Unfortunate, but so true.  We're desperately digging for studies to
guide us in our decision-making, but lots of them are not sound
methodologically or the results are misinterpreted, or "unexciting"
results are omitted altogether, or all three.  Then we compound the
error by applying aggregate data to our individual cases.  Our
physicians, on whom we so much want to rely, in their recommendations,
more often than not,  fly by the seat of their pants -- at best, their
favorite pants -- taking the patients along for the ride.

This is what, snipped,  preceeded Dominic's post:

DOMINIC WROTE:

Thank you all, and Dominic:  And before I go any further, apologies to
the distinguished John Hopkins team if I have in any way quoted them
inappropriately. I've tried hard not to.
This the document I'll now be quoting from (originally from Ron99,
thanks):
http://www.eurekalert.org/pub_releases/2007-10/jhmi-stf092807.php

Dominic you wrote:
   
"I just faced this quandry myself. The simple way I look at it is
this. I may develop hormone insensitive cells that are initiated by
the use of ADT but the fact is testosterone drives PCA. So ADT can at
least reduce the risk of spread related to those hormone dependant
cells."

Aye...there's the rub.... Dominic, I believe you've hit the quandary
in the solution of your quandary!
We slow the growth. Yes. But do we maybe also encourage the spread of
lethal metastasis eventually?

Here are some extracts from the press release from John Hopkins (as
distinct from the original research) in plain layman's language which
helps guys like me:

The first extract confirms the reason why you - and probably me -will
take the therapy:

".. (androgen deprivation)......is effective at slowing tumor growth,
they (the John Hopkins researchers) emphasized."

After those cautionary words because the research is new, some
conclusions are reached fromn this early research:

..." A popular prostate cancer treatment called androgen deprivation
therapy may encourage prostate cancer cells to produce a protein that
makes them more likely to spread throughout the body..."  

"......the researchers experimented on a prostate cancer cell line
that depends on androgens to grow.  When they removed androgens from
the chemical mixture that the cells live in, their production of
nestin increased."

In further experiments: "....cells weren't able to move around and
through other cells nearly as well as cells with normal nestin
levels."

And the effect of that as regards Pca spreading through the body:
"Prostate cancer cells with hampered (Mike Hi read this word as
"less") nestin expression were also less likely than normal prostate
cancer cells to migrate to other parts of the body when transplanted
into mice."

Here in short is the opening para of the JH press release; and the
last para.

..."A popular prostate cancer treatment called androgen deprivation
therapy may encourage prostate cancer cells to produce a protein that
makes them more likely to spread throughout the body, a new study by
Johns Hopkins researchers suggests."

..."What all this suggests is that nestin levels increased when
prostate cancer cells are deprived of androgens and may encourage the
cells to metastasize," says Berman.
(The research team was led by David Berman, an assistant professor of
pathology, urology and oncology at The Johns Hopkins University School
of Medicine.)

    End excerpts.

Dominic, like you, I'll still try the delaying tactics with homone
therapy. It's easy. I'll outlast the bastard. There's no way it'll get
me before the due day.

Best wishes to all
MikeHi
"Exponential lightspeed". Def: The discovery of the cure for Pca at a
speed which defies Einstein.

I hadn't seen the citation at:
http://www.eurekalert.org/pub_releases/2007-10/jhmi-stf092807.php

when I wrote the above lines.  It does more clearly state
that the researchers were concerned about the possibility
of ADT making metastasis easier.

Nevertheless, it is still the case that we have empirical
studies to show that life is prolonged by early ADT.  So
either the Nestin issue is not a factor, or it's just one
factor and that ADT does other things that more than make
up for any negative Nestin effects.

I would still put my faith in the studies showing longer
life with early ADT.  Those studies didn't measure the number
of molecules of Nestin in a cell, they measured the number of
years that a man lives.  That's the measurement that we care
about.

  Alan

kh,

Has anyone suggested "second line" hormone therapy to you?
Some docs use estradiol patches and/or ketoconazole.  Not
everyone is helped, but some men are.

I'm not trying to second guess the docs at JHU.  They know
vastly more than I do.  But if you haven't had it yet, it's
something to ask about.

   Alan