Hormone Therapy - Interesting (positive) Paper

Surely the God, there must be something written on this ever changing topic since May, 2007?

Really.....you would think though, that after all the latest documented cases of HT that we should no longer be dealing with myths but facts. I found that even as late as last year when I tried to rationalize my own HT recommendations that there were many different opinions.

Hi Bud, Dr. Myer's message is a message of hope and is based on more recent medical science than the old myth he is trying to supress. The introduction of PSA testing has changed the way PCa has been diagnosed in the last two decades. As more men are diagnosed with earlier stages of prostate cancer including earlier stages of advanced prostate cancer, less men present with multiple lymph node or bone mets at diagnosis. This implies significantly less tumor burden at the initiation of therapy and an opportunity for early hormone suppression to induce massive cell death in the androgen dependent portion of the tumor load. For many years, the medical profession had evidence that demonstrate that the lower the tumor burden the better the response to hormone suppression. This was clearly demonstrated by Crawford ED et al. In this study, men were stratified by the degree of their cancer progression. The response to combined hormone suppression was as follows: 1. Advanced with major symptoms such bone pain, weight loss etc. responded for 8.5 months. 2. Advanced with minor symptoms, responded for 15.4 months. 3. Advanced with disease limited to lymph nodes, response was 4 years. In this study, done more than a 20 years ago, even a significant number of the patients in the first group were responding after 4 years (about 10%). about 30% to 40% of the patients with disease limited to lymph nodes were still responding after 10 years. This is a clear indication that an androgen deprivation response is directly proportional to the degree of disease progression at the time of diagnosis and the tumor volume ratio of androgen dependent/androgen independent cells. More evidence of this is supported by Labrie et al. in a study in which response to androgen deprivation was correlated to the number of bone lesions at the initiation of therapy. Men with 5 or less bone mets had the longest response. These are known biological facts. Androgen dependent tumor cells die when deprived of  androgens while androgen independent cells survive. Why would anyone allow  androgen dependent cells to become androgen independent when they could be killed by androgen deprivation applied early on in the first place? Hormone suppression is known to prolong time to progression, but is it possible that it could also extend survival? There are a number of studies in which results indicate that early disease detection and early hormone suppression not only postpone disease progression but also improves survival. This is something that *fits* in the overall picture of explaining the 40.0% reduction in mortality experienced in the U.S.A. since the mid nineties. The old myth that patients diagnosed with advanced prostate cancer only respond to hormone suppression for a year or two is simply a myth. In this age of early detection and of earlier stages of advanced prostate cancer at diagnosis this myth is no longer supported by the current medical literature. This myth perseveres because of doctors that believe that saving hormone suppression for later when bone mets develop is perfectly fine. Dr. Myer's message is supported by current medical evidence.   RalphV

Thanks for your comprehensive response RalphV.

I liked/like the paper cause I have heard the 'myths' stated and the paper 'debunks' those myths.

I really this bit for the paper:
The pessimist has his worst fears confirmed whereas unexpectedly good things often happen to optimists!

To me that says if I do my best to positively approach life and my battle with these nasty prostate critters that have taken up residence, the better my life will be overall and the better my chances are of beating the little nasty critters. Or at least surviving and dying of something else.

On this thread
www.healingwell.com/community/default.aspx?f=35&m=2388995
John T states:
The median duration of HT is 11 years, according to Dr Scholz. This means that 1/2 the patients are still on it after 11 years and for the other half it stopped working somewhere short of 11 years.

MsWorryWart - A very nice and wise lady recently told me: at some point we to accept that God is leading our hand with choices. I agree with the very nice lady.

Zufus has said a few times - fighting these little nasty prostate cancer critters is the Twilight Zone. What works for one person may or may not work for another guy.

Bud

Post Edited (Raddad) : 4/14/2012 6:31:04 AM (GMT-6)

Thanks for the article and discussion. Wonder if new meds like Zytiga, etc. will extend the statistics very much.

Ralph:

Thanks for the update (or should I say reminder).

So, why is when to start HT, early or late, still considered a grey area?

Mel

ralph:

Actually, it's even more complicated than that, according to the doctor I see at Umich.

It is not only the ration of sensitive to non-sensitive cells and the overall tumor burden, it also depends on the ability of the cells to make their own T (ie: to work around the T deprivation). This is an unknown factor and researchers are searching for the answer

Mel

uh... Ralph:

I don't think I'm arguing that point. I am on the side of sooner rather than later (although I haven't yet started HT).

I am merely pointing out that the prognosis or course of disease is more complicated than just the ratio of sensitive to insensitive cells.

Mel

"MSWW,

Sounds like your husband is responding well to HT. That is awesome. I've been wondering about you guys. He is a lucky guy to have you so involved.

I will not be offended, just always trying to learn, but why isn't Myers a fan of MSWW?

Thanks,
JL"

Well, it now seems like a mutual non-fan Myers/MSWW feeling. LOL :)
I got your email, and I replied.

Seriously, aside from personal preference, personalities, etc., there's really not a whole lot more to it.

Thanks!