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Medical Forum / Diseases and Disorders / Prostate Cancer / March 2006Understanding prostate cancer hormone therapy "syndrome"
Fri Mar 10, 2006 2:49 PM ET By Anne Harding NEW YORK (Reuters Health) - Men with prostate cancer may be put on hormone therapy, to block testosterone production in an effort to halt or slow tumor growth. While some health effects of so-called "androgen deprivation therapy" (ADT) for prostate cancer are clearcut -- for example sexual dysfunction -- there is this whole set of less specific, more vague symptoms, like changes in mood, memory, feeling unwell, being tired. A new study suggests that these symptoms are likely due to the fact that the patients are older, sicker and have more advanced disease. "Androgen deprivation is probably not playing a big role in causing these symptoms," Dr. Vahakn B. Shahinian of the University of Texas Medical Branch in Galveston told Reuters Health. Based on the findings, he added, the therapy should not be avoided in patients for whom it is indicated based on concerns that they will develop symptoms collectively known as "androgen deprivation syndrome." Shahinian and colleagues assessed the rate of depression, cognitive impairment or constitutional symptoms (weight loss, fever, fatigue, malaise) in 50,476 men with prostate cancer and 50,476 men without the disease. They report their findings in the Archives of Internal Medicine. Among men who received ADT, 31 percent had at least one diagnosis of depression, cognitive problems or constitutional symptoms, compared to 24 percent of prostate cancer patients who weren't given the therapy, and 23 percent of the non-cancer cohort. However, after adjustment for age, other illnesses, stage of disease and other relevant variables, the differences between the prostate cancer groups either disappeared or were greatly diminished. After adjustment, men on the therapy were 8 percent more likely to have a depression diagnosis, 1 percent less likely to have cognitive impairment, and 17 percent more likely to have constitutional symptoms. Therefore, ADT is probably not a major player in causing these symptoms, the authors conclude. SOURCE: Archives of Internal Medicine February 27, 2006. knowledge is power - growing old is mandatory - growing wise is optional "Many more men die with prostate cancer than of it. Growing old is invariably fatal. Prostate cancer is only sometimes so." http://community.webtv.net/PALMER_ENT/doc see thread http://tinyurl.com/pds7v ...Ron missed that one ron, sorry... knowledge is power - growing old is mandatory - growing wise is optional "Many more men die with prostate cancer than of it. Growing old is invariably fatal. Prostate cancer is only sometimes so." http://community.webtv.net/PALMER_ENT/doc not a problem Curtis, just wanted to give others the benefit of seeing what's been said so far...ron What about testing PCs pts going into ADT for their baselines, and a comparable number of men not going into ADT, then retest everyone 12 months later to observe changes. That sounds like a much better test of the real issue: Does ADT cause the ADT Syndrome? THIS trial would test ADT changes more directly, with lab tests of each hypothetical SE, than just using statistics to sort out ADT responses after the fact. It would also directly eliminate aging as a factor, as all pts would age just one year. How many middle-aged men acquire ANY, let alone several, "ADT SEs" in just 12 months? SIX months? Has anyone solicited Strum's opinions on this trial? I.P.. > What about testing PCs pts going into ADT for their baselines, and a > comparable number of men not going into ADT, then retest everyone 12 [quoted text clipped - 5 lines] > year. How many middle-aged men acquire ANY, let alone several, "ADT SEs" > in just 12 months? SIX months? The proper way to do it would be with a double blind study in which two matched groups were given the drug or a placebo. Since such a study doesn't seem feasible, the next best thing is something like what you describe. These are called prospective studies. The kind of retrospective study they did comes in third. In any statistical study, there is always the problem of confounders that you may not have accounted for. Prospective studies are better at avoiding confounders but in real life they are not entirely free of them. And another issue is that some studies will give incorrect results just by chance. this is usually pretty unlikely for any given study, at least if it is well designed, but given a large number os studies, it is highly probably some some small number of them will be wrong. The upshot is that one must try to evaluate all the evidence. No one study should be considered as settling a question of this kind. The best we can conclude from the study under discussion is that previous ideas that ADT had significant side effects in many men MAY be exaggerated. > Has anyone solicited Strum's opinions on this trial? > > I.P.. >> What about testing PCs pts going into ADT for their baselines, and a >> comparable number of men not going into ADT, then retest everyone 12 [quoted text clipped - 3 lines] > The proper way to do it would be with a double blind study in which two > matched groups were given the drug or a placebo. Isn't that a natural progression of drug testing? Phase I?  SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05, 2/06 PSA .07 .05 .06 .09 .08 .132 Non Illegitimi Carborundum > What about testing PCs pts going into ADT for their baselines, and a > comparable number of men not going into ADT, then retest everyone 12 > months later to observe changes. That sounds like a much better test of > the real issue: Does ADT cause the ADT Syndrome? I just relooked at Scrum's book and on p. 153 is the results of such a test of 77 naive men. 17% had mental/emotional problems within 1-2 months 30% had bone and joint pain within 2-6 months 38% had gynecomastia after 1 year 45% had anemia within 2-12 months 48% had hot flashes within 1-2 months 56% had weakness within 1-4 months 57% had Hypercholesterolemia within 4-6 months. Another issue that is not apparently answered is the relaxation of some of these sides. For instance, my hot flashes started within 1-2 months and completely disappeared within 12. Hypercholesterolemia is a bitch to counteract, but seemed to level off over a year ago. > I just relooked at Scrum's book Er, it's STrum, not Scrum, which is a play in rugby :-) > and on p. 153 is the results of such a test of 77 naive men. Um, *hormone*-naîve. I reckon that they likely knew what's what otherwise ;-) > 17% had mental/emotional problems within 1-2 months 30% had bone and > joint pain within 2-6 months 38% had gynecomastia after 1 year 45% had > anemia within 2-12 months 48% had hot flashes within 1-2 months 56% had > weakness within 1-4 months 57% had Hypercholesterolemia within 4-6 > months. (1) There is an arithmetic error in the book regarding the total affected by hypercholesterolemia. The total affected in any degree should be 52%, not 57%. (2) Steve K has lumped together the figures in the chart to reach his totals. The breakdown, for example, of the Mental/Emotional Changes is Severity Grade 0-1= 2 (3%) and Grade 2-3 11 (14%), total affected *in any degree* = 13 (17%). He simply reports that 17% suffered such problems. With all due respect, this is misleading. The chart clearly tells us that not all patients were affected to the same degree. This appears in the other categories of SEs on the chart, as well. It is interesting to note the widespread omission of so much information (and I do not blame Steve K for this) about this important issue. We see folks who have an ax to grind go on and on about the horrors of ADT. They fail, deliberately, I fear, to let us know that there are myriad ways to treat and overcome such alleged horrors. In their book, Strum and Pogliano explicitly state, "learning about the possible side-effects of ADT should not dissuade the patient from embarking on a course of of ADT but rather direct him to focus on what measures can be used to accentuate the positive aspects of ADT while minimizing the negative" _A Primer on Prostate Cancer_, 2nd ed, page 152. and "Few patients experience all of the possible side-effects of ADT." (ibid) and "Treatment is available for most of the adverse effects that *may be possibly* encountered as part of ADS. Many, but not all, of these signs and symptoms can be prevented, corrected and/or reduced." (Emphasis mine) (ibid) Where, kiddies, do we see any of this cited by the ax-grinders? Answer: nowhere. Hmmm. Regards, Steve J "There is nothing sadder than the brutal murder of a beautiful theory by a gang of ugly facts." --Francois, Duc de la Rochefoucauld > Another issue that is not apparently answered is the relaxation of some > of these sides. For instance, my hot flashes started within 1-2 months > and completely disappeared within 12. Hypercholesterolemia is a bitch > to counteract, but seemed to level off over a year ago. > We see folks who have an ax to grind go on and on about the horrors of ADT. > They fail, deliberately, I fear, to let us know that there are myriad ways to treat > and overcome such alleged horrors. > "Treatment is available for most of the adverse effects that *may be > possibly* encountered as part of ADS. Many, but not all, of these signs > and symptoms can be prevented, corrected and/or reduced." (Emphasis mine) > (ibid) > > Where, kiddies, do we see any of this cited by the ax-grinders? Answer: > nowhere. Hmmm. Cited often and discussed several times, Stevie, but you deliberately ignore that in your continued attempt to deny your own SEs and discredit both Strum's body of work and my quotations and discussions of same. Again, I caution people considering early adjuvant or primary ADT to research not only its SEs but the medications which may mitigate those SEs. Few of those anti-SE meds are panaceas, some have their own SEs which warrant yet more drugs to mitigate THEIR SEs, and some are outright nightmares for some people. Regard Steve's dismissal of and my concern for those medication snowballs as worth the price you paid for them, but take this advice as solid gold: do your own research, because you're not going to get the whole picture here. I.P. > Er, it's STrum, not Scrum, which is a play in rugby :-) As I confessed in an earlier post, mistyping is just another SE of ADT. > In their book, Strum and Pogliano explicitly state, "learning about the > possible side-effects of ADT should not dissuade the patient from > embarking > on a course of of ADT but rather direct him to focus on what measures can > be used to accentuate the positive aspects of ADT while minimizing the > negative" _A Primer on Prostate Cancer_, 2nd ed, page 152. I think it is safe to say that there is no standard with regard to the treatment of prostate cancer post RP and post RT. Or, maybe, post RP. Clearly, Strum looks at HT almost as a panacea (slight exaggeration). Neither Walsh nor Scardino to. To compound things, I have a feeling that improvements are coming so fast that there will never be a consensus to the argument. By the time there is, chemotherapy will likely move up closer to the front of the line; and viruses and vaccines will move into chemo's current slot. SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05, 2/06 PSA .07 .05 .06 .09 .08 .132 Non Illegitimi Carborundum I don't remember if it was Strumm or Scardino who said some of these symptoms begin at 15 months regardless of the age of the patient. I was 48 and am enjoying some of the SEs. I wonder how many 45 to 50-year-olds were used in their ADT group. SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05, 2/06 PSA .07 .05 .06 .09 .08 .132 Non Illegitimi Carborundum > Fri Mar 10, 2006 2:49 PM ET > [quoted text clipped - 44 lines] > invariably fatal. Prostate cancer is only sometimes so." > http://community.webtv.net/PALMER_ENT/doc > I don't remember if it was Strumm or Scardino who said some of these > symptoms begin at 15 months regardless of the age of the patient. Er ... one month. My onc team, including ADT specialists, said I'd experience my SE suite with a one-month ADT test, excluding the things such as osteoporosis and muscle atrophy which take several months of T deprivation to show up. I.P. >> I don't remember if it was Strumm or Scardino who said some of these >> symptoms begin at 15 months regardless of the age of the patient. And I.P. corrected: > Er ... one month. I still haven't found the 15-month reference. Perhaps it was in Scardino's and perhaps it said "by 15 months" or some such phrase. But, having re-checked Strum (and recalling anecdotal memory) you are correct sir. SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05, 2/06 PSA .07 .05 .06 .09 .08 .132 Non Illegitimi Carborundum Steve check Strum's book, page B25, section 4.16, it is 15 months. > Steve check Strum's book, page B25, section 4.16, it is 15 months. What it is is all over the map, depending on which SEs we're talking about. In Strum's ADT Syndrome article, he charts acute and chronic SEs. The acute begin in < 2 months, the chronics > 6 months. (Either set gives me extreme pause.) Other researchers say one month for most SEs, obvious exceptions including muscle and bone atrophy. The point is that anyone on ADT as a PC treatment (as opposed to a month or two to shrink the prostate before primary treatment) will most likely be on it long enough to experience their full personal SE suite. I.P. >>> I don't remember if it was Strumm or Scardino who said some of these >>> symptoms begin at 15 months regardless of the age of the patient. [quoted text clipped - 5 lines] > and perhaps it said "by 15 months" or some such phrase. But, having > re-checked Strum (and recalling anecdotal memory) you are correct sir. I hadda do SOMETHING to offset my presumption that AU was still part of the UK. I.P. |
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