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  1. Jim Marshall (not a doctor) said ... Cardiovascular If you know the term 'cardiovascular', you probably know two major things - heart attack and stroke. A fuller list includes: Abnormal heart rhythms, or arrhythmias Aorta disease and Marfan syndrome Congenital heart disease Coronary artery disease (narrowing of the arteries) Deep vein thrombosis and pulmonary embolism Heart attack Heart failure Heart muscle disease (cardiomyopathy) Heart valve disease Pericardial disease Peripheral vascular disease Rheumatic heart disease Stroke Vascular disease (blood vessel disease) Risk factors Risk factors for cardiovascular disease that you can change: Tobacco smoking Not enough physical activity Poor diet Excessive alcohol consumption. Risk factors your doctor can find: High blood pressure High blood cholesterol Being overweight or obese Having diabetes People with diabetes have twice the risk of developing cardiovascular disease. The rate of stroke can be up to five times greater, and prevalence of heart attack up to ten times greater, for people with diabetes. There are other special conditions your doctor may identify. For instance, for me personally, unless I work at it, I find myself with low salt levels which gives a much higher heart attack risk. Hormone therapy (androgen deprivation therapy, ADT) It is a fact of life for men with prostate cancer that is know to be, or thought to be, out of the prostate, that in many treatments your doctor may recommend hormone therapy. Simply, prostate cancer will use testosterone as a food. Hormone therapy stops your body producing testosterone.Your treatment may include just one period of hormone therapy with radiation. For many men in this group, however, the prescription is hormone therapy for the whole of your life. Types of hormone therapy in this study Hormone therapy mostly used with radiation, or to live long, fits into two groups: Firmagon Firmagon (degarelix) is the only member of the GnRH antagonists currently available (as of 8 December 2019). The rest GnRH agonists include: Zoladex (Goserelin), Lupron (leuprorelin), Eligard (leuprolide), Lucrin (leuprorelin acetate), Suprefact/Suprecor (buserelin), Synarel (nafarelin), histrelin (Supprelin), Suprelorin/Ovuplant (deslorelin), Triptorelin (diphereline) The choice if you are at risk of cardiovascular disease. Simply, the authors find Firmagon (degarelix) to be a better choice if you have cardiovascular risk. Most important is that the authors worry that specialist doctors might not be finding out from your GP if you do have cardiovascular risk before starting hormone therapy. Problems with Firmagon (degarelix) Convenience for patient. A Firmagon injection must be given every 28 days. Other ADT formulations offer, besides every 28 days, 84 days, 168 days, and even longer. Convenience for doctor. Mixing the Firmagon injection takes about 15 minutes. Injecting takes several minutes, and there are special rules. Some other ADT formulations are much more straight forward. Pain. Where the injection goes in. For me pain does not start until day 2. Flu-like symptoms. I know this is a rare symptom because for the past 4 years I have been on Firmagon I have had the opportunity to talk to many men on this drug, and only one man has reported this - me! On days 2, 3 and sometimes longer, I feel crook! Oh well - life wasn't meant to be easy! ... end Jim Int J Clin Pract. 2019 Nov 22:e13449. doi: 10.1111/ijcp.13449. [Epub ahead of print] Cardiovascular Risk with Androgen Deprivation Therapy. Rosenberg MT1.In LibraryGet PDF Author information Abstract BACKGROUND: From the primary care perspective, many urologists and oncologists appear to be ignoring an FDA warning to assess patients' cardiovascular (CV) risk before instituting androgen deprivation therapy (ADT) with gonadotropin-releasing hormone (GnRH) agonists. A growing body of data suggests an association between androgen deprivation therapy (ADT) and CV/cardiometabolic risk, particularly for GnRH agonists. METHODOLOGY: The author examined available evidence regarding CV side effects with GnRH agonists and antagonists to determine what urologists, medical oncologists, primary care physicians (PCPs), and patients need to know about these risks. RESULTS: Data are inconclusive and somewhat conflicting - both low testosterone and testosterone replacement have been associated with elevated CV risk, for example. But the distinction between GnRH agonists and antagonists is becoming clearer, as agonists appear to be more strongly linked with CV risk, perhaps due to the transient testosterone surge they cause upon administration. Moreover, adverse CV events associated with GnRH agonists can emerge relatively quickly, within weeks to months. Conversely, two studies show that GnRH antagonists may significantly reduce CV risk compared to GnRH agonists. CONCLUSIONS: Both GnRH agonists and antagonists carry some degree of CV risk. Although the risk appears to be lower with GnRH antagonists, urologists and oncologists should communicate with PCPs to determine patients' baseline CV risk levels before implementing ADT with either type of agent. © 2019 John Wiley & Sons Ltd. KEYWORDS: GnRH antagonists; androgen deprivation therapy (ADT); cardiovascular risk; gonadotropin-hormone releasing (GnRH) agonists; myocardial infarction; prostate cancer; stroke PMID: 31755635
  2. There are five Thursdays in this month. Each Thursday I aim to present one of the YouTube videos from the PCRI. Hormone therapy, also called androgen deprivation therapy (ADT) keeps most of us alive by robbing the body (and the prostate cancer) of androgens. The main androgen is testosterone. When our bodies are without testosterone, some men experience hot flashes (also called hot flushes). The experience varies from man to man. Some men have no hot flashes. Others have their life very affected. Personally, my hot flashes were mild at first, and gradually faded to undetectable over a few years. In this video, PCRI’s Executive Director, Mark Scholz, MD, discusses various methods for managing hot flashes that occur in men who are undergoing hormone therapy for prostate cancer: And a reminder that we have a few videos of our own on the JimJimJimJim channel: https://www.youtube.com/jimjimjimjim/videos The Prostate Cancer Research Institute (PCRI) is an important source of information for about prostate cancer for patients, families, and the medical community. As part of their mission to empower men and their caregivers they make YouTube videos.
  3. This video today is about weight training for men on hormone therapy for prostate cancer. Hormone therapy is also called 'Androgen Deprivation Therapy' (ADT) because it robs a man of androgens. The main androgen is testosterone. Androgens fuel prostate cancer. And a reminder that we have a few videos of our own on the JimJimJimJim channel: https://www.youtube.com/jimjimjimjim/videos The Prostate Cancer Research Institute (PCRI) is an important source of information for about prostate cancer for patients, families, and the medical community. As part of their mission to empower men and their caregivers they make YouTube videos.
  4. " In what seems to be a first, study researchers are saying that they might have uncovered a link between ADT and Alzheimer’s. Their study is small and preliminary and it does not prove a cause-and-effect relationship, but merely shows an association between ADT and Alzheimer’s disease." Click here to read more.
  5. Paul Edwards

    Firmagon injection - minimising side effects

    One of the drugs used in androgen deprivation therapy is Firmagon (degarelix). Firmagon requires a monthly injection. There can be severe pain at the site of the injection (caused by bruising and rashes which can last for 3-4 days each month). This post has been updated with additional suggestions about how to miminise the pain from a Firmagon injection.
  6. Paul Edwards

    Coming out of the closet

    Dr Richard Wassersug writes the Life on ADT Blog and is a co-author of the book Androgen Deprivation Therapy:An Essential Guide for Prostate Cancer. In 2007 he wrote an article in the New York Times announcing that he was a eunuch. Click on this link to read the article
  7. Depression resulting from Androgen Deprivation Therapy is a completely under-recognized phenomenon, according to a recent article. Click on this link to read the article. Beyond Blue 1300 22 4636 and Lifeline 13 11 14 provide support for depression.
  8. Luteinising hormone-releasing hormone agonists (LHRHa) or antagonists are used for Androgen Deprivation Therapy in men with advanced prostate cancer. These include Zoladex, Lucrin, Eligard and Firmagon. Oral estrogen (eg, diethylstilboestrol [DES]) was previously used for Androgen Deprivation Therapy before the development of LHRHa drugs. Oral estrogen ceased to be used for Androgen Deprivation Therapy because of cardiovascular toxicity (damage to the heart). The cardiovascular toxicity was caused by the way that oral estrogen was metabolised in the liver. If estrogen is administered intravenously, by injection into a muscle or transdermally (using patches on the skin), it is metabolised in a different way from oral estrogen. Scientists believe that administering estrogen in this way could avoid the cardiovascular toxicity that occurs with oral estrogen. They are conducting a large clinical trial (PATCH) in the United Kingdom to see whether this is correct. If it is correct, then estrogen might be a much cheaper method of Androgen Deprivation Therapy with less side effects than the very expensive LHRHa drugs. A study was conducted of some of the men participating in the PATCH trial to examine whether estrogen and LHRHa drugs had different effects on bone mineral density. Click on this link to read a report by Malecare on this comparison of the effects of estrogen and LHRHa drugs on bone mineral density. [Edit - There was a problem with the original link which has now been fixed. Thanks to Laura for letting us know. ]
  9. The New Prostate Cancer Infolink reports Full data on ADT + chemotherapy from the STAMPEDE trial now published The report has links to the full text of articles in the Lancet regarding this research. "For men with metastatic prostate cancer starting [androgen deprivation] therapy for the first time, we found strong evidence to support the addition of docetaxel to androgen deprivation therapy as the new standard of care, and this combination should be offered to men who are fit to receive chemotherapy. " There is no sufficient evidence yet to recommend docetaxel plus androgen deprivation therapy for hormone-naive men men diagnosed with micrometastatic prostate cancer (cancer in the lymph nodes but not yet metastasised to the bone - M0)
  10. Paul Edwards

    ADT negatively affects mood

    Researchers asked prostate cancer patients to fill in an online questionnaire on their mood in relation to the prostate cancer treatments they had received. Their results showed that, compared to patients not on ADT, ADT does indeed negatively affect the mood of men, most notably increasing their sense of fatigue and decreasing their sense of vigor. The authors also asked partners of patients to rate the patients’ moods. The partners reported similar declines in the patient’s mood that the patients reported, but to a greater degree than the patients themselves. Often our partners know us better than we know ourselves. Van Dam D, Wassersug RJ, Hamilton LD. Androgen deprivation therapy’s impact on the mood of prostate cancer patients as perceived by patients and the partners of patients. Psycho-Oncology 2015; [epub ahead of print] 31 August 2015. www.ncbi.nlm.nih.gov/pubmed/26332203
  11. The Life on ADT blog has a report on recent research. Click on this link to read it.
  12. A retrospective study of nearly 17,000 patients has suggested that androgen-deprivation therapy (ADT) is associated with an increased risk for the future development of Alzheimer's disease in men with prostate cancer,. Click here to read a report in the New Prostate Cancer Infolink about the study. Researchers can’t prove a direct cause-and-effect link between ADT and Alzheimer’s in an observational study like this. Some other unknown variable might be influencing the results........ Given that it’s a first-time association in a retrospective analysis, this study helps inform future research but it’s not appropriate at this point to make treatment decisions off of it......... If your doctor has put you on this medication for your prostate cancer treatment, you should continue it. Consult with your physician, but don’t stop taking your medication based on a study like this....
  13. A good video by the Prostate Cancer Canada Network Calgary. Psychologists from the Tom Baker Cancer Centre in Calgary Canada, Lauren M. Walker and John W. Robinson, share a talk the context of when Androgen Deprivation Therapy, or ADT, is used for treatment. They also talk about the studies and work they've done on the treatment, the side effects and ways to deal with them.
  14. In today's teleconference it was suggested that Megace might be useful to reduce hot flushes. I notice that Chuck Maack recently referred in a US forum to a warning by top Medical Oncologist Stephen Strum against men on androgen deprivation therapy using Megace for hot flushes. Strum warns: "I am not a user of Megace in this setting since it is metabolized to DHEA and then to androstenedione and then to testosterone. When the PSA is in good control and the testosterone is low, I use Depo Provera intramuscular injection 400mg ONCE and that usually eliminates hot flashes forever. The emphasis on "usually" added since there are rare cases wherein the hot flashes are not reduced/eliminated. Therefore, a 400mg Depo Provera intramuscular injection just once would be what I would have done were I experiencing hot flashes. Make sure the prescribing/administering physician is providing Depo Provera and at the recommended dose, and not Provera. Though both are Medroxyprogesterone, the difference is that Depo Provera is an addition of acetate. There are physicians not familiar with that difference who prescribe Provera when the requirement is, specifically, Depo Provera. HOWEVER, IMPORTANT TO NOTE: Depo Provera has also been known to cause gastrointestinal bleeding and a low HCT percentage can also be attributed to loss of blood. If you are experiencing fatigue and shortness of breath subsequent to Depo Provera, you may be experiencing a blood loss with this gastrointestinal bleeding and don't know it. Be sure your physician keeps an eye on red blood counts (RBC) as well as HGB and HCT levels". You should not start any treatment for hot flushes unless you have first discussed it with your doctor.
  15. Paul Edwards

    ADT affects the brain

    Cognitive impairment can occur in cancer patients who are treated with a variety of therapies, including radiation therapy, hormone therapy, and chemotherapy. After chemotherapy treatment it is commonly called "chemo brain." Signs of cognitive impairment include forgetfulness, inability to concentrate, problems recalling information, trouble multi-tasking and becoming slower at processing information. The number of people who experience cognitive problems following cancer therapy is broad, with an estimated range of 15 to 70 percent. There have been several studies analyzing this side effect in breast cancer patients, but few have investigated cognitive impairment following androgen deprivation therapy (ADT) for men being treated prostate cancer. A new Moffitt Cancer Center study indicated that men who are on ADT have greater odds of experiencing impaired cognitive function. In this study, researchers used formal tests to compare the cognitive ability of 58 prostate cancer patients on ADT to 84 prostate cancer patients not on ADT, and to 88 men without cancer. The researchers also reported for the first time a possible genetic link among those individuals who experience cognitive impairment whilst on ADT. They found that patients who have a particular version of a gene called GNB3 were 14 times more likely to suffer from cognitive problems on ADT. The researchers suggested that doctors: before starting ADT, should discuss the risk of changes in cognitive functioning with their patients; and after starting ADT, should also ask their patients if they suffered cognitive impairment with a view to referring them for assessment and treatment as needed. I wrote to one of the researchers and asked what treatment was available for prostate cancer patients on ADT who suffered cognitive impairment as a side effect. This was his reply: “Unfortunately little research has been done on ways to improve cancer treatment-related cognitive impairment. But some recent studies have suggested that "brain training" may improve cognitive function...and [there is] some preliminary evidence suggesting benefits to cancer survivors who had cognitive impairment. There are also medications that could be helpful, such as stimulants (e.g., methylphenidate, modafinil). It is also recommended that other issues that could contribute to cognitive decline be adequately addressed. For example, depression or sleep problems could easily worsen cognitive functioning and are usually treatable. Exercise has also been shown to be very important for cognitive function. I would recommend first addressing the issue with your oncologist or perhaps requesting a referral to a neuropsychologist or another provider who may be able to make recommendations tailored to your situation.” Brian D. Gonzalez et al Course and Predictors of Cognitive Function in Patients with Prostate Cancer Receiving Androgen-Deprivation Therapy: A Controlled Comparison http://jco.ascopubs.org/cgi/doi/10.1200/JCO.2014.60.1963
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