This forum is for the discussion of anything to do with Prostate Cancer. There are only four rules:
No fundraisers, no commercials (although it is OK to recommend choices of treatment or medical people based on your personal research; invitations to participate in third-party surveys are also acceptable, provided there is no compensation to YANA);
No harvesting e-mail addresses for Spam;
No insults or flaming - be polite and respectful at all times and understand that there may be a variety of points of view, all of which may have some validity;
Opinions are OK, but please provide as much factual evidence as possible for any assertions that you are making
Failure to abide by these simple rules will result in the immediate and permanent suspension of your posting privileges.
Since this is an International Forum, please specify your location in your post.
Re: Things That Puzzle Me About PCa # 14 in an unlimited series
Hi Terry,
Interesting thoughts. I wonder if the answer still lies in the unknown. Or unproven to be more precise.
"There might be a very small risk of mutation from androgen dependent cells" to quote part of your post.
If I remember correctly, Dr. Strum has mentioned that for higher Gleason grades, using Casodex alone can/may/will encourage mutation of the androgen receptors. And usually we only have the hit & miss results from a biopsy to base a decision upon.So is a G6 definitely a G6 only ? Path. reports after surgery often suggest otherwise.
In the U.K., the medical world has shot itself in the foot before. Some years ago, nearly everyone who walked into a surgery was tested for cholesterol. If the result looked a bit high; they were put on a statin.( The ratio in cholesterol, which is the important figure was usually not tested ! )
Result has been various problems thought linked to long term statin use in younger people.
HRT was all the rage a decade or two ago. Again, health problems have been noted as a possible result.Prescribing HRT has quietly been reduced it seems.
Over-prescription of antibiotics is well known.
And so I wonder if this sort of thing may influence current thinking regarding such approaches of "managing" a problem.I guess only long term studies would help here.
Personaly I think the approach you suggest could be ideal for more elderly patients, for whom surgery , R/T etc . would be a large step to take. The difficulty I suspect would be in finding long term results. Many patients would die of something else.But I suggest that is the best result.
Perhaps when the stronger meds such as Abiraterone & MD3100 become available, a limited ( time ) application might be more successful with less risk of mutations ? For example, a six month course of more efficient blockade could yield better outcome, and yet would be more bearable than any continuous treatment.Just a thought.
Re: Things That Puzzle Me About PCa # 14 in an unlimited series
Well, Terry, more delicious food for thought.
As you are well aware, here in the good 'ol USA, we would have to work hard to see a medical oncologist who might suggest such a course of action/treatment. When I first was diagnosed, I read everywhere I looked that I should consult:
1. A urologist
2. A radiation oncologist
and
3. A medical oncologist...but probably this only after the disease had progressed so much that 1 & 2 could no longer play with it.
OK, I'm being a little facetious there, but really not that much. I doubt that many medical oncologists in the US even encounter many men with early PCa – the urologists/radiologists keep them in their corrals.
I am interested in what you think the implications for this are to Active Surveillance? If one subscribes to this opinion, is the early ADT attack necessary right away, or at what point does it become necessary? Roger from Indiana
Re: Things That Puzzle Me About PCa # 14 in an unlimited series
Terry,
I asked my onco about this very issue. He said that some do actually put this forward as a treatment strategy - but usually with older men. In my case, my relative youth would invite ADT resistance later on. He also mentioned that there's some evidence to suggest that long-term use of ADT (even on an intermittent basis) might encourage cells to become more aggressive (or perhaps he meant that it's the aggressive cells that survive.
Either way, the combination of age and aggressiveness, made me opt for radiation
Re: Things That Puzzle Me About PCa # 14 in an unlimited series
Terry,
Dr Bob Leibowitz in Los Angeles has been treating low risk patients with 13 months ADT3 for years and reports results equal to all other treatment options. He has published papers on his results that can be found on Compassionateoncology.com.
