On Monday, March 11, 2013 2:17:17 PM UTC-5, Edward Dolan wrote:
wrote in message

...



On Sunday, March 10, 2013 5:45:51 PM UTC-5, Edward Dolan wrote:

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How is that androgen deprivation therapy working out for you I wonder? I

had a friend who was on that for many years and it never seemed to bother

him in the least. I had just one shot prior to my radiation treatments and

it just about drove me crazy. I had almost continuous hot flashes night

and

day for 4 months. I knew I would never get used to it, but many of the

guys

at the VA were so scared of cancer that they wanted to continue to get

those

shots even after their initial treatments.



By the way, those shots are expensive. I think you could probably get them

at the VA for not much cost.



I don't want to be bothered with the VA. Too much bureaucracy and

inconvenient location/travel. My medicare and medicare supplement

completely cover costs of all medical treatments and yes they are ALL

quite expensive,



Yes, if you have got the cost covered then you are doing it right. The VA is

fine once the initial bureaucratic measures are taken care of. After that it

is smooth sailing.


I also prefer to be able to make my personal choice of hospitals and doctors.


My cancer is not organ (prostate) confined and metastatic and is

considered high-risk with poor prognosis. The first line of defense for

advanced, metastatic prostate cancer is systemic treatment in the form of

androgen ablation, or what is commonly referred to as androgen

deprivation therapy (ADT). Hormonal manipulation is the mainstream

medicine standard of care and is essential in the management of advanced

prostate cancer. Lupron (leuprolide acetate) is a

Luteinizing-Hormone-Releasing hormone (LHRH) agonist (substance that

initiates a physiological response when combined with a receptor) that

shuts down testosterone production. Bicalutamide (Casodex) is an

anti-androgen that inhibits testosterone from binding to prostate cancer

cell’s androgen receptors. Adrenal glands produce a testosterone

precursor (androstenedione) that is metabolized in the prostate into

testosterone. When testosterone comes into contact with 5AR enzymes in

the cancer cell nucleus, testosterone is converted into the metabolite

dihydrotestosterone (DHT), a far more powerful stimulant of cancer cell

growth (5 times more potent). Dutasteride (Avodart) inhibits Type I and

Type II 5Alpha Reductase (5AR) enzymes. By personal preference, and with

cooperation of my doctors, for two years, I was on a triple androgen

blockade (ADT3) consisting of Lupron, bicalutamide (Casodex), and

Avodart. ADT is both therapeutic and of critical prognostic importance

with proper monitoring of PSA and testosterone levels. Duration of

response to hormone therapy is highly variable. ADT initially causes

most, but NEVER all of the prostate cancer cells to undergo genetically

programmed cell death (apoptosis). Some prostate cancer cells are

resistant or adapt to hormone therapy and continue to survive.

Hormone-refractory (androgen-independent) prostate cancer cells are

totally resistant to hormone therapy and there is currently no

significantly effective treatment strategy for hormone-refractory,

metastatic prostate cancer. Despite encouraging initial hormone therapy

response rates, 80-90% of patients eventually develop progressive

androgen-independent prostate cancer, for which there is currently no

curative therapy. When cancer cells become resistant to hormone therapy,

salvage chemotherapy is employed with some additional prolongation in

duration of survival (10% survival rate after 30 months). The encouraging

news is that recently approved drugs and promising new drugs on the

horizon, in the clinical trial pipeline, hold out hope for long-term

survival for those with hormone-refractory prostate cancer.



You have a doctor’s knowledge of what is transpiring and of how to treat it.

Most folks never want to know that much about their disease, no matter what

it is. They figure that is what they are paying the doctor for. What you say

above makes me wonder if older men should ever be taking any testosterone to

boost their sexual performance. Those ads on TV disgust me!

I feel that it is my life and I have an active role to play in my health care. It is my own best interest to learn as much as I can and assume some responsibility in the treatment of my disease. I view my doctors as practitioners with whom I have formed an alliance in a joint effort of treatment and care. I am not one of those who leaves all the decision up to my doctors. I think it is unwise to do. My doctors have been very positive concerning how I have managed matters.

Agreed about testosterone. Hormonal manipulation is fraught with problems. Older men who opt for testosterone are taking a risk particularly be fueling the growth of undiagnosed prostate cancer.

Ed, you were given a Lupron injection prior to radiation to kill of as

many cancer cells as possible and reduce prostate volume to improve

radiation treatment targeting. Once a Lupron injection is given, they are

generally given continuously. That is standard of care. To answer your

specific question regarding Lupon injections, ADT does have its downside.

Treatment induced menopausal side effects include anemia, hair loss, dry

eyes, dry skin, hot flashes, erectile dysfunction, abdominal fat deposit,

weight gain, breast pain and/or enlargement, decreased size of testes and

penis, emotional changes (anxiety, depression, and mood swings), fatigue,

loss of libido, sleep disturbance, myalgia (muscle pain), nausea,

increased urinary frequency, discomfort or obstruction, and changes in

bowel function, including diarrhea and rectal incontinence. More serious

side effects include peripheral edema (swelling of hands, feet, ankles,

and lower legs), decreased muscle mass, loss of bone mass

(osteopenia/osteoporosis), elevated serum glucose, Type-II diabetes,

hypertension, cardiovascular disease (heart attack and stroke), elevated

cholesterol and triglycerides, decreased HDL cholesterol, memory

impairment, cognitive decline, abnormal liver function, increased risk of

SREs (skeletal-related events … pathological fractures, spinal cord

compression, and severe joint and bone pain), and excess serum cortisol.

Some anti-aging experts refer to cortisol as the “death hormone” due to

multiple degenerative effects that cortisol produces including immune

dysfunction, brain cell injury, and arterial wall damage. As daunting as

the side effects are, I had only two alternatives. I could allow the

disease to rapidly progress unabated, or I could opt for ADT to survive

longer with the distinct possibility of a compromised quality of life.

Neither are appealing alternatives, but I opted for ADT. Unfortunately,

that is an option that I realized would most likely reduce me to a shade

of my former self.



Yes, I am sure I just had the Lupron shot. It was suppose to be good for 3

months, but it lasted 4 months in my case. The hot flashes were the worst

side effect for me. Frankly, I would not want to be on that treatment for

long. The business about the erectile dysfunction is funny since the Lupron

shot also completely takes away libido. Sex apparently is just chemistry. It

is not exclusively in the mind as I once thought.

We are biologically wired and the mind does play a role, but without the proper level of hormone, the mind matters not in the least. It is like a weapon devoid of ammunition.

If I were in your shoes the hardest thing for me to overcome would be

depression. I tend to dwell on every unpleasantness that comes down the

pike. I do not take ill health well. I have always thought that a modicum of

good health is priceless for which we should be ever thankful. I am always

amazed at what some folks are able to put up with. I can see now that you do

not have it easy at all. Everyone I have ever known who had prostate cancer

apparently caught it early enough so as to avoid your extreme treatments.

I wish that I was fortunate enough to have caught it early on, but it is in my bone. My last computed tomography (CT) and scintigraphy (nuclear medicine bone imaging), commonly referred to as a bone scan indicate that where the sclerotic lesions exist they are less extensive and less intense, so that is good at least.

To be more specific, I have experienced dry skin, hot flashes,

depression, and decreased muscle mass. I have just deliberately opted to

begin intermittent androgen deprivation therapy well aware that it is no

standard of care. I determined to do so because the American Society of

Clinical Oncologists recently issued a report specifying that

intermittent ADT is almost as effective as continuous ADT but without its

associated side effects. With some degree of apprehension, I decided to

remove my safety net. Although unconfirmed in clinical trials, it is my

conjecture that with intermittent ADT, tumor cells are forced into normal

pathways due to testosterone rebound with the subsequent probability of

an increased duration of treatment efficacy and delay in progression to

castrate resistant (hormone refractory) disease. When my PSA begins to

rise again, androgen dependent tumor cells should be responsive to the

next cycle of hormone therapy. In the interim, I continue to take

dutasteride (Avodart) as maintenance therapy to inhibit conversion of

testosterone into the more dangerous metabolite dihydrotestosterone.



You are most likely on the cutting edge of treatment. If knowledge alone

could save you, you would be saved. But one also needs some luck. All your

efforts deserve some of that too.

I hear that.

Well, that is far more than you probably expected to hear back in the way

of a response, however since you are being reasonable (you are capable

when you want to be), I took the time to be very thorough in my reply.



I could follow your explanation of all the complications and treatments as

long as I read slowly. On the other hand, I never wanted to be a doctor. I

learned that when I was a Hospital Corpsman in the Navy for 4 years. I

mostly can’t bear to even think much about my own ailments. I think you are

one tough guy to be able to cope as well as you are. Maybe cycling is good

for us after all if it makes us tough when we need to be.

Because of pain in my lower back and pelvis, I didn't ride at all last year.. I think the problem is scar tissue from radiation. I will give it a go again this year now that I am feeling a somewhat better, but with testosterone at castrate levels, my performance will never again be the same and recovery between efforts slower. Consequently, I have no intention of logging mega-miles and competing with those half my age. Sadly, those days are behind me now. As much as I enjoyed mixing ti up with the younger set, riding hard, far, and fast, in a way it is a relief not to be burdened by the compulsion to do so anymore.




Best,



Ed Dolan the Great