When should I start HT

Ak123 said...
I was hoping to postpone the HT as long as I can

There is no definite answer when you need to start with HT. Patients on intermittent HT usually terminate a HT holiday period when the PSA value rises again between 4 and 10 ng/ml. Maybe you can use that as a guidance for your decision and wait till the PSA value has risen above 4 ng/ml.

George

Allen,nooooo, I am not really ignoring it at allll. I have looked at the TOAD study. It’s just that I am so frustrated and upset and trying to make sense of all of it as you can imagine. I am sorry if I gave you that impression and I do appreciate very much your response. The Problem is every doctor has an opinion and it’s hard to figure out the reasonable ones. I just wish if someone can explain to me what is the disadvantage if I waited for the PSA to reach let’s say 4. Thanks everyone

AK123 said...
I just wish if someone can explain to me what is the disadvantage if I waited for the PSA to reach let’s say 4.

Yes, you are completely ignoring what I wrote: "One of the more interesting learnings from the TOAD RCT was that castration resistance set in earlier among men who delayed the start of HT. It had been thought that HT drives selection of hormone-resistant cancer. While that may be somewhat true, the effect of getting rid of so many cancer cells with HT has a much bigger effect. "

I honestly don't know how to say that more clearly.

Snuffy Myers is retired. If you live in NY, you have the best medical oncologist in the world at MSKCC - Howard Scher. Don't mistake self-publicity for competence.

I am just very scared of the HT. I am very active and I am afraid if it knocks me totally down that I won’t be able to work out and stay active. Does anyone know the REALITY of the side effects please? I am not on any medication or anything. I just take some vitamins and antioxidants.

Ak123 said...
I am just very scared of the HT. I am very active and I am afraid if it knocks me totally down that I won’t be able to work out and stay active. Does anyone know the REALITY of the side effects please? I am not on any medication or anything. I just take some vitamins and antioxidants.

HT is scary! This HW tread started by WifeofPie discusses real experiences.
I hate Lupron

Ahh....that's the fly in the ointment with ADT chemical castration, isn't it. We are all so different clinically, and the variables are so many, that when we (I) start peeling back the onion, especially with clinical trials, there are few, if any, clear answers.

How does one know that including ADT before, with or after RT really helps, if it does then how much and for how long, what it's long term risks are....and are they worth taking? No one can say with any certainty. The empirical data I've read, and reread, is so qualified as to be unconvincing. The devil is certainly in the detail.

Of the RO's I've talked to, their 'opinions' are as varied as one can imagine. It's interesting to note that none of them have taken ADT themselves and when challenged, their most honest answer about the severity of side effects is "I don't know". Note that women seem to have a much milder reaction to HT than us men do.

In my situation, the friends and colleagues who have taken ADT have mostly had terrible experiences with them. Any of them. These many anecdotal stories are enough for me to be VERY wary of enduring chemical castration, unless my condition is dire. No, I'm forgoing ADT with my upcoming SRT.

Good luck to all of you forced to make this choice, and choose wisely.

Here's a full breakdown of side effects and their relative incidence, and prevention/treatment strategies. I hope you take the time to read it.

/pcri.org/preventing-and-treating-the-side-effects-of-testosterone-deprivation-therapy-in-men-with-prostate-cancer-a-guide-for-patients-and-physicians/

Keep in mind that this is like the package inserts with drugs - just because a side effect is listed, it doesn't mean you will get it.

Quality of life evaluations were the same with early of delayed androgen deprivation - humans are very adaptable - we get used to everything.

Tall Allen said...
Here's a full breakdown of side effects and their relative incidence, and prevention/treatment strategies. I hope you take the time to read it.

/pcri.org/preventing-and-treating-the-side-effects-of-testosterone-deprivation-therapy-in-men-with-prostate-cancer-a-guide-for-patients-and-physicians/

Keep in mind that this is like the package inserts with drugs - just because a side effect is listed, it doesn't mean you will get it.

Quality of life evaluations were the same with early of delayed androgen deprivation - humans are very adaptable - we get used to everything.

For me, TA, where that 12 year old article falls short is first, it doesn't make any case for the success of ADT use, and second, it doesn't indicate the number or percent of men who experience these very serious side effects. Much can be read into it's nonspecific general summary:

"The medical evidence that testosterone deprivation therapy has substantial anti-prostate cancer effects continues to mount. Consequently, its use has become increasingly more common for all stages of prostate cancer. However, the potential for significant side effects that can dramatically reduce a man’s quality of life are a real concern with this type of therapy. Unfortunately, little attention has been given to the prevention and treatment of these side effects. It is my hope that this guide will open the lines of communication between men and their medical providers, and provide a tool to help them prevent and treat these side effects effectively, so that men can gain the full benefit of this treatment and still maintain a good quality of life."

It does come down to the life altering and enjoyment of existing impacts of chemical castration. I submit that not enough has been proven about ADT benefits; and that those listed side effects are more than an obscure laundry list. They are real for many men, and can suck the joy of life out of people with no other choice but to be adaptable. We are all going to die one day of something, but why add to the misery of getting there?

Thanks again all for your input. One side note for those who are going to do SRT. I have made the mistake of not getting HT befor I did my radiation. Althoug my psa was .07 at the tineof radiation, I wish I had combined them. I was watching last night a lecture from a Canadian doctor who said based on some trials that bringing the psa down to .02 with HT then doing the radiation gave 80% chance for non recurring cancer for about 7 years but again who knows. I went to sleep feeling bad and regretinot doing it in this settin. Too late now to think about it I guess.

Thanks chask
To be honest, I always had the gut feeling that the radiation won’t work but I got pushed into it by many people. All I was hoping for the radiation is to buy me a couple of years or so and it did not buy me even a couple of days. I really don’t believe in. For you, it bought you a few years if I am reading your signature correctly but sometimes I worry about getting bladder cancer from the radiation. My RO says secondary cancers are about 2 % but I am not sure about that. Like you said nothings helps by looking back at things.i do appreciate your response.

There is still some confusion, at least on my part, about when to take ADT.

Allen says. . . " I must have talked to a half dozen excellent medical oncologists
about this and opinions vary. All agree that there are 3 situations that require immediate HT:
1. high PSA (>10 ng/ml), or
2. rapid doubling time (<9 months), or
3. detected metastases or symptoms "

That sounds totally reasonable to me.

Then, "Some have incorporated the findings of the TOAD RCT into their practice and use ADT
when recurrence after salvage RT (>0.2) is confirmed" . . . And, "The ones who go with TOAD
point to the fact that quality of life was not impaired by the earlier start, and time to castration
resistance was not shortened by it --".

If one can extend the PSADT from, say <9 months, to 3, 5 or even 10 years, using diet and
exercise, how is my quality of life not impaired? It's likely that I could delay ATP for many years;
possibly for the rest of my life.

As I read threads, like this one below, It's hard to believe that my "quality of life" will be the same.

/www.healingwell.com/community/default.aspx?f=35&m=3841918


Cashless

Quality of life is a personal assessment, and it's something you can't know unless you've walked a mile in those shoes. I'm just reporting what the men said. As I said, people are adaptive - one can learn to live with no libido and hot flashes, while still enjoying one's life just as much.

If you want to believe that diet and exercise will delay progression, I hope you're right.