"Steve Jordan" sniped (no, that's not misspelled)

Looked then, have forgotten the details, can't find the links now. Please
repost and I'll look again and, if pertinent, add them to my other data
below.

"a" study? My data come from dozens of studies and was examined and approved
by a team of oncologists.

For example, from the last time I posted this for forum critique:
I've spent the last six weeks studying a dozen cancer books and dozens of
web sites, including Walsh, PCRI (Strum, Scholz, et.al,), Lange, Marks,
Blasko, Oersterling, leading universities and hospitals, NCI, ACS, NEJM,
JAMA, Lancet, the VA, Harrison's Internal Medicine, etc. (I've researched
medical issues on the web for many years and always wear hip boots.)

ADJUVANT TREATMENTS CONSIDERED

WW, ADT1,2,3 (early or at biochemical or clinical failure), IAD,
antiandrogen monotherapy, immunotherapy, angiogenesis, MAB, etc.

EARLY ADJUVANT ADT BENEFITS . . . OR LACK THEREOF
* 5-yr-relapse-free ADT improvements run from negligible to 10-15% . . . not
much benefit for the SEs.

* Adjuvant ADT helped N=1 patients, but trials do not demonstrate clear
advantages to ADT after RP w/N=0, even with PSA elevation.

* Major meta-study found no evidence that early adjuvant ADT provides any
advantage, even w/rising PSA; Walsh, the Mayo Clinic, Sloan-Kettering, the
ACS, and universities agree (citing failure to prolong life, SEs, QOL, and
accelerated refraction).

* Pts w/asymptomatic mets MAY experience fewer serious complications with
early, rather than late, ADT.

* Finasteride monotherapy slightly improved prognosis, but => more,
higher-grade refractory tumors.

* ADT 2 or 3 (CAB) not promising, not curative, may promote refraction, no
5-yr benefit, more SEs.

* IAD MAY delay refractory mutation, MAY extend heartbeat by 6-12 months,
and MAY reduce side effects towards the end of each HT-off cycle . . .

* Young G8 T3c RP pts have unacceptably high relapse and refraction rates
even with adjuvant ADT,

* But it's ineffective after biochemical failure w/Gleason >7.

* T3c, G > 6, and/or aneuploidy => high p(AIPC) => low p(big ADT benefit).

* All those results => little risk and much reward potential in delaying ADT
at least until PSA DT is known.

* (OTOH, accumulating evidence supports ADT w/locally advanced disease.)

* Antiandrogen monotherapy w/Casodex reduces SEs to primarily gynecomastia,
may be as effective as LHRH agonists or castration for locally advanced PC,
and is approved in 60 countries for that purpose.

ADTSIDE EFFECTS, DOWNSIDES, CONCERNS

* ADT SEs, in approximate decreasing order of my concern about them:
fatigue/weakness/lethargy/anemia (the earliest and most obvious andropause
SE), depression, osteoporosis (seriously underreported) and attendant
fractures, cognitive dysfunction, hot flashes/night sweats (and the SEs of
meds that reduce them), extreme irritability, emotional turmoil, poor sleep,
nausea, diarrhea, lipid elevation, liver damage, psychological stress,
pronounced personality alteration, upper body muscle atrophy, weight gain,
breast pain, insulin resistance, and libido/ED effects. (Surprised at that
last one being last? Think about it; who'd want sex with all that other crap
going on?)

* ADT < 12 mo => patients suffer typical ACUTE Androgen Deprivation Syndrome
(ADS; see Strum) - invariably compromising healthy, active lifestyles -- but
maybe not significant CHRONIC symptoms. Chronic symptoms -- some nearly
inevitable in patients treated > 12 mo -- are much more prevalent with ADT
than is currently recognized or reported.

* Probabilities of various SEs combine mathematically to virtually guarantee
(p > .97) one or two SEs I'm not willing to accept just for a slight,
debatable, statistical lifeline benefit.

* Anti-SE meds (e.g., antidepressants, anabolic steroids, NSAIDS) have their
own, major, SEs.

* I have two conflicts with biphosphonates: NSAIDS give me ulcers and I'm on
a PPI for GERD.

* ADT after RP can extend life . . . if given for 28 months, but

* Two years on ADT may permanently suppress T and thus maintain SEs, and

* Trial ADT takes 6-12 months to reveal all its SEs - about the maximum
extent of its lifeline extension.

* ADT => T deprivation => SEs. T > 20 => little benefit. This may mean no
pain (SEs), no gain.

* ADT drives PSA down, hiding the REAL killer, AIPC, while it proliferates.

* OHSU demonstrated that ADT T deprivation alters hippocampus to sharply
decrease two-minute word retention (short-term memory), resembling early
Alzheimer's or stroke.

* Geriatric psychologist I consulted reports most of her ADT pts suffer
dramatic to devastating emotional impacts, often a near absence of the
emotions we want plus wide swings in the moods we don't want; she regards
ADT as primarily for patients who consider a heartbeat more important than
QOL, who fear death above all, or who are encountering clinical failure.

* "PC for Dummies" says ADT converts Mr. Nice to Mr. Extremely Irritable. I'm
Mr. Irritable awreddy.

* My survey of adjuvant ADT pts on alt.support.cancer.prostate => 14
respondents => 3 w/light SEs, 5 w/serious SEs, 6 w/devastating SEs; some of
the latter - and their wives -- considered ADT worse than the alternative.

* Typical IAD on/off cycle  => 9-16 months on, 6-9 off, w/lingering SEs
dominating off cycle => little SE break => low therapeutic index.

* Antiandrogen SEs = primarily diarrhea (less w/Casodex) and breast pain . .
. + maybe long term PC stimulation.

* PCRI/Scholz: "The biggest difference between adjuvant treatments is QOL,
not survival; choose by SEs."

BOTTOM LINE

The few months adjuvant ADT MAY add to my life are highly likely be burdened
with SEs which threaten the most important elements of my life. I'd far
rather feel like an athlete, think like a student, and be a good companion
to my wife for 5 years and then die than feel like road kill, think like a
fencepost, and be a major PITA for 6 or 7 and die on her anyway. Life's
about quality, not just quantity, and the steeper the slide from vigor to
rigor, the better. Besides, Partin says my glass is 1/6 to 2/5 full; I don't
want to poison it, especially with CC waiting to render my PC -- and ADT --  
moot.

Steve can hang his trust in one trial if he likes; I'll be glad to add his
to my data if a) he'll link it again and b) my onc board says it outweighs
the data above.

I.P.