The same goes for HT (aka ADT), except the ADT average is larger by a
whopping couple of months. And ADT is no piece of cake either. The
reason people pursue these things is the hope they will be the
exceptions who gain years, not just months, of longevity, and the hope
that ADT will improve, rather than degrade, their overall comfort.

I.P.

I think that's right.  However I.P.'s point that some individuals will
have better responses is well taken.  There are individuals, for
example, who have had many years of remission on hormone
therapy, although the averages are less.

I also like Steve J's point that life is worth fighting for.

It may also be that we can develop an arsenal of 10 treatments,
each good for an average of six months, and give someone
5 years of life by applying all of them sequentially.  Maybe.
Maybe not.

This is a tough one.  There are multiple aspects to this
question.  First of all, all people who buy insurance pay
for this treatment.  So there is a stiff societal cost for
treatments that are ultra-expensive but have limited
benefit.

I don't think it's illegitimate to consider those costs.  For
example, a treatment that adds one day of life but costs
ten million dollars clearly seems like something that
insurance shouldn't pay for.  A treatment that adds ten
years of life buts costs a few dollars clearly should be
paid for.  So where does the line fall in between?

Another dimension to this problem has to do with the
costs of this drug that have nothing to do with the cost
to develop, manufacture or administer it.  The drug
companies invest millions in developing this kind of
drug and only do so because they expect to get patent
protection that allows them to charge whatever the
market will bear.  So they may well charge 2, 3, 4, 5
or 10 times the cost while they still hold the patent.
They may well hire a thousand sales people to sell
it full time, pay for hundreds of millions in television
ads, spend millions on gifts and "educational seminars"
in exotic resorts for doctors, and so on, all of which
must ultimately be paid for by the insurance
consumer.

These are tough social questions.  I have some
ideas about them, but no hard and fast answers.

    Alan

One of the things reearchers will do is to look beyond the current
state of affairs and see what's possible and what's worth pursuing.
The research on Provenge is a big deal in this regard, I believe,
since it means that the idea of stimulating the immune system to
attack prostate tumor cells does do something useful.  Had the
clinical trials not shown any effect, continuing along this avenue of
research would have been harder to justify.

Provenge is the first of what we all should hope will be many
treatments of this form.  I wouldn't be surprised if in a few years,
Provenge is supplanted by another drug that does the same thing but
better.

For now, for the men with PCa who need it and want it, the average of
four months extension is worth the cost, if it keeps researchers on
the hunt.

--charlie