22nd January 2008
[COLOR="DarkGreen"]I tried interspersing answers in green earlier and it seemed to work, so here goes again.
[QUOTE=able5;3402954]THREAD TITLE CORRECTION...
"Hormone Therapy (Chemical Castration) Side Effects..."
I have a relative in his early 50's who chose hormonal therapy as his treatment for prostate cancer. He was always pretty secretive about his situation so I did not know he was diagnosed until he approached me soon after my diagnosis and he told me that he felt like he needed to shared his personal experiences with me as I was in the process of making a treatment choice. Not being familiar with this treatment other than the name he gave it, "Chemical Castration", I asked him how it works.
[COLOR="darkgreen"]That is definitely one of the names for the therapy, and it describes the main objective: stopping production of testosterone, which of course fuels the cancer, from the testes. I don't care for that name because it's misleading and scary. :( You still retain all your equipment, and the side effects are reversible :) if you are on intermittent therapy, provided the combination of age of 70 or over and time on therapy longer than two years, or bad luck in rare cases, makes it impossible to produce testosterone again even when the medication is stopped. ("Two years" is not an absolute boundary, but the risk of not being able to recover increases the longer blockade is continued beyond two years.) These days "orchiectomy" - actual removal of the insides of the testicles, is not done much. That, of course, is actual castration. It is the fastest way to stop production of testosterone, and that is sometimes crucial when the patient is in bad pain because of growing spinal metastases; the patient normally experiences rapid relief as the metastases cease growing and begin to shrink. It is also the least expensive form of hormonal blockade. If the case permits at some point after orchiectomy, some men may be able to regain testosterone with patches of medication.
He shared with me that the primary strategy of hormonal therapy is to decrease the production of testosterone by the testes or block the actions that testosterone has on the prostate cells.
[COLOR="darkgreen"]That's correct but incomplete, as the adrenal glands are normally in a kind of balance with the testes, and can also produce testosterone. Normally they contribute only about 5%, but when the brain senses a shortage of testosterone, the adrenal glands can ramp up production, in some men contributing up to 40% of the former normal amount. That can wreck a hormonal blockade program and is the reason many of us take "antiandrogen" drugs like Casodex, flutamide, or Nilutamide, with other options outside the US. The latter act by blocking the action of testosterone or dihydrotestosterone on the androgen receptors of the prostate cells. Another class of drugs, the 5-alpha reductase inhibitors finasteride (formerly Proscar) or Avodart, block the conversion of any remaining testosterone to DHT, which is a far more potent fuel for the cancer. The 5-ARI drugs have some additional beneficial effects.
I was shocked when he mentioned, "Hormonal therapy cannot cure prostate cancer. Instead, it slows the cancer's growth and reduces the size of the tumor(s)." :eek:
[COLOR="darkgreen"]For the most part that is true: while a few actual cures seem to have happened, mostly it is a method of controlling the cancer, in many cases for many years if not indefinitely:). It usually does more than slow the cancer's growth. Normally, it will reduce the cancer ("reduces the size"). For instance, my urologist (I finally found a very good one) has done DREs while I am well into a course of triple blockade and has found my formerly somewhat enlarged, rock hard prostate to be flat and soft. Blockade typically will turn off virtually all production of PSA in the first few months; it will then kill many of the cancer cells in the months through months nine to about twelve, it is thought; it will also apparently put virtually all or all of the remaining cancer cells into a dormant state:), but, for most of us, unfortunately, won't kill them.:(
He continued to tell me that his side effects were pretty significant and included decreased sexual desire
[COLOR="darkgreen"]That's very common, though degrees vary, a lucky 10% gets the full benefit but desire is unaffected, and countermeasures can help to a degree for many of us.
and ability to have erections,
[COLOR="darkgreen"]That is also very common, though often some ability remains, and countermeasures can help quite a bit.
hot flashes,
[COLOR="darkgreen"]Again, this is very common, though degrees vary. Older men tend to have an easier time with most of the side effects, though some do not. The fact that your relative is in his 50s - relatively young, could be why he is experiencing a heavier burden from side effects. Experience in one practice described on page 153 in "A Primer on Prostate Cancer" was that 23% had fairly mild flashes while 25% had bothersome flashes, with some requiring medication. That totals 48%, with 52% not experiencing flashes worth mentioning. There are a number of countermeasures.
fatigue, and decreased muscle strength.
[COLOR="darkgreen"]I never experienced fatigue due to hormonal blockade except fatigue resulting from interrupted sleep during the early months, which I could take care of with a nap. The Primer reports mild weakness in 51% of patients, with really bothersome weakness in an additional 5%. Typically, blockade patients lose some muscle, especially upper body muscle. However, aerobic and strength exercise can fully take care of this for most of us. I did not noticeably lose lower body muscle, but did lose some upper body muscle during the first round of therapy. I did a lot of fast walking but little for my upper body. Dr. Mark Scholz and others have emphasized that strength exercise makes it possible to even build muscle while on blockade, even with virtually no testosterone. I thought I'd give it a try, and I actually succeeded in building upper body strength during my last blockade cycle. That made me a believer. My impression is that exercise also eliminates the fatigue problem for most of us. Dr. Scholz has similar recommendations for another muscle of great interest to us, and that apparently helps a lot with some of the issues mentioned above. ;) Exercise also helps prevent or counter depression. Exercise is clearly a key countermeasure!
Some other serious side effects he and his doctor have noticed since being on this therapy for a while include anemia,
[COLOR="darkgreen"]I've never had an anemia problem, but a fair percentage of us do. The Primer puts mild anemia at 32% and bothersome anemia, perhaps enough to require medication, at an additional 13%; thus, 55% of us don't experience anemia. There are excellent countermeasures, such as drugs like Procrit, but use is a judgment call as there are some side effects/complications issues.
altered lipid levels,
[COLOR="darkgreen"]Also fairly common, with a total of 57% experiencing "hypercholesterolemia" according to the Primer, 18% mild and an added 34% significant enough for medication. We now know that statin drugs help prevent well advanced, lethal prostate cancer, especially when used for at least three years, so taking statins is a natural here, in my non-medically trained understanding of the issue and research. Both diet and exercise also can make a big difference with lipid levels.
decreased cognitive function,
[COLOR="darkgreen"]The Primer gives a total of just 17% for this one, with 14% in the bothersome/requiring medication column. I think that may be low. My wife would certainly agree. :D (Of course, she's wrong there! ;)
and decreased bone mineral density.
[COLOR="darkgreen"]This is another common side effect, so common that some doctors automatically start their patients on a bisphosphonate drug coupled with calcium and vitamin D3 without even testing for bone density. Fortunately, the bisphosphonates are, in my opinion, wonder drugs, and they basically take care of this issue. Without bisphosphonates, hormonal blockade would be a far less effective option. Strength exercises also are highy recommended, particularly those for the lower back.
Needless to say, after hearing his story, my treatment decision became much easier.
[COLOR="darkgreen"]That's pretty understandable, especially if you have a low or intermediate risk case and have a decent shot at a cure. However, blockade does not cause incontinence, and for those of us on intermittent or one cycle blockade, the side effects are fully and fairly quickly reversible once we go off therapy. Some low-risk men have chosen triple hormonal blockade with finasteride or Avodart maintenance as their only therapy and have achieved outstanding control of their cancer and an excellent quality of life. However, data on this is limited to just a few practices, and it is obviously investigational and not a standard of care.
So far, from what he shares with me, his numbers and his prognosis are very encouraging but he does admit that living with the side effects is sometimes extremely difficult.
[COLOR="darkgreen"]He may not know of the many countermeasures available for the side effects. On the other hand, some men have great difficulty finding relief. He may do much better if he can go off-therapy for a while, provided he hasn't stayed on blockade so long that the body can no longer resume production of testosterone.
He says he takes a lot of meds, both prescription and OTC, to counteract these side effects and he says he finds himself popping pills almost hourly for relief.
[COLOR="darkgreen"]I've got one of those four times a day pill organizers. Blockade is a hands-on therapy. I'm sometimes envious of my friends who had seed therapy and were in and out in a day and have had few side effects.
I'd be very interested in hearing from those who are having similar first hand experiences with hormone therapy and can share some of the ways they counteract the side effects.
[COLOR="darkgreen"]I would be happy to go into more detail, but this is already quite long. You could focus on specific effects in replies. The Prostate Cancer Research Institute has a newsletter called PCRI Insights that is available in printed copy and online, and the latest issue has an excellent article on side effecs and how to counter them.
Thanks!:)
[COLOR="darkgreen"]Take care, and thanks for giving me a chance to speak from one of my favorite soap boxes,
Jim
[QUOTE=able5;3402954]THREAD TITLE CORRECTION...
"Hormone Therapy (Chemical Castration) Side Effects..."
I have a relative in his early 50's who chose hormonal therapy as his treatment for prostate cancer. He was always pretty secretive about his situation so I did not know he was diagnosed until he approached me soon after my diagnosis and he told me that he felt like he needed to shared his personal experiences with me as I was in the process of making a treatment choice. Not being familiar with this treatment other than the name he gave it, "Chemical Castration", I asked him how it works.
[COLOR="darkgreen"]That is definitely one of the names for the therapy, and it describes the main objective: stopping production of testosterone, which of course fuels the cancer, from the testes. I don't care for that name because it's misleading and scary. :( You still retain all your equipment, and the side effects are reversible :) if you are on intermittent therapy, provided the combination of age of 70 or over and time on therapy longer than two years, or bad luck in rare cases, makes it impossible to produce testosterone again even when the medication is stopped. ("Two years" is not an absolute boundary, but the risk of not being able to recover increases the longer blockade is continued beyond two years.) These days "orchiectomy" - actual removal of the insides of the testicles, is not done much. That, of course, is actual castration. It is the fastest way to stop production of testosterone, and that is sometimes crucial when the patient is in bad pain because of growing spinal metastases; the patient normally experiences rapid relief as the metastases cease growing and begin to shrink. It is also the least expensive form of hormonal blockade. If the case permits at some point after orchiectomy, some men may be able to regain testosterone with patches of medication.
He shared with me that the primary strategy of hormonal therapy is to decrease the production of testosterone by the testes or block the actions that testosterone has on the prostate cells.
[COLOR="darkgreen"]That's correct but incomplete, as the adrenal glands are normally in a kind of balance with the testes, and can also produce testosterone. Normally they contribute only about 5%, but when the brain senses a shortage of testosterone, the adrenal glands can ramp up production, in some men contributing up to 40% of the former normal amount. That can wreck a hormonal blockade program and is the reason many of us take "antiandrogen" drugs like Casodex, flutamide, or Nilutamide, with other options outside the US. The latter act by blocking the action of testosterone or dihydrotestosterone on the androgen receptors of the prostate cells. Another class of drugs, the 5-alpha reductase inhibitors finasteride (formerly Proscar) or Avodart, block the conversion of any remaining testosterone to DHT, which is a far more potent fuel for the cancer. The 5-ARI drugs have some additional beneficial effects.
I was shocked when he mentioned, "Hormonal therapy cannot cure prostate cancer. Instead, it slows the cancer's growth and reduces the size of the tumor(s)." :eek:
[COLOR="darkgreen"]For the most part that is true: while a few actual cures seem to have happened, mostly it is a method of controlling the cancer, in many cases for many years if not indefinitely:). It usually does more than slow the cancer's growth. Normally, it will reduce the cancer ("reduces the size"). For instance, my urologist (I finally found a very good one) has done DREs while I am well into a course of triple blockade and has found my formerly somewhat enlarged, rock hard prostate to be flat and soft. Blockade typically will turn off virtually all production of PSA in the first few months; it will then kill many of the cancer cells in the months through months nine to about twelve, it is thought; it will also apparently put virtually all or all of the remaining cancer cells into a dormant state:), but, for most of us, unfortunately, won't kill them.:(
He continued to tell me that his side effects were pretty significant and included decreased sexual desire
[COLOR="darkgreen"]That's very common, though degrees vary, a lucky 10% gets the full benefit but desire is unaffected, and countermeasures can help to a degree for many of us.
and ability to have erections,
[COLOR="darkgreen"]That is also very common, though often some ability remains, and countermeasures can help quite a bit.
hot flashes,
[COLOR="darkgreen"]Again, this is very common, though degrees vary. Older men tend to have an easier time with most of the side effects, though some do not. The fact that your relative is in his 50s - relatively young, could be why he is experiencing a heavier burden from side effects. Experience in one practice described on page 153 in "A Primer on Prostate Cancer" was that 23% had fairly mild flashes while 25% had bothersome flashes, with some requiring medication. That totals 48%, with 52% not experiencing flashes worth mentioning. There are a number of countermeasures.
fatigue, and decreased muscle strength.
[COLOR="darkgreen"]I never experienced fatigue due to hormonal blockade except fatigue resulting from interrupted sleep during the early months, which I could take care of with a nap. The Primer reports mild weakness in 51% of patients, with really bothersome weakness in an additional 5%. Typically, blockade patients lose some muscle, especially upper body muscle. However, aerobic and strength exercise can fully take care of this for most of us. I did not noticeably lose lower body muscle, but did lose some upper body muscle during the first round of therapy. I did a lot of fast walking but little for my upper body. Dr. Mark Scholz and others have emphasized that strength exercise makes it possible to even build muscle while on blockade, even with virtually no testosterone. I thought I'd give it a try, and I actually succeeded in building upper body strength during my last blockade cycle. That made me a believer. My impression is that exercise also eliminates the fatigue problem for most of us. Dr. Scholz has similar recommendations for another muscle of great interest to us, and that apparently helps a lot with some of the issues mentioned above. ;) Exercise also helps prevent or counter depression. Exercise is clearly a key countermeasure!
Some other serious side effects he and his doctor have noticed since being on this therapy for a while include anemia,
[COLOR="darkgreen"]I've never had an anemia problem, but a fair percentage of us do. The Primer puts mild anemia at 32% and bothersome anemia, perhaps enough to require medication, at an additional 13%; thus, 55% of us don't experience anemia. There are excellent countermeasures, such as drugs like Procrit, but use is a judgment call as there are some side effects/complications issues.
altered lipid levels,
[COLOR="darkgreen"]Also fairly common, with a total of 57% experiencing "hypercholesterolemia" according to the Primer, 18% mild and an added 34% significant enough for medication. We now know that statin drugs help prevent well advanced, lethal prostate cancer, especially when used for at least three years, so taking statins is a natural here, in my non-medically trained understanding of the issue and research. Both diet and exercise also can make a big difference with lipid levels.
decreased cognitive function,
[COLOR="darkgreen"]The Primer gives a total of just 17% for this one, with 14% in the bothersome/requiring medication column. I think that may be low. My wife would certainly agree. :D (Of course, she's wrong there! ;)
and decreased bone mineral density.
[COLOR="darkgreen"]This is another common side effect, so common that some doctors automatically start their patients on a bisphosphonate drug coupled with calcium and vitamin D3 without even testing for bone density. Fortunately, the bisphosphonates are, in my opinion, wonder drugs, and they basically take care of this issue. Without bisphosphonates, hormonal blockade would be a far less effective option. Strength exercises also are highy recommended, particularly those for the lower back.
Needless to say, after hearing his story, my treatment decision became much easier.
[COLOR="darkgreen"]That's pretty understandable, especially if you have a low or intermediate risk case and have a decent shot at a cure. However, blockade does not cause incontinence, and for those of us on intermittent or one cycle blockade, the side effects are fully and fairly quickly reversible once we go off therapy. Some low-risk men have chosen triple hormonal blockade with finasteride or Avodart maintenance as their only therapy and have achieved outstanding control of their cancer and an excellent quality of life. However, data on this is limited to just a few practices, and it is obviously investigational and not a standard of care.
So far, from what he shares with me, his numbers and his prognosis are very encouraging but he does admit that living with the side effects is sometimes extremely difficult.
[COLOR="darkgreen"]He may not know of the many countermeasures available for the side effects. On the other hand, some men have great difficulty finding relief. He may do much better if he can go off-therapy for a while, provided he hasn't stayed on blockade so long that the body can no longer resume production of testosterone.
He says he takes a lot of meds, both prescription and OTC, to counteract these side effects and he says he finds himself popping pills almost hourly for relief.
[COLOR="darkgreen"]I've got one of those four times a day pill organizers. Blockade is a hands-on therapy. I'm sometimes envious of my friends who had seed therapy and were in and out in a day and have had few side effects.
I'd be very interested in hearing from those who are having similar first hand experiences with hormone therapy and can share some of the ways they counteract the side effects.
[COLOR="darkgreen"]I would be happy to go into more detail, but this is already quite long. You could focus on specific effects in replies. The Prostate Cancer Research Institute has a newsletter called PCRI Insights that is available in printed copy and online, and the latest issue has an excellent article on side effecs and how to counter them.
Thanks!:)
[COLOR="darkgreen"]Take care, and thanks for giving me a chance to speak from one of my favorite soap boxes,
Jim