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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.

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!

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.

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.

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.

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.

Best,

Ed Dolan the Great