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Old 02-14-2012, 02:13 AM   #1
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Sore and Moody from Hormone Therapy

I am currently going through hormone therapy for my prostate cancer. I have had 4 shots of Zoladex and my PSA is now below detectible levels. As of today, I will be going off my daily dose of bicalutamide, no more Zoladex and only taking Avodart for maintenance. Will be watching my PSA monthly. I normally work out on a daily basis. A few weeks ago, I started lifting heavy weights to increase my strength level. I am now starting to feel tired and sore from all the activity. I think I should stop the heavy lifting and go back to the machines instead of free weights. I have also found that over the last month or so, my mood seems to be getting worse at times. Moments of negative thoughts, emotional and sometimes feeling I am fed up with the hot flashes which keep me up at night and are brought on during the day when I am painting, which is what I do for a living. I am concerned about the emotional roller coaster and sometimes feel that I can only work part time because I seem to be getting tired after painting for 3 or 4 hours. I hope once my testosterone starts coming back, I will start feeling stronger and feel better emotionally. If anyone has any suggestions on how I can feel better, I would appreciate the advice. I am also in the process of making arrangements to see Dr. Myers in the next three to four months to get his advice on how to improve my lifestyle. Thankyou.

 
Old 02-14-2012, 05:54 AM   #2
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Re: Sore and Moody from Hormone Therapy

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Originally Posted by Crispy Crunch View Post
I am currently going through hormone therapy for my prostate cancer. I have had 4 shots of Zoladex and my PSA is now below detectible levels. As of today, I will be going off my daily dose of bicalutamide, no more Zoladex and only taking Avodart for maintenance. Will be watching my PSA monthly. I normally work out on a daily basis. A few weeks ago, I started lifting heavy weights to increase my strength level. I am now starting to feel tired and sore from all the activity. I think I should stop the heavy lifting and go back to the machines instead of free weights. I have also found that over the last month or so, my mood seems to be getting worse at times. Moments of negative thoughts, emotional and sometimes feeling I am fed up with the hot flashes which keep me up at night and are brought on during the day when I am painting, which is what I do for a living. I am concerned about the emotional roller coaster and sometimes feel that I can only work part time because I seem to be getting tired after painting for 3 or 4 hours. I hope once my testosterone starts coming back, I will start feeling stronger and feel better emotionally. If anyone has any suggestions on how I can feel better, I would appreciate the advice. I am also in the process of making arrangements to see Dr. Myers in the next three to four months to get his advice on how to improve my lifestyle. Thankyou.
Great news.
I wish you get that good mood back and strengths.
You may thing in taking it easy from the drugs but I would recommend you to get tested periodicaly. Testosterone, DHT, and DEXA. Lipids will give you a check on the effects of Avodart, if any.
Probably all that will not give you the peace and quictness you are looking for but it will show that you are in command.

Happy Holidays.

Baptista

 
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Old 02-15-2012, 05:15 AM   #3
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Re: Sore and Moody from Hormone Therapy

Congratulations to you both that you have reached this point! You have worked hard to get this program and to follow it. Now it is time to reap the benefits. One benefit is that just reaching this point so successfully gives good information about the cancer and how you respond. That will be helpful downstream.

Is the last Zoladex shot effect due to wear off about now? It typically takes several months for the effect to substantially disappear, but the three times I have been on Lupron, I noticed some changes within a week or two past the point where I would have gotten another shot. I believe you will be mostly back to normal within two to four months (usually three months for me), and likely fully back to normal within a half year. That said, Avodart holds down libido for a minority of us; if that happens, you might consider a switch to one or two finasteride pills daily.

A couple of times I have pushed too hard too soon on working to recover. That could be what is happening to you with the free weights. While it is hard to be patient, it would probably help if you reduced what you are doing to a comfortable level for a while. I'm convinced that would help. Celebrex is helpful in avoiding soreness, of course, and is also helpful against the cancer. It might be an option for you. While it has a little cardiovascular risk (and some other risks), that risk appears to be very low if heart factors are good. I'm now on it (second time), and it helps a lot with avoiding soreness. However, it can mask pain that is a good warning that we are doing too much. Years ago I got a years-long shoulder injury from sawing tree branches when I was on Celebrex because I did not get a clear warning from soreness and pain. I've learned.

Are you on any soy supplement or soy food for the hot flashes? I believe that helps. The flashes should start fading soon. Are you using fans (in the bedroom at night to circulate air, car fan, hand fan available - aimed at the neck especially - at work)? They helped me a lot and have helped many others of us.

Seeing an expert doctor will result in ways to prolong the vacation period, hopefully indefinitely, and open up other options.

I'm also convinced your mood will soon start improving. You've earned it!

Take care,

Jim

 
Old 02-15-2012, 09:51 PM   #4
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Re: Sore and Moody from Hormone Therapy

Hi Jim: Thankyou very much for spending the time to respond to me. I really appreciate the information and advice that you send my way. If I had to take a 5th Zoladex shot, it would have happened yesterday, but I don't have to. So I am assuming I will start to get my testosterone back over time and the hot flashes will disipate. If I go off the Avodart and switch to finasteride will it be just as effective as the Avodart? Maybe you could also explain how the Celebrix is effective against the cancer? I think if I warm up first on the weights and take it easy I will be okay. I hope I will be off the Zoladex for a long time and that the Hormone therapy will work for many years to come. I know that if it stops working there are other avenues available and scientists keep coming up with new and better drugs, so I am confident I will be around for a long time! One last thing Jim, Rhonda and I think your terrific! I don't know if you feel comfortable with this or not, but Rhonda told me that you may not live to far from Dr. Myers office. It would be really something for us if we could possibly meet you when we are down to see him, if you don't live to far away. It would be a real pleasure for the two of us to meet you. Rhonda and I really enjoy meeting new people and you have been an inspiration for both of us. I think you are a very positive person. Let us know if this might be a possibility. Once again thankyou for your help, I really appreciate it. Irv.

 
Old 02-24-2012, 07:22 PM   #5
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Re: Sore and Moody from Hormone Therapy

Hi Irv,

You're welcome, and I admire your perseverance and success in getting on triple blockade and reaching the point where you can take a vacation. It's well earned!

Avodart is usually somewhat more effective than finasteride for most men, and that likely includes you as you have responded well. Which drug to use could be a judgment call depending on how satisfied you are with recovery as testosterone comes back, and what the PSA and DHT are doing. While on vacation from the heavy duty drugs, my DHT was 11 on two finasteride daily, but it dropped to 5 after a short time on one Avodart and is probably lower now. Along with the Celebrex, I credit switching to Avodart for enabling me to maintain fairly good control of my PSA after it was rising too far with just thalidomide and two finasteride daily.

Regarding Celebrex, known as a "COX II inhibitor," there is an impact on PSA for many of us, especially with a rather high dose of 2 X 200 mg daily. I started taking it again in late November after my PSA started to rise on just thalidomide and Avodart, and I believe it is a key element in keeping my PSA stable for the past few months. Of course it is known for helping arthritis patients with muscle soreness and joint pain, and I too welcome the relief it gives from muscle soreness. In the past I have had to use an NSAID like Aleve to get a good night's sleep after a gym workout or vigorous physical work, even while taking thalidomide, which is a great sleeping aid. I haven't needed Aleve at all while taking the Celebrex. COX-II inhibitors got a bad reputation for heart and stroke trouble some years back, and COX-II inhibitors Vioxx and Bextra were pulled from the market. Celebrex had a much better risk record, and the risk it does have appears to be low if the patient has a good cardiovascular profile. I had stopped taking it a few years ago when my insurer decided not to cover it, because of what was known then about the risk. Now, based on new information, the insurer is covering it again, at least for me.

Celebrex works in several ways against prostate cancer. In the lab, NSAIDs, which include Celebrex, block both androgen dependent and independent prostate cancer. They block an important pathway for cancer cell survival known as NF-kappa beta. They increase the sensitivity of prostate cancer cells to radiation. They block conversion of arachidonic acid to prostaglandin E2, which is a promoter of prostate cancer, and which may help the cancer grow new blood vessels. (Prostate cancer cells produce ten times the amount of prostaglandin E2 as do normal cells.) COX-II inhibitors also help block the formation of new blood vessels for many cancers. There is a good description of this in an old Prostate Forum, Volume 4, Number 10 (published in 1999), on page 5, including research references for these points. The discussion mentions that, because of Celebrex's effect on "p-glycoprotein", it appears that Celebrex should not be taken for a period before and after chemotherapy. I have also heard that patients allergic to sulfa drugs may run into trouble with Celebrex.

I found I was able to build muscle on blockade, but I had to do it very gradually. I tried to speed up several times but got so sore I could not sleep well. You should feel the benefits of returning testosterone soon, but it will build up gradually. The increasing level will make workouts a lot easier.

Take care,

Jim

 
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Old 02-25-2012, 10:19 AM   #6
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Re: Sore and Moody from Hormone Therapy

Hi Jim.

Thank you for this valuable information about Celebrex. I'm guessing that this drug would be a consideration only after the first line hormonal therapy stops responding, right? That is, as long as Irv is doing well with intermittent bicalutamide, zoladex and avodart, then he doesn't need to consider anything else for the moment.

I don't know how Dr. Myers will respond to Irv's case, when we see him. However, I'm sure he'll be pleased that we fought for triple blockade. I hope he agrees with Irv's decision to take a break after the year of being on the heavy meds. I'll be so pleased if he says that that would've been his recommendation.

It would be great if Dr. Myers gives some idea about what might be a consideration for future treatment.....like Celebrex, as an example. My greatest concern is that the cancer was found in Irv's seminal vesicle and that he had extracapsular penetration and a positive margin. However, I try to look at the more positive side....I wonder if the fact that the positive margin was unifocal, as opposed to multifocal, maybe that gives hope that the cancer isn't like microscopic wildfire all over his body...maybe it localized to one spot and is truly oligometastatic. Maybe there's a possibility in the future that effective radiation can obliterate the cancer for good without the threat of horrible side effects for him, like a permanent colostomy. Afterall, he hasn't suffered from colitis symptoms for almost a decade already. I also look at the fact that his Gleason score wasn't too too horrible at 3 + 4 (7) but with only 20% being 4. I hope that the surgery removed all of the 4 cells and that he's only left with 3s (Wouldn't that be nice).

I wondered why, after surgery, his PSA began to rise so quickly (much quicker than before surgery at which time it seemed to be quite stable) and I'm hoping that that may be because his blood supply was so fresh from the rawness after surgery that it provided a lot of fuel for the cancer to proliferate. (I don't know if that makes medical sense, but his urologic oncologist did say, after being asked why, suddenly, the PSA was increasing faster, that sometimes after surgery, the cancer "proliferates"....his word) Of course the PSA number was much smaller after surgery than it was before but that shouldn't have any effect on doubling time, should it? I'm hoping that now that Irv has battled the beast with the hormone therapy, and he's healed completely from the surgery, that the cancer, especially with the help of the Avodart, will grow extremely slowly, giving Irv a lot of time to look forward to before having to go back on the Zoladex and Bicalutamide....and, as a result, give him time for medical advancements to come up with more incredible ways to fight this awful disease. Only time will tell....but I sure am looking forward to what Dr. Myers has to say about Irv's case and what all of his recommendations will be.

Rhonda

 
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