fact, for patients with late stage prostate cancer that are often preferred for clinical trials, the PSA level and changes in level is not regarded as a reliable indicator, nor are changes in bone mets, though both may be good clues.

I appreciate your mentioning the paper published in the New England Journal of Medicine. I was not aware of that, relying instead on information presented to the FDA by Dendreon about the key trial. Among other points, the abstract of the paper reports three year results, stating that " The 36-month survival probability was 31.7% in the sipuleucel-T group versus 23.0% in the placebo group." Every other account I've seen has used 33% and 11%, so I'm puzzled by the difference.

However, as far as I've heard, there has been no question about the design of the trial leading to artificially favorable redsults, especially since the results line up so well with previous results. There has, on the other hand, been some speculation that the bar for success, which was exceeded, was set unreasonably high, as the so called "placebo" arm was actually a delayed, frozen/thawed version of Provenge, meaning that Provenge was actually competing with a delayed version of itself. In other words, there is some thought that Provenge may actually be even more successful than the trial results indicate.

You mentioned the "modest" success of the drug in the trial. Actually, an advantage of 4.1 months is very impressive in a clinical trial setting for a cancer drug used against late-stage disease, though such achievements are not well appreciated by either the media or by some doctors, mentioned by the media as authorities, with a superficial understanding of clinical trial results for prostate cancer. Provenge has been discussed in a number of threads on this board, including discussion of the real-world value of the success achieved, and you can find those discussions if you search the board.

I hope this helps.

Take care,

Jim

 
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