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Medical Forum / Diseases and Disorders / Prostate Cancer / August 2004Information on hormone therapy
I get the impression from reading other postings here that most doctors have only a hazy idea of how to apply hormone deprivation therapy. Some put their patients on it permanently. Some do it intermittently. Some do it immediately upon PSA failure. Some wait for PSA to climb to some level. Some use combined androgen blockade. Some use a single agent. Some use it prior to surgery and some don't. Some use it prior to radiation and some don't. And so on and so on. A lot of people have reported that they asked their doctors questions about all this - exactly why they prescribed some particular approach and what the alternatives are. Many of you seem to have been unable to get clear answers - presumably because the doctors didn't have them. This isn't real surprising. The surgeons spend their time studying and practicing surgery. The radiation oncologists spend their time on their specialty. Only the medical oncologists study HT extensively - and few of us ever see a medical oncologist. For those who haven't seen it, there is an interesting website run by the Prostate Cancer Research Institute, a not for profit organization founded by two medical oncologists who specialize in HT and PCa, Drs. Stephen B. Strum and Mark C. Scholz. It looks like a very good site for learning about HT. Their website is at: http://prostate-cancer.org/ A couple of interesting looking example articles at the site are: "Hormone Therapy in Prostate Cancer" http://prostate-cancer.org/education/andeprv/hormone.html and, "Intermittent Androgen Deprivation" http://prostate-cancer.org/resource/pdf/Is3-3.pdf These guys have done a lot of research and are actually able to provide theoretical hypotheses and cite experimental evidence for their conclusions and recommendations. You have to be willing to read some highly technical stuff, but any of you who are on HT, might benefit from reading it. These guys make it appear that, at least for some patients, it's possible to live a long time on HT, and to use HT intermittently in ways that can maximize lifespan and minimize side effects. Alan > I get the impression from reading other postings here that > most doctors have only a hazy idea of how to apply hormone [quoted text clipped - 4 lines] > Some use it prior to surgery and some don't. Some use it prior > to radiation and some don't. And so on and so on. I don't think this is because the doctor has only a hazy idea of how to apply the therapy. There is a lot of conflicting evidence about the best approach, and this is a topic of very active research at present. In such situations, each doctor is going to try to determine for him/herself what seems to be the most convincing evidence, and then choose the therapy based on that. It is not surprising that different doctors may come to different conclusions, although of course that is confusing to us as patients. That just reflects the state of current research on the subject. Also, it may be that whether or not a certain course of action is advisable may be highly dependent on the circumstances. From time to time I do Medline searches of abstracts on prostate cancer research. Last time I looked at articles on hormone therapy. I remember vaguely one study which seemed to conclude that using hormone therapy before surgery might be beneficial for certain kinds of cases. So a doctor might in fact recommend it for certain patients but generally avoid it. > A lot of people have reported that they asked their doctors > questions about all this - exactly why they prescribed some > particular approach and what the alternatives are. Many of > you seem to have been unable to get clear answers - > presumably because the doctors didn't have them. My doctor always gave me clear answers to any questions I asked. I found out subsequently that what he said differed from what other equally expert doctors had concluded. For example, he told me that seeds were not appropriate for someone like me with a Gleason 7 tumor. I've since found that some brachytherapists claim it is highly appropriate for such cases, and others restrict themselves to Gleason 6 or lower. Since I was never interested in seeds anyway, that wasn't an issue for me. There were a few other matters where his definite answers differed from what I was able to discover independently, but they were peripheral matters. On everything important that concerned my treatment, what he told me was confirmed by what I could find out independently. In any case, you really have no choice but to follow your doctor's instructions, even if you find something out on the web that disagrees with it. A layman just doesn't have the depth of knowledge and experience to judge what is relevant and what isn't. You may learn more than your doctor about X, but you won't be able to tell if X is important or not in your particular case. If you don't feel your doctor has sufficient depth of knowledge to treat you, you should get another doctor, but you should not quibble about details. > This isn't real surprising. The surgeons spend their time > studying and practicing surgery. The radiation oncologists [quoted text clipped - 32 lines] > and to use HT intermittently in ways that can maximize > lifespan and minimize side effects. And if you look elsewhere in the research literature, you will find other evidence contradicting what they say. I can't emphasize strongly enough that we as patients shouldn't be trying to evaluate the research evidence ourselves. There are all sort of important issues which we haven't the foggiest idea about. Papers should be addressed to an audience of other scientists who know how to do that. If you go out and look for yourself and decide that one particular guy is convincing, then you are in effect being your own doctor, and we all know that is usually a big mistake. It is better to choose a doctor based on objective criteria which you do understand, and then folow his instructions. You don't have to do it blindly. If you find out about another approach that looks promising, you should certainly discuss it with your doctor. But you shouldn't choose the doctor on the basis of which scientific paper makes the most sense to you. > Alan Alan and Leonard, Forgive me if this is old information. Today I viewed the July 2004 issue of Clinical Advisor. Statement regarding PCa was as follows: Taxotere (docetaral) has previously been approved by the FDA for breast and lung cancer. It has now been approved for androgen-independent mestatic PCa. It inhibits cancer cell division. It is infused in combination with prednisone. A great improvement over present hormone therapy which wears off in 2 or 3 years. John in OR I was just now browsing the NG and caseystengel today stated he had been on taxotere which ended last November. I regret my post thinking it was a new drug. John in OR > I was just now browsing the NG and caseystengel today stated he had been > on taxotere which ended last November. I regret my post thinking it was > a new drug. John in OR No regrets required. As far as I know, chemotherapy was not very effective against prostate cancer in the past, but it has been refined in the last few years and is becoming more effective. They now know more about dosages and about effective combinations of drugs. Your original posting talked about chemotherapy as a longer lasting alternative than hormone therapy. Indeed, it can actually be curative - killing all the cancer for some patients and some cancers. Lance Armstrong (six time winner of the Tour de France bike race) has apparently been completely cured of his testicular cancer by means of chemotherapy. Unfortunately, chemotherapy is often very tough on the body. Even Armstrong, a guy who must be as tough as anyone on the planet, was laid pretty low by it (see his wonderful autobiography _It's Not About the Bike_) Hormone therapy is much easier to take. One guy on this group, I forget his name, decided he wanted chemotherapy after RP failure, skipping the HT interlude. He figured that if the chemo failed, then he'd get what he could from HT. But he wanted to hit the cancer with chemo as soon as possible, in the earliest possible stages, in hope of a cure. I hope he reports back to us on his progress. Alan >Subject: Re: Information on hormone therapy >From: jwbrockhouse@webtv.net (John Brockhouse) [quoted text clipped - 12 lines] >2 or 3 years. > John in OR Did you get the impression that the cells were permanently inhibited? That would be very good- I recently completed a chemotherapy series involving ten taxotere infusions. Ah, I remember: Adriamycin and Ketoconazol, Taxotere and Estramustine. I think I hate estramustine... ;-} SIGNATURE File: Ranking the 20th Century Presidents: 1.Reagan 2.Eisenhower 3.Kennedy 4.Nixon 5.Bush 6.Hoover 7.Truman 8.T.Roosevelt 9.Coolidge 10.Ford 11.Carter 12.McKinley 13.Taft 14.Harding 15.Harrison 16.Clinton 17.Wilson 18.F.Roosevelt 19.Johnson > ... > I can't emphasize strongly enough that we as patients shouldn't be [quoted text clipped - 9 lines] > certainly discuss it with your doctor. But you shouldn't choose the > doctor on the basis of which scientific paper makes the most sense to you. I think your approach to this has much merit. It's true that medicine is a highly technical and scientific subject and a layman's attempts to be his own doctor will indeed often founder on lack of sufficient background in science and medicine. I agree with one conclusion you draw from this that, if a patient thinks his doctor is making mistakes, he needs to change doctors rather than take over his own treatment. Nevertheless, and without disagreeing with that, I still stand by what I said in the original posting. I have known quite a few doctors each of whom was highly knowledgeable in his specialty, but often very much at sea in other areas. Both radiation oncologists and urologist/surgeons treat prostate cancer. But you wouldn't go to a radiation oncologist for an RRP and you wouldn't go to a surgeon for radiation treatment. And yet we blithely take hormone therapy from doctors who are not medical oncologists. What I said in my original posting was that many patients here are getting hormone treatment from surgeons or radiation oncologists, and those doctors don't always have as much knowledge of medical oncology as they need to make informed decisions. I particularly remember one posting to this newsgroup by olfart in response to "Hormone Therapy - How Long". He said: When I asked how long I would continue this the Urologist first said "probably for the rest of your life". When I asked the reasons for this he hesitated a minute and then said "well at least for a few years". When I asked for more details he said "well probably for a year". Olfart went on to say that his surgeon had a good reputation and had been in practice for over 15 years. Is that guy an expert in hormone therapy? The website I directed people to in my posting was created by a couple of very well known and respected medical oncologists whose specialty is hormone therapy and who have done much original research in that field. I think they're worth reading. If I went to a surgeon and he told me that the way Patrick Walsh did RRP wasn't the right way to do it, I'd find another doctor. And if I went to a urologist or a radiation oncologist and he gave me advice about HT that was at odds with what Stephen Strum and Mark Scholz advised, I might well do the same thing. When I reject a surgeon whose recommendation is at odds with Walsh, I'm not making a scientific judgment. What I'm doing is judging that the doctor whose recommendation I'm rejecting is at odds with the worlds foremost authority - a man respected by the entire medical and scientific community. That's not being my own doctor - it's using common sense. So too with medical oncology. Learning as much as we can about treatment won't turn us into doctors. But it might help us to make informed judgments about whether our doctors truly know whereof they speak. Alan >>... >>I can't emphasize strongly enough that we as patients shouldn't be >>trying to evaluate the research evidence ourselves. There are > I think your approach to this has much merit. It's true that > medicine is a highly technical and scientific subject and a [quoted text clipped - 17 lines] > yet we blithely take hormone therapy from doctors who > are not medical oncologists. I can't disagree with what you say. But the question is how you go about choosing the right oncologist. Usually this is done by asking your current doctors for recommendations or looking up the qualifications of the specialists you have available to you. I would not decide myself among competing theories of how best to approach such therapy and then choose the oncologist that way. > What I said in my original posting was that many patients > here are getting hormone treatment from surgeons or [quoted text clipped - 47 lines] > > Alan |
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