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How long does it 'generally' take for testosterone and sexual function to return following cessation of ADT [in my case Lubron ]? I realize that at times it doesn't come back at all.
Is there anything that can be done to hasten it ?
How quickly does alcohol affect a man? How bad is a hangover? There are no answers to these questions - even if there were studies to quote, they would not apply universally.
The other factor - apart from our individuality - is the period during which the ADT has been applied and the dosage: the longer the tme/the heavier the dose, generally the longer the recovery time.
Sorry I can'r be more exact than that, but that's the way it is. As far as I know there is nothing that can be done to hasten this.
Aloha Patrick,
Terry is right. Each of us has so many variables that it would be impossible to predict time of recovery. I'm showing signs of recovery at 8 months after EBRT & one year of Lupron Depot 3 month shots. I can not tell which hip received the last shot, they both hurt, & one side was six months ago. The good news is that I can give my wife some pleasure. The first time, I woke up from a dream, with a very painful member (been more than a year). We road tested it several days later. No feeling on my part, no release, some twinges of pain if I press too hard. But, it is the start of recovery. Last week, my testosterone tested at 0.19 (the range is 2.4 to 8.27, units?). I would not wish the cost (time/pain) of this recovery on anyone.
Joe
Yes, I am taking Megestrol Acetate, up from one pill daily to two as of this past week to put down flashes/chills. Are you certain they will interfer with the return of testostrone ?
Patrick,
After reading so many articles, I'm sorry that I cannot quote a source but I have read in several locations that one should discontinue Megace within three months of lupron cessation as it interferes with T production. Maybe some other mentors could further enlighten us on the subject as I have only two months remaining of lupron therapy. I take one 20mg. tablet down from two and still have the damn flashes but are bearable compared to the past w/o Megace.
Pat,
I have done some research since your last posting and you are exactly right. Megace is a testostrone inhibitor. I think I'll stop the darn stuff and tough out the flashes for fear of losing testostrone return. It could well be that the longer it stays away the more difficult it will be for it to come back and I don't wish to risk that.
My urologist made no mention of this bit of nasty side effect....why am I not surprised ?
Many thanks for your information, I did not suspect.
Patrick,
I have also read that it is prudent to cut back slowly on the megace, ie. stop taking one pill for a week to ten days, then quit taking the other. Good Luck - p (Alaska, USA)
I have cut back from two to one but hope I can cut out even the one....perhaps there is something not testostrone inhibiting that will help my flashes.
Hi Patrick,
Other than dietary intake, (avoiding coffee, alcohol, hot liquids, spicy foods, etc.) I have looked into several different methods to control hot flashes - there seems to be four main categories: Hormonal (progestin derived), herbal, anti-depressant, and anti-convulsive. The hormonal and herbal all probably interfere with T production, the other two while not directly affecting T levels decrease libido and may foster ED. So the choices seem to all hamper recovery from ADT. I guess your could continue to use one form or the other for a couple months and then see what happens or go cold turkey beforehand knowing that any decrease of hot flashes over several months time might be related to an increase in T level. It doesn't seem like an easy decision and certainly not one that any of us were warned about in the drug package inserts before we embarked on our rough journey. My Uro says to wait a year before getting your T level checked. - p (Alaska, USA)
Patrick, I am in a similar boat as you. I have finish Zoladex implant a little over two months now and my testosterone level is 0.69 nmol/L and it should be between 5.8 to 28 nmol/L according to the lab. I was on Zoladex and Casodex and then Avadart for 6 months. I have seen on another site some concern that if erections are not experienced for some time then there is a risk of losing the muscle strength to create it and maybe even some of the length. It is not a great feeling knowing that we will have to wait until our bodies start producing the leydig cells again (testosterone producing interstial cells) and even wondering if by some fluke of nature we are not able to produce them again. I really wonder if in fact prolonged lack of erection escalates the problem of being able to have an erection.
I agree. Some where, out there, is one heck of a lot of information that we are not getting. My wife has been with me each visit, and after the fact, we wonder if we both missed what the doc said....I do not think so ...
Joe
I suspect if we knew how bad it was we would never consent to using it. I continue to maintain that urologists should have to take it for three months themselves before passing it off on us unsuspecting.
I've been on Lupron and Casodex for nearly five months of a planned six month treatment. Radiation ended a couple of weeks ago. Up till now I've had zero interest in sex. I took a 20 mg Levitra tablet yesterday and I got a pretty good erection with a climax. So how can that happen if there is virtually no testosterone in my blood?
I thought the whole idea behind ED drugs was to accomplish just what you experienced, despite a lack of testostrone.....Be happy it worked, apparently for some men there is no effect at all.
I wasn't expecting any response so soon. Remember that the ED drug itself does not give you the erection. You have to get stimulated as well. I figured with no testosterone there would be no response to stimulation.
Paul from RI, USA.
The success of ED drugs seems to be related more to nerve and blood vessel health following treatment rather than lack of T. After radiation, there can be ongoing cell death for up to two years and increasing ED in the years following.
In my case, I was expecting to get ER and Brachy concurrently with six months ADT but with my numbers, it was highly recommended that a two year course of Lupron would be needed for a best scenario "curative attempt". I knew that the ADT would not be any fun at all so you can imagine my shock when the radiologist recommended two years and was supported by two other doctors.
Cure is the name of the game and I'm looking forward to "paying now and playing later." Of course after research, playing later might not be an option - hell, there's a good chance that I won't even be cured.
With all this running through my mind, I have to be very optomistic and realize that with this two years (now realizing probably three with recovery time included) I'll be able to see my son graduate from college, maybe get married and start a family before possible further treatment is needed. Statistics overwhelmingly state that at worst case, I should be free of disease symptoms for at least five more years if I'm not cured. For this opportunity I am extremely thankful and it makes me feel like the whole ordeal will be worth it.
The gold standard used to be removal of the testes which would have immediately removed all hope of ever producing T again. With this in mind, I am greatful for the Lupron even though its a major disruption of QOL.
My advice to those going through the adjuvant ADT therapy - Keep the faith, brothers, thing will get better. - p (Alaska, USA)
I'm sure I'm missing something here. I was under the impression that Lupron simply 'masked' the actual cancer present and did not do anything to kill it. If that is true then why continue taking it ? If it is not true then what does it do ?
I hate the damn stuff and hope never to take it again and I only had two shots.
There are very good books on prostate cancer that recommend "penile therapy" meaning using artificial means to achieve erection at least twice a week in order to protect the potential for normal erection. The problem with not doing so is that fibrosis occurs and in that case the ED is permanent.
In the case of an adjuvant therapy to radiation, Lupron has been shown to kill many and weaken other PC cells. If the PC is contained in the prostate bed receiving radiation "cure" rates are statistically higher as the radiation takes awhile to kill all the bad cells and there is a higher probability that weakend cells will die too. Those cells that do survive will probably become androgen-independent at some time meaning other forms of therapy will be needed. In any case of distant spread, you're right about Lupron merely masking the disease as it will eventually come back.
In a nutshell, if you don't rid your body of the PC what are a couple or more extra years of symptom free life worth? At worst it's a trade off of QOL versus mestastic agony. If and when I get to that point I'll be sure to post whether my Lupron experience was worth the extreme disruption to my every day life. Until I reach that point (hopefully, I won't), I can't really say if the drug is worth it. -p
Guys! There are some pretty definite statements being made in this thread that imply that there is some certainty in PCa diagnosis and treatment, when there is none. So to say, or imply, that all men on ADT (Androgen Deprivation Therapy) have the same side effects is just not so. The observed and reported reactions are very wide and varied. I am one of the fortunate ones who has not yet had any severe problems. Sure, there have been some issues to deal with, but not enough to interfere in my chosen life style or what I do. On the other side of the coin I am aware that there are some men who have genuinely bad reactions, but I have to say that from my observation (and that of my oncologist) they do seem to be in the minority.
But I only chipped in here because of what seems to be a misunderstanding about the function of ADT. Essentially it is not to merely suppress cancer cells, but to starve them of their principle source of energy DIH (dihydrotestosterone) which is derived from testosterone. If this is completely successful, the cancer cells ‘die’ and therefore cannot become androgen independent.
However, amongst the many current theories, one that seems to have gained a bit of traction is that the reason that some tumours progress after ADT is initiated, there are some cells that are naturally androgen independent. The ADT knocks out the androgen dependent cells, leaving the androgen-independent cells free reign to take over. That is one of the rationales for combining ADT and EBRT (External Beam Radiation Treatment) or other radiation treatment: the ADT gets the androgen dependent cells: the radiation cleans up the androgen independent cells.
Of course, theory is one thing and reality is another, and so there are failures of treatment that should be expected to succeed. But when you read a story like Doug Adam’s , you know that the disease that is suppressed by ADT will NOT always come back.
ADT is a very worthwhile weapon in our battle - but like all weapons it can be dangerous if used improperly or by people who do not have enough training.
My urologist stated that there are in fact two types of cancer cells within the prostate. One type of cell is what is referred to as stem cells. These cells do not require testosterone to live but they replicate into either more stem cells or androgen dependent cells. The second type of cell is the androgen dependent cell which replicates rapidly and metastasizes whereas the stem cell does not metastasizes. So the andogen deprivation will eliminate the metastasizing cells by causing atrophy and finally death of those cells but does not affect the stem PC cells. As a consequence one still needs some type of therapy to remove the stem cells in the prostate before more androgen dependent PC cells are produced and start migrating out of the prostate.
TV, I think it is important for everyone to understand that although your urologist may hold this view, it is not a universal one. There are many theories as to how prostate cancer takes a hold and how it spreads. It may be that when the genetic threads are finally unwound we may have a better understanding, but until then, there is a good deal of guesswork.
