Another reason not to jump on HT when its not really needed

This article concerns me, if true, and I have no way of really knowing, sure seems to indicate that a lot of men jump on HT way too soon in their PC progression, and greatly increase other medical issues.

http://www.pcf.org/site/c.leJRIROrEpH/b.5801103/k.FD7/Prostate_Hormone_Therapy_May_Up_Heart_Risks.htm

I'm so glad you posted that link. It gives us a completely different way of looking at hormone therapy, which would probably have been our next step if radiation therapy 'fails'. Now if they could just figure out which cases are going to progress quickly and which will not...

Juliet

""One third of men over 65 who don't have surgery or radiation get this therapy," she said. "Yet its effects have never been studied in a controlled trial."

My BS alarm just went off.....Could it be that this one third were diagnosed with metastatic disease and HT was their ONLY choice???

I think it's effects have indeed been studied..Their PSA often drops to undetectable and their symptoms are completely relieved for long periods. The race is on...Will it be PC, heart attack or stroke that lays them to rest?? The heart attack and stroke risk can be mitigated. Not so with the PC risk...

ADT was the FIRST effective medical treatment for PC... It's STILL the only effective treatment when surgery or radiation fail. Now they want to limit or abandon it because of the side-effects ?

My U-doc billed Medicare $2918 for having his nurse give me an Eligard shot..Do you think they are going to give THAT up???

Who's going to tell Strum?

That is one point of view. If you listen to Strum, Myers and Scholz, the doctors that have used HT for years you get another point of view. In every aspect of oncology that we know of, there is not one case that starting chemo sooner rather than later is recommended. Strum is pretty insistant that the earlier you begin HT the better it works because of the low tumor burden and the PC cells have not yet had a chance to mutate.
Also most of the heart related risks are associated with the weight gain that is common with HT. Every major oncologist also suggest a health diet and regular excercise program to keep the weight off. Patients that have no weight gain don't have the cardiac risks.
There is one study that shows an increased risk of heart attacks, D"Amico, Journal of Urology June 07 and four others that show no risk or less risk: Fritz Schroeder, European Urology Sept 08, Jason Efstathiou, Journal of Clinical Oncology, Jan 09, Urs Studer, Journal of Clinical Oncology April 2006, and Payam Hakimian, British Journal of Urology International, August 2008.
It is also well known that many doctors perscribe HT to older patients and patients with known cardiac problems that preclude surgery and this can contribute to a built in bias.
If I had to bet my life on it I would go with Strum, Myers and Scholz's view.

David, The idea of HT only masking psa is totally wrong. There have been thousands of cases where imaging and follow up biopsies after HT have shown major shrinkage in tumors. I was instructed that I could not have HT before I had my Combidex scan because within two weeks of HT any lymph node tumors would be undectable on the scan because HT is so effective in shrinking tumors. There have been many postings on this board of patients that have had identifiable masses or bone leisons that have completely disappeared after a couple of months on HT. Andrew, Ohio State, had a mass on his bladder that led to total constriction. Within 2 months on casodex the mass completely disappeared and his catheter fell out on its own. He was given 6 months to live by doctors and a year later is doing fine with undectable psa and no detectable masses by just taking Casodex.

JohnT

John, with respect, there are always the rare exceptions to the rules, I acknowledge that. Its very much on a case by case basis in my opinion. We have men here with aggressive acting Gleason 7s, in unstable condition with fast BCR, and men that are solid 8/9s that are holding their own after years. When we are talking about a verified Gleason 6 environment, I completely agree on most of the current thinking.

david

I wonder if the risk could be mitigated with, not just lifestyle changes to prevent weight gain, but medications aimed at reducing the likelihood of stroke and heart attack. Of course, many older men take those already...

Juliet

David,
The hospital where I had my RT refuses to give HT at the same time as RT as they don't want the HT to mask the effect of the RT, which is yet another indicator that HT does something positive with PCa, the problem is though the negative stuff it does to the rest of your body.

I also question they way the statistics about increased heart/stroke problems are reported. A doubling of risk needs to be quantified in numbers as well as percentages. If the normal risk is 50 guys per thousand and the HT doubles it to 100 guys per thousand that would seem to me to be less of a problem than if the normal risk is 450 guys per thousand and the HT doubles it to 900 per thousand. (The report mentions the actual numbers for diabetes so why not the actual numbers for cardiac stuff and strokes too?)

All I know is that I will have a very long think about ever embarking on HT if RT fails as my family has a history of heart/stroke problems. And I have already had trouble with weight gain after surgery and RT, suggesting I can't exercise enough etc.

This is another reminder of the importance of dealing with doc who are specialists in prostate cancer, which nearly always runs to a different timescale than other cancers. A doc who sees all sorts of cancer patients may be too used to the idea that his patients don't live for that long after diagnosis and that for them a treatment that improves things for a few months may be the best that can be done for them, whereas guys with prostate cancer ae looking for treatments that improve things for many years.
It almost makes you question those urologists who start off by saying "you've got more chance of dying from a heart attack with the PCa inside tou than from the PCa itself" - what if the heart attacks that such guys die from are caused by the treatment for the PCa!!!


Alf

Mel,these is from your post:

"The other school -- the predominant school of experts methinks -- suggests that this is the wrong approach and we should hit things earlier with HT before things get out of control".

Me thinks, that sometimes that "let's throw everything at it" approach means the doctor(s) in question don't really know the best approach to use, so they use up al the patient's cards at one time and hope for a win. I don't agree with that approach.

The only rad oncol I met with that was remotely suggesting HT with SRT, was real unsure of himself when questioned hard, in the end, he had to admit to me, that he didn't know if I really needed it (HT), and he didn't know if it would actually help (HT).

Not very hope inspiring there coming from a doctor that had mostly dealt with PC guys in his practice. So his ending answers sealed the deal for me, no HT with SRT

The next 2 rad oncol simply were in agreement, no HT before SRT, they needed to see how the SRT work and its effectivness as a standalone secondary and possible curative means. They didnt want anything else in the mix.

David in SC

Welcome to the Twilight Zone issues on PCa, plenty of exceptions, choices, non-definables, unknowns, even includes bias, agendas, errors and good and bad judgements. There is no one set protocol or one set choice, unless you hire the Soup Naz_ type guy. (which they should know there is many ways to treat PCa).

I talked to Andrew the other night, doing well and has to pinch himself that his journey could have ended up way different with a hack n slash doc that was going to reinvent his parts surgically. He fired a couple of docs(in Ohio) with heavy agendas on his well being (much to his own good), Dr. Fred Lee gave him a better assessment of his case with PCa. The casodex and his other drug (older but like proscar) have done very well for him, my onco-doc in Michigan cared enough to see that he got on casodex and such immediately, the other docs let his psa get to over 120 or so...without any drug protocols. My onco-doc told Andrew that his catheter would probably fall out on its own after a little while, even though it had been in him (the same one) for over 3 months as PCa grew around it and wasn't coming in and out easily. Well it did fall out and he had been peeing normally ever since and totally elated with that and his low psa level that stabilized so well, he has been off the drug many months now and getting a psa test in 1-2 weeks and blood work too. His story is unique and shows why one should question everything and get further opinions. 

Post Edited (zufus) : 1/2/2011 10:31:05 AM (GMT-7)

David,
I was surprised that castration had a higher risk factor (40%) than ADT (27%)