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Is treatment, loss of Quality of Life (ADT), worse than the disease?

Hey Everyone,

Great site. I can see it's not just me that can not control my emotions. I'm told I will be this way for the rest of my life, what's left of my so called life. Knowing what I know now not sure I would go this route again. If I wasn't married with children I know I wouldn't. Stage 4 - 54 years old, diagnosed in '05. and ADT (Lupron) Zytiga, pregnisone and 4 weeks of daily radiation, done on Monday.. Grown boobs and spare tiire, have become socially isolated (my choice). Gain a couple of miserable years? Apologize for macabre post. Woke up this morning dry heaving, in soaking sheets and pillows exhausted again. Fatigue is a deal breaker - I used to be a happy, high energy man. Another bad day of thousands. I know see a shrink, go on more drugs. I have and paying a stranger to listen to my troubles does not help me much. I keep most of it inside with my family, everyone has that favorite song they like or even love, eventually you get tired of it and put it away, that's how I feel when I talk about my woes. I have a wonderful, supportive wife but I think even she get's tired of the repetition, hence, I keep most of my misery to myself.

Hopefully will snap out of it soon, I usually do. Dead is for a long time.

Wish you all the best, working on my coping skills.

Dean Gudmundson.

Re: Is treatment, loss of Quality of Life (ADT), worse than the disease?

Dean you post the somewhat rhetorical question Is treatment, loss of Quality of Life (ADT), worse than the disease? I believe the answer is Yes, it can be. It was that reasoning which made me decide not to have therapy in 1996 when I was diagnosed at age 54, four years younger than you were – see Why I Did Not Choose Surgery Or Any Other Treatment. It is what still drives me and which has kept me off ADT (Androgen Deprivation Therapy) for longer than my oncologist would like – see my story for all the details.

BUT….it seems likely that there is a substantial difference between me and you as far as our diagnoses are concerned. Mine was Stage T2b: PSA 7.2: Gleason 7 and although you do not give all your details, you say you were staged T4, so presumably you had a high Gleason Score. Would I have made the same decision – to avoid treatment - if I had a worse diagnosis? I really don’t know, because I didn’t have the knowledge I have now back then. But I suspect, given my take on life and its values, that I would have followed the advice of Dr Israel Barken who said, in 2002, The overall approach I believe in is doing the Minimal Intervention that the patient feels comfortable about combined with the Maximum Surveillance that medical science allows.

The key words are “…minimal intervention that the patient feels comfortable with ….” or, as we say on the front page of this site It is the individual's ultimate choice that the path he decides to follow is his own and that of his family, based on his particular circumstances.

So, just how you evaluate the balance between therapy and it’s consequences and any change of therapy and the consequences of that decision is a personal one that I cannot help you with – and neither can anyone else. I don’t know how much research you have done into your options – and the consequences. I do know that some men have achieved extraordinary results by trying alternatives, which possible have different consequences. One that always springs to mind in this connection is Bob Parsons . Why don’t you read his story and perhaps mail him about his thoughts to see if you can do something other than what you are doing now.

Taking some positive action like this may help with your depression too. You can’t ever just ‘snap out of it’. I know that because I am prone to depression and have twice been seriously suicidal. BUT…. I know that it is possible to work your way out of depression – if you are committed to that process and do the work yourself. No one else can do it for you. My suggestion, based on my personal experience is that the value of exercise and human contact cannot be underestimated. Start today with a walk around the block: build it up until you are walking longer distances: make sure you are eating a healthy diet. Both of these will also help with your obesity which can also be depressing – so you get a physical and mental boost. Start getting back to your social scene. Find some kind of spiritual peace – be it in religion or, as in my case mediation using yoga techniques.

Of course it is hard to do these things. There is no easy way. But every small step you take is a step on the upward spiral away from the deep gloom of depression. That’s my experience.

I hope this helps some. Good luck on your journey.

Re: Is treatment, loss of Quality of Life (ADT), worse than the disease?

Hello everyone who replied. Much appreciated.

About two months ago I have completely given up alcohol, sugar, now eating healthy and am am physically active . Have lost 25 lbs. Am not socially isolating myself and spending a lot of time with my children. Seems to be paying off in the head dept. We'll see.

Again thank you all for taking the time to respond.

Best,

Dean Gudmundson

Re: Is treatment, loss of Quality of Life (ADT), worse than the disease?

Dean,
I’m 55 and at 19 months now of 40 planned months on Lupron. My radiation oncologist indicated I should be on ADT for 36 months after IMRT. He is following the National Comprehensive Cancer Network protocols for high-risk PCa to the letter. (Gleason 4+5=9 and staged cT3b.)
Like you, I seem to be in that percentage of men who do not tolerate Lupron very well and have experienced every single side effect of ADT in spades despite being the perfect cancer patient and following every single recommendation to the letter. With the fatigue, ED, insomnia, and 40+ hot flashes a day hitting me hard, I just wanted to end it all to say the least.
To build on comments from Paul, I was continually urged by my RN wife to seek counseling. The first four counselors were absolutely worthless. But she told me not to give up. Low and behold, I hit the jackpot with counselor number five. That counselor urged me to also see a psychiatrist and he has me on some fabulous meds that have increased my energy to what I used to have and I sleep great all through the night. Just that has enabled me to start to crawl out of my severe depression. While I still have a lot of the remaining side effects to deal with, the meds at least allow me to face them without thoughts of suicide now.
All I can say is NEVER give up Dean. Keep trying and eventually you will find what works for you despite the Devil’s spit going into your system.
Please feel free to contact me if you ever want to talk.
Tommy B in USA

Re: Is treatment, loss of Quality of Life (ADT), worse than the disease?

Dean,
I only had the ADT treatment with Casocex and Zoladex for 6 months but it was very difficult near the end of the 6 months for me.

I knew to be careful about weight control. I was eating less than 2000 calories, and I was on the treadmill or bike burning off 300 calories a day, but I still gained weight.

I found the local PC support/information group to be very helpful as there were other men to talk to that were going through the same problems or had got through them. It really helped me!

I was also offered a drug that was supposed to work quite well to control hot flashes for some men and had the bonus effect of being an anti-depressant. If I had to have the ADT more than 6 months I would have tried it.
- Frank (also T3b)

Re: Is treatment, loss of Quality of Life (ADT), worse than the disease?

Hi Dean,

I'm glad you like this site and have found similar stories to your own.
YANA was the first good PCa site I found when I was diagnosed (same year as you)in 2005.
The very name says it all - You Are Not Alone.


I too was a T4, (Gleason 7, PSA 182), and was 'written off' by my then urologist. He said I had just a few years to live.
I wasn't shocked or frightened - I felt great sadness - but the over-riding emotion I felt was anger.

That urologist and his bad attititude lit a fire in my belly and I was determined to prove him wrong.
Once I found a good, caring oncologist, everything changed for the better.

Initially I had Zoladex injections and 37 Radiotherapy sessions.
After two and a half years of hormone therapy I was able to stop all meds.
This happy situation lasted 36 months before I had to resume HT because PSA started to rise quickly once more.

I am now on HT for the third time in eight and a half years.

Dean, I can thorougly empathise with the personal torments you mention in your post.
I have suffered them all at one time or another over the years.
Having PCa really is a roller-coaster journey.

If there is any advice I can give, it would be this:

Diet is hugely important in fighting the illness and its side effects.
Personally, I chose to follow the Jane Plant (dairy-free) diet a month after diagnosis in 2005, and have rarely ever suffered hot flashes.

Supplements can be very very useful too. I have stayed on a supplement regime for over 8 years now.

Being pro-active in your treatment is vital. I question everything my consultant recommends, and sometimes we disagree.
For instance, I won't stay on Zoladex (or Lupron) injections longer than 2 years if my PSA has dropped to its nadir and stayed there for a full 12 months.

My consultant and I have formed a really good friendship and I think we trust eachother's judgement now. We both agree that at this stage in the journey, we shouldn't allow PSA to go above 10.0 (if/when I'm lucky enough to quit meds again.

As for being very down, I too found it hard to talk to anyone about my depression. I went through hell for about 18 months a few years ago before I finally admitted I couldn't beat it alone.

By trial and error, I found some anti-depressants that actually worked well for me. I tried about four other types before I found that one.

Finally, you might know that I got sick and tired of all the PCa research and other heavy PCa stuff I was preoccupied with on the computer in the first 18 months of my illness.

In October 2006 I set up a site called Bollocks To PCa, because I thought there must be other guys like me who needed a break from all the seriousness, and would enjoy going somewhere to post some really silly, often outrageous humour.

B2PCa went from strength to strength, and we even have get-togethers twice a year.
There are many guys among us who felt in the same situation you do now, yet have blossomed simply through letting off steam and having a good belly laugh at the daily posts on B2PCa.

Terry himself is one of our best contributors of crazy humour!

You can see more of my own experiences on my profile here, and if you wish, please feel free to email me as regards diet etc.


Wishing you all the very best,

George

ENGLAND

Re: Is treatment, loss of Quality of Life (ADT), worse than the disease?

My Husband often says that he wishes he had never had a psa test and never went on Zoladex. Been on it for over 5 years. Initial diagnosis psa 95 gleason 9
Urologist won't agree for him to have a break from it. It has had the most awful impact on his and our quality of life in fact we both agree that life will never be the same again......

Re: Is treatment, loss of Quality of Life (ADT), worse than the disease?

Jen,

As has been said so often, there are many variants of prostate cancer, some of which are very much more dangerous than others. From what you have said your husband's diagnosis points to his having one of the more dangerous forms with the very high Gleason Score and the high PSA. so whilst the ADT (Androgen Deprivation Therapy)which he is undergoing has impacted you both so badly, it appears to be managing the progression of the disease adequately. Without that management his life might well have been endangered after five years.

There are other forms of ADT other than Zoladex and men have reported different reactions to some of them. The first reaction of some urologists to the suggestion that another option should be tried is mto say they are all the same and they function in the same way, but there is no doubt from the stories I have read over they years that there ARER differeing reactions.

So, can I suggest that you try to discuss this with your doctors and ask if you can try another medication? No guarantees, but it might help.

All the best
Terry in Australia

Re: Is treatment, loss of Quality of Life (ADT), worse than the disease?

Hey Terry,
I have been on this site and found it quite informative and different than most PC websites. I read your personal account with PC and found the approach you took quite refreshing.
I was Dx about a month ago with PC: T1c, PSA 10.1, Gleason 3/4=7, 3 out of 12 site cancerous. Two had 10% but one was 70% with 60% 3 and 40% 4. Here is my dilemma. I have been on TRT treatment for the past 12 years. It has made a profound difference in my quality of life. My PSA has been slowly rising over thew past 12 years but took a jump up from 5.6 to 10.1 this past year, so I got a biopsy.
Because my PSA had been creeping up I decided to voluntarily come of of TRT and did so for about 4-5 months. My urologist is one of those who is hesitant to use T and is a big believer in early ADT. During those 4-5 months I followed a progression of loss of libido, loss of muscle mass, fatigue, night sweats, emotional depression, and the worse thing was loss of mental acuity. I work in a very high powered job and have to be on my game. I got so bad off that I put myself back on the TRT.
My plan is to have brachytherapy with 25 sessions of EBRT. I don't mind the treatment at least I don't think I do. Here is the problem. My urologist stopped my TRT. He knew I would refuse ADT. However, stopping TRT is functionally the same as ADT. I panicked because I know the ramifications of this. After 12 years my gonads are not going to produce T. I sympathize with the guys on this thread. To me I will suffer two deaths. One is the end of life and the other is the termination of TRT. My life as I know it would change. I value my quality of life more than squeezing a few extra years out of life as a cripple. I would need to sell my business and retire. It would have very heavy consequences.
I have found a few urologists who are willing to continue to treat me with TRT. I figure why not maintain my T levels the same as a eugonadal man who does not go through ADT. Why does he get to keep his level of T at 500 and I need to suffer with 200. What is the difference between exogenous vs endogenous T. If T is that bad why not start early ADT on all men. I can understand ADT once PC has metastasized to bone but I have failed to find any literature that supports an increase in survival rates. Or let's say the literature is divided with no definitive conclusions drawn.
Thanks for listening.
Bob

Re: Is treatment, loss of Quality of Life (ADT), worse than the disease?

Hello Bobx,

Can I assume you went completely (cold turkey) off Testosterone, If so perhaps it would have been better if you had slowly weaned yourself off it, so that there would be less of a shock to your endocrine system.

You didn't say when you started taking testosterone, but after 12 years perhaps you have reached an age where you would begin losing muscle mass, libido, etc., anyway.

Jack

Re: Is treatment, loss of Quality of Life (ADT), worse than the disease?

9 days cold turkey off TRT when I was first diagnosed, and I was ready to end it all. it was THE WORST thing I have ever experienced in my life. Death would have been better.

Thankfully, I found a URO who would continue me on my TRT as I did AS. glad to say, I am succeeding and winning the battle.

don't give up the fight!

Re: Is treatment, loss of Quality of Life (ADT), worse than the disease?

Hey Walt,

That is what I meant by the first death. I know some guys are happy staying alive and that trumps quality of life for many. I also know some guys are not as adversely affected by ADT as are others. I do know there are plenty of guys who suffer the effects of ADT and I am one of them. When you look at all of the symptoms involved with ADT it is legion. The way i see it is that if I can maintain a good healthy perspective on life and keep myself in the best shape possible I think I will have a better long term chance of survival than being debilitated physically, emotionally, and spiritually.
If someone were to tell me that I can live until 85 on ADT with all of its ramifications vs 75 on TRT with a high quality of life I would choose TRT until 75. I know that sounds anathema to many but these are personal life decisions each man has to make for himself. The irony is that no can can show me any data to prove they are correct. With TRT I may outlive the ADT guy.
Did you have a difficult time finding a URO to continue you on TRT? I had to look hard but I did find some. Do you mind me asking what your DX and treatment was and how you are doing today?
Thanks so much,
Bob

Re: Is treatment, loss of Quality of Life (ADT), worse than the disease?

BoB X, thanks for the reply. I agree with you 100% re the quality of life issues. I made the same calculation; I'd rather have 10 normal years, than 20 as something else. my story is here:

http://pub2.bravenet.com/forum/static/show.php?usernum=154144579&frmid=42&msgid=873212&cmd=show

My treating URO had another guy in his "umbrella" corporation that specialized in Andrology, and he referred me to him when he was uncomfortable keeping me on the TRT after diagnosis. this second URO has been awesome. truly.

I have done the "footwork" in my life; better diet and exercise, and they have done the rest. my PSA's are dirt-low, and everything else is grand (all things considered). the details are in the link to my post here.

Basically I am one year on AS and feeling (and doing) great. I feel I have made the right choice, and am fighting. I am not giving up a normal life without a fight. I am wiling to take some risk. when you read my story, you'll understand why.

thanks for listening. I will never give up.

Re: Is treatment, loss of Quality of Life (ADT), worse than the disease?

Walt,
Made my last post before I read your reply. Thanks so much. I am glad there are others out there in the same boat.
B

Re: Is treatment, loss of Quality of Life (ADT), worse than the disease?

BoB X, you are onto the the SAME thing I thought!!!

Normal guy, not on TRT, gets diagnosed with low-volume, low-risk PCa. they don't put him on hormone blocking therapy! so, why would a guy on TRT (like me and you) diagnosed with same, have to go cold turkey!?!?!?!?

it was difficult for me to justify (especially in light of the pain, and the fact that I was at the very end, of that long dark tunnel. Looking back, I'd give myself only a few more days and I probably would have punched my own ticket. it was that bad. :(

but I have arisen like the Phoenix!!!!!!!!!! I will, now, never give up the fight. Ever. :-)

Re: Is treatment, loss of Quality of Life (ADT), worse than the disease?

Walt, you are the man. I like your spirit!!
Bob

Re: Is treatment, loss of Quality of Life (ADT), worse than the disease?

thanks brother. may we all get through this together, I say. :)

Re: Is treatment, loss of Quality of Life (ADT), worse than the disease?

Hey Walt,
Just finding my way around the website. I read your story. So you were 3+3 and still on AS. Would you change your mind if you were 3+4? I think Terry on the board was originally a 3+4 and went for active surveillance. There are docs who will put you on TRT with a 3+4 but that is with good informed consent. I am ok with the brachy and EBRT but I just don't want ADT. There are a host of UROs who will not put you on ADT with a 3/4. Again not to be rhetorical but what is the difference for a man with a 3/4 with a T level of 500 vs a man with the same Dx but with exogenous T to give him the same level as the other man? Why is one man made to suffer and the other isn't? I have been really digging into the literature and it is really a mixed bag of thinking with not a lot of good double blind RCT.
Bob

Re: Is treatment, loss of Quality of Life (ADT), worse than the disease?

Hi BobX

You wrote:There are a host of UROs who will not put you on ADT with a 3/4.

That's not surprising since, as Peet in a recent post said, they're mostly knife wielders. However, when I presented myself to my urologist, who by noow does surgery with the DaVinci method, I was 77 years old, so he wisely decided I had to go with ADT. My PSA at the time was 800 (800) and I had already lost my libido, so the other side effects such as hot flashes, weight gain, etc. have been tolerable. My primary doctor is willing to prescribe T, but I feel my QOL is good enough.

BTW I see Walt, who uses supplements, has put out an invitation to anyone who wishes to ask him questions. You could ask about supplements for mental clarity. I bet he could name a few that are out there if you had to discontinue the TT.

Jack

Re: Is treatment, loss of Quality of Life (ADT), worse than the disease?

Hey Jack,

Thanks for the response. This game is such a personal matter. All men have to make their own personal decisions as to what is best for them. I don't think there is any doubt that financial remuneration is a very significant factor in many doctors decisions regarding treatment. All I know to say about that is "buyer be aware". I think there is a place for ADT. I just don't want it for me at this point in my treatment especially with lack of hard core data. I know the ramifications for me.

My plan is to go without ADT as long as possible. I still enjoy many aspects o being a "man". I do not mean that in a pejorative sense of the word at all for those on ADT. Regardless of that I highly value mental acuity. When would I acquiesce to ADT? Probably with bone metastasis. I agree with Patrick Walsh with respect to the fact that there are no studies that show an improved survival with early vs late ADT. You can find studies to support both points of view.

If I had a PSA of 800 and had already been without "T" at the age of 77 I would probably do what you did. I find it interesting that your PCP would put you on T.

I have talked to Walt about the T dilemma. He is a good guy and is helpful with answering questions. Hey we are all seeking help in our own way.

Wish you the best!!

Thanks,

Bob

Re: Is treatment, loss of Quality of Life (ADT), worse than the disease?

Hey Jack,

I started about 12 years ago. I stopped maybe 11/2 years ago for about 4-5 months. I experienced a progression of symptoms. I stay pretty active and work out. I lost weight in muscle mass. The most difficult aspect for me was my thinking started getting a little cloudy. I was not on my game. That is a life changing predicament in my profession. The symptoms progressed gradually and the recovery was gradual for me. i seems it rook about 2 months to get back on top of things. Whether I stopped cold turkey or not I think i would have still wound up in the same place. At my age I am sure I will naturally lose some muscle mass. Losing mental acuity is a different matter;
Thanks for the feedback.

Bob

Re: Is treatment, loss of Quality of Life (ADT), worse than the disease?

G’day BobX,

Your post generated an interesting exchange I think. I will not join in the “T or not to T” debate for a number of reasons, but thought I’d just comment on a couple of your remarks

If T is that bad why not start early ADT on all men. I can understand ADT once PC has metastasized to bone but I have failed to find any literature that supports an increase in survival rates. Or let's say the literature is divided with no definitive conclusions drawn.

This is a question I asked a number of times in various Forums over the years when I was more active (and when there were some excellent debates which are less apparent now). It seemed so logical to me that if prostate cancer was indeed a chronic illness, as it clearly is in the majority of cases, and if T was in fact what fed all cases, then surely the sooner you cut off the T with ADT – intermittent maybe - the better? The main arguments against were to point to various studies highlighting the dangers of ADT, mainly as far as cardiovascular events were concerned. But those studies were generally speaking in the use of ADT by old men and very ill men – and they often presented variances in outcome. Where, I asked, were the studies for younger, healthier men with early stage and low GS tumours. The answer seemed to be that there were none. So essentially what was being used to oppose early ADT treatment was a medical belief based on extrapolated data that might or might not be correct. As time went by and some of the genetic studies started coming out I came more and more to believe that the entire T debate may be built on some pretty sandy foundations. The multiplicity of prostate cancer variants combined with the extreme variability in physiology of individual makes it all but impossible, in my opinion, to draw any good conclusions about T and Pca with out current tools and knowledge.

If someone were to tell me that I can live until 85 on ADT with all of its ramifications vs 75 on TRT with a high quality of life I would choose TRT until 75. I know that sounds anathema to many but these are personal life decisions each man has to make for himself. The irony is that no can can show me any data to prove they are correct. With TRT I may outlive the ADT guy.

I have a similar outlook, which is what drove my decision making – let me have the fifteen years that I thought might be the maximum on offer with none of the potential negative consequences that seemed to be most likely associated with any therapy I could have, especially as I might have the same number of years with the negative consequences, since there are no guarantees in the prostate cancer business.

Just one thing though. There is that old joke about who the heck wants to live to 85 – usually asked in jest by younger men. The answer is men of 84. As I have now passed my initial target of 15 years, I believe I would rather like to hit my secondary target of 20 years. And with three more to go, perhaps I’ll make it.

Good luck to you whatever path you take. In the absence of any good data you must take the decision that suits you and your life best.

Terry in Australia

Re: Is treatment, loss of Quality of Life (ADT), worse than the disease?

Hey Terry,

Thanks so much for the kind reply. I stumbled on this website in a serendipitous way. I was actually on another prostate forum and happened to read some of your posts. I followed your links and as result read your story. You have a pretty amazing story and a very refreshing website. I had actually briefly visited your website but not in a serious way. I must say with all due deference you were and are a true maverick. You went against the establishment in so many ways. Excuse the pun but that takes "balls" especially going up against the so called medical gurus.

I am fairly new with the PC business since I have a relatively recent Dx. It is not specifically my field of expertise. However, I do have a decent knowledge of how the medical world operates. In the world of evidence based medicine I have an appreciation for systematic meta analysis of randomized controlled trials. Here is the rub. The more I read about PC the more the data seems elusive. There are studies that support any perspective but the hard data is not there for the most part. We can each use the data to support our thesis. In the end much is not known.

My initial attempt on a PC forum was a bit daunting. I used a pseudonym in which I was somewhat chastened. I have my reasons for not wanting my personal information going viral but I do no mind talking with anyone on a personal basis. I think there is a strong visceral emotional element for all men when initially Dx with PC. It doesn't exactly make your day. I think many times all a man my want is some emotional support. We are barraged by a plethora of information feeling we have to make some rapid decisions. That is engendered to a large part by the medical establishment. Obviously my first post was about ADT and TRT. Wow, I got hit pretty hard. I felt I was maneuvering against the Orwellian "Big Brother". Having said that I have found there are many men who feel the same way I do. I have to give kudos to men like Abraham Morgentaler for confronting mainstream urology. You have done the same thing. I am sure you have accumulated a few bruises along the way.

My problem with the TRT is that men who have been on TRT are in a trap with respect to PC. I can personally speak for its positive effects in my life. My life would be radically changed without it. After you have been on it for so long your testicles have atrophied to the point where there is no going back. A eugonadal man with a localized cancer can refuse ADT. In fact, many urologists today would not even recommend it. Although it seems apparent many do. Whether a man chooses ADT or not is his personal decision. He can refuse it. However, for the man who has been on long term TRT, not keeping him on TRT just because he has what appears to be a localized cancer is the same as functionally putting him on ADT. By default the hypogonadal man is penalized. There seems to be the proverbial "gas on fire" fear. We could each argue the data. Morgentaler has a very compelling point of view as expressed in his book Testosterone
For Life. TRT for men with PC or who have been successfully treated for PC who desire TRT are in the position of frenetically trying to find an MD to prescribe it or having to beg for TRT. I read with empathy about the men whose lives have been changed by ADT and they beg their doctor to prescribe it to no avail. Again the eugonadal man does not have this same problem. I have read the stories of many men on this website.

We see the commercials on TV and the internet about TRT and its benefit for truly hypogonadal men who truly manifest symptoms of low T. The irony is once PC is even intimated they are thrown under the bus. They have lost their voice to the paternalistic perspective of urologists who are unable to put the hard core RCT data on the table.

I am not derogating those brave souls who choose ADT. I also think there is a time and place for it. My argument is to allow men to have a choice with respect to the possibility of TRT in the treatment planning of their PC. I have not heard anyone espouse this problem. I think perhaps men may be apprehensive about it for fear of reprisal. I also think that doctors are hesitant for possible litigious reasons. However, in this day of informed consent I think they have a weak argument.

Anyway thanks for a very nice website that allows us to voice our concerns. You have truly been a leader and model with respect to your travelled path. You did this 17 years ago? Thanks for being a pioneer and carving a path through the wilderness of PC.

Bob



Re: Is treatment, loss of Quality of Life (ADT), worse than the disease?

well said Sir!

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