Interesting Study on HT side effects by Johns Hopkins

As one who recently had conversations with my Medical Oncologist about HT, I found this study very interesting.

It details a few things other than the normal side effects that have been discussed here more often. Thought I might post it here for others to see and chime in on.

http://www.johnshopkinshealthalerts.com/alerts/prostate_disorders/JohnsHopkinsProstateDisordersHealthalert_3400-1.html?ET=johnshopkins_blog:e37363:548695a:&st=email&st=email&s=EPH_100422_005

Sonny

Sonny, I couldnt get the link to work either, perhaps you can recheck it?

I know we don't like cut and paste, but since it is a fairly short article, I hope the modes won't mind. I can't seem to make the link work for others.

Here is the news brief that was emailed to me:

Male sex hormones (androgens) -- testosterone in particular -- are required to maintain the size and function of the prostate. As a result, a number of prostate cancer treatments are aimed at interfering with the effects of androgens. Blocking testosterone can temporarily cause the cancer to regress, or at least to grow more slowly.

Now research reported in BJU International (volume 102, page 44) finds that men who undergo androgen-deprivation therapy (ADT) for prostate cancer lose bone and muscle mass and accumulate more body fat.

Researchers documented these changes in body composition over 36 weeks among 72 men (median age, 73) with prostate cancer who were receiving intermittent ADT. At the start and end of the study, the men with prostate cancer underwent dual-energy x-ray absorptiometry scanning to determine whole-body and regional lean mass, fat mass, and bone mineral content and density. The researchers also measured PSA, testosterone, and hemoglobin levels and evaluated the men's physical activity levels and fatigue at both time points.

Bone mineral density decreased by about 1.5% at the hip, 4% at the spine, 2% for whole body, and 1% in the upper limbs. Lean body mass decreased in the upper limbs by about 6%, in the lower limbs by 4%, the trunk by 1%, and whole body by 2%. During the same period, fat mass at these sites increased by 21%, 19%, 12%, and 14%, respectively. The men also experienced greater levels of fatigue and became less active during the treatment period.

Bottom line: If you're on ADT for your prostate cancer, be aware that over time, these changes can increase the risk of cardiovascular disease, bone fractures, and falls. Taking steps to reduce your risk of these conditions, including lifestyle changes and medication, is an important component of your care.

Sonny

Those minor side effects (LOL) are not the same and alot is just the opposite mostly on what happens when using: DES, emcyt, estradiol patches(vs. the LHRH's as per your info)...which some patients would be better candidates for and some might not if one is of high blood clotting risk parameters. Of course most all the docs literally push LHRH (Lupron, Zoladex, Eligard, Precisis, Trelstar) and or casodex and its equals, and they work but have alot of effects and costs in many ways and highly profittable. Long term useage is possibly a real serious dilemna but it is hopefully a patients choice, as there are still many other drugs to fight PCa, many more.

The estrogen drugs I mentioned, in Journal of Urology article Nov. 2003- builds or does not deplete bone density (+++), doesn't deplete memory as does the (LHRH)other things, I can atest to looking, feeling and being stronger on these alternative drugs, of which there is no profits to be made. Did ADT3 for 2 yrs.(glad that ended), done DES intermittently for around 4 yrs., huge difference in effects, for me had way better psa results, extremely low in costs (mega difference in cost). Journal article mentions 1 -mg as being a safe doseage, 5-mg used 30-50 yrs. ago was not always safe but was highly effective and was used for many decades and still used today in many countries, too. But of course your uro-doc (genius) will tell you it is junk or that patches are too,(based upon???), however wiser onco-docs may or will prescribe it to you as some do for patients. Is treating patients all about the money???? Well you can contemplate what the experts are doing by their acts and history and decided for yourself, perhaps.

This is an honest question looking for an honest answer, but hopefully an answer thats more than about the "money" aspect:

Why are most of the doctor's I have talked to locally, been either out right negative to HT, or real cold at best. I am talking about my Uro, Surgeon, 2 of 3 radiation oncologist, my original medical oncologist from 10 years back, and even my GP of 13 years plus.

Besides the obvious more visible side effect issues, i.e. gaining weight, hot flashes, etc, could it be because of more serious long term issues like Sonny's clip indicated? I know that it has helped several of you guys in particular, and I am one that never wants to argue with success.

The doctors I have talked to seem to be up to date on technology and breakthroughs in general. Just trying to figure out their collective coolness with HT in general.

This is kind of a part 2, meant to include also, when HT drops the PSA, in some case dramatically, is it just masking what is really going on, or is it really lowering the PSA to the new lower levels? If it is masking, then is that a good or bad thing other than buying time for the patient?

David in SC

Sonny, thanks for posting the info.  David,  Dr. Myers has an article on the PCRI web site,  www.prostate-cancer.org/pcricms/node/203  that may answer your questions.  Here is a short paragraph from his article titled, "Beating Prostate Cancer with Hormonal Therapy".

"Over the last several years, a growing number of patients tell me they’ve been told that hormonal therapy doesn’t kill prostate cancer cells, but just stops cancer growth and artificially lowers the PSA test, thereby fooling us into thinking cancer cells have actually died. I find this myth very strange. Time and again, hormonal therapy clinical trials have reported shrinkage of measurable cancer metastases. Depending on the clinical trial, up to 30% of patients enter complete remission, which means that all detectable prostate cancer has disappeared! How can you enter a complete remission without having killed prostate cancer cells?"

I hope this helps.

Carlos

David,
PC cells are either androgen dependent or androgen independent. Most tumors have both cells. HT will kill the androgen dependent cells, and if that's all you have then you will go into complete remission. A lot of patients have a small number of androgen independent cell which keep on growing. Hence the intital reduction of psa due to androgen dependent cells dying then a future rise as the androgen independent cells keep growing.
This is the simplified version as there are many variations to this.
This is also why HT works well on some patients and on others it works for only a short period of time. A good oncologist can mix things up and through other tests can find out what works and what doesn't. It is critical to get a oncologist skilled in PC as PC works differently than other cancers and there are a lot of tricks a good doc has to keep you living a long time.
JT

Ohio: that's exactly why I am trying to find the right way to ask these kinds of questions, of all things PC, I am a complete novice with HT methodology and matters dealing to advanced cases. I think many of us here need to learn more about that end of things.

John: your answer and point of view already helped to explain something on this subject for me. Still sounds very complicated.

David, sounds like you are well informed, and on the right path for you at this point in your journey. Sounds like it would really take a seriously dedicated to the subject of HT kind of doctor to know what he/she was doing with their patients at that juncture. Lot of complicated drugs, with complicated dosing and use.

Surgery is a little more straight forward, as far as understanding, there's a real physical and mechanical feel to it. And having been through major radiation twice in my life so far, I understand the basic "mechanics" of that as a treatment. But the HT stuff and research and clinical testing is way over my head, and I am the first to admit that.