Definitely yes!

The doctors I consider leaders in hormonal therapy for prostate cancer believe that some patients with mild recurrences after surgery or radiation will be able to keep their prostate cancer completely in check with just a mild drug like Avodart, or perhaps with its older companion drug, finasteride, formerly known as Proscar.

Monitoring would feature the PSA doubling time (PSADT). The drug should knock the PSA level down and keep it down as I understand it. In some patients the PSA may rise, but the doubling time may be so long that they would have to live to well over 100 before the cancer would be a problem. In others Avodart and finasteride would not be enough. Radiation, cryotherapy, or more heavy duty hormonal blockade, etc. might be needed.

Yesterday I reviewed a DVD of Dr. Charles Myers talk on nutrition to the International Conference on Prostate Cancer 2006. He described studies of several nutritional items that also had a profound effect on recurrences. One was pomegranate juice, which was mentioned on this board in a thread started on 12/17/2007. He believes that in some patients nutritional and other lifestyle tactics may be all that the patient needs.

Jim

Hi Jim: Is Avodart or Finasteride used after re-occurance after surgery and radiation?? I wonder why they don't try them instead of Lupron or Zoladex for a few months to see what the PSA is going to do. Maybe it has something to do with the amount of money they reap in from giving the shots. I think I will ask my oncologist about it. I would like to get off of this shot every three months and do away with these hot flashes that I have every two hours at night. Rich

Hi Rich,

I have heard Dr. Charles Myers state that Avodart of finasteride were options to try for recurrences that appeared to be mild after surgery or radiation, before trying other tactics, such as more robust hormonal blockade, radiation after surgery (or sometimes even after radiation, as described by Dr. Michael Dattoli), cryosurgery, etc. He has stated that use of that class of drug is probably all that some men will need.

Those two drugs are much weaker in the hormonal blockade arsenal, as their prime role is to block the conversion of testosterone to DHT, as noted earlier. When one of these drugs is used but without combination with a more powerful blockade drug, testosterone is still being produced with no reduction and is able to dock with receptors on the cancer cell without hindrance. However, since DHT is five to ten times more potent as a fuel for prostate cancer, reducing it may be enough to control the recurrence. As you noted, watching the PSA will tell if it is enough.

The advocates of nutrition and other lifestyle tactics to combat prostate cancer, like Dr. Myers, would also like to see the patient use those tactics also to help control the recurrence, and use them whether the recurrence is mild or strong. Our support group just reviewed a talk he gave at the International Conference on Prostate Cancer 2006 on diet and PC, and the apparent impact of some nutritional items was striking. In fact, it appears that the impact is much greater than the impact of finasteride or Avodart. However, only finasteride's impact has been validated in a gold-standard type clinical trial, and trials for Avodart are not due to report for another year or so. (Dr. Myers will be presenting again at this year's conference in early September, but not on this topic.)

I wish you well with those damn hot flashes! :( Mine have ranged from a nuisance to an aggravation but have not been a major concern. There are several countermeasures that seem to help many of us with the flashes. Soy isoflavones probably help, just as they seem to help women with flashes. Exercise also seems to help, and there are other tactics. Of course, some of us find complete and rapid relief from certain drugs, like Megace and Depot Provera.

Your doctor is probably not at fault for going straight to heavier duty hormonal blockade drugs, though he may have overlooked or have not been convinced of the soundness of the option of using just a mild drug. As far as reimbursement, that picture apparently has changed dramatically, with some doctors now even losing money on what they are allowed to charge for the LHRH-agonist drugs like Lupron and Zoladex, causing them to opt out of Medicare. There is a concern that some docs are now prescribing orchiectomies instead of blockade drugs for monetary reasons, which is unethical and so recognized by medical associations. The evidence I've seen on this doesn't convince me that it is happening on any broad scale, as other developments, like the growth of intermittent blockade, could well account for changes in the use of LHRH-agonist drugs.

Take care,

Jim