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pauldhodson

Testosterone therapy

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pauldhodson

Hi Guys, I have recently had a Zolodex implant. My current Oncologist is very conservative and each time I discuss something controversial, such as Testosterone therapy, Bi-polar Androgen Therapy, weekly low-dose chemo (as opposed to high dose three-weekly infusions) she [is not enthusiastic [moderator]].

 

I live in Perth, does anyone know of an [ ] Oncologist in Perth, who [may be more enthusiastic[mod]] about new treatment options?

 

Cheers

Paul

Edited by Admin
Moderation of comments about doctor.

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JimJimJimJim

It is not quite accurate to call these new treatment options.

Bi-polar androgen therapy (video coming shortly) is experimental at this stage.

Weekly chemo vs three-weekly chemo has been shown to be less effective when chemo is needed. I wonder if you are referring to treatments offered by a fairly well-known doctor who had not published his results, where chemo and testosterone are offered at points for which there is no evidence of effectivenesss yet?

 

I can't say anything about your doctor's attitude, but if you want to have treatments that have been shown to be effective, the three you mention are not there yet.

Jim

 

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Paul

I had hormone implants on 2 occasions ( the 3 month version ) when my PSA started rising after Radical Prostatectomy surgery ( Da Vincci ) 

This treatment in my case was used to starve the cancer with a follow up of a seven week x 5 days per week of radio therapy 

Happily I am now cancer free

 

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Gary Thomas

Hi Paul,

One of the members of advanced prostate group in Perth sees medical oncologist, Dr Simon Troon at Hollywood Hospital. He has found that he is easy to talk to and a good communicator.

Margaret Amm and the group are interested in your progress.

 

Regards,

Gary Thomas

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pauldhodson

Hi Gary, I have a referral for Simon Troon. I tried to get in to see him earlier this year, but his secretary told me he was up to capacity and not seeing any new patients. I'll give him another go Gary, thanks. I have been meaning to get back to the Advanced PCa support group, but it's a busy life I lead!

Cheers

Paul

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pauldhodson

Hi Jim, Thanks for your comments. I appreciate that these treatments are experimental, I am prepared to try unproven things, I just need an Oncologist who does too.

 

Also Jim, if you mean Dr Bob Leibowitz, then yes, that's where I'm getting some of my info. He describes very good patient outcomes, but I agree, he hasn't published much actual evidence.

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Clive

Dear Jim,

 

I have a question about hormone therapy.

I know that testosterone feeds prostate enlargement as well as prostate cancer. Over a number of years I have had increasing waterworks problems due to prostate enlargement. A very recent CT scan (to evaluate my cancer) showed the prostate to be 50.5mm long and over the last month the waterworks problems became intolerable. A couple of months ago I was put on minipress to shrink the prostate but even under under the small initial dose it considerably lowered my heart rate with disastrous results. (I collapsed and went unconscious.) So, when I was first diagnosed with metastatic cancer by the urologist I also asked him about surgery for my enlarged prostate and was told that the cancer was more urgent. Even so he told me to think hard about starting cancer treatment as I would have no quality of life and if it were him he would prefer a quick death! 

On advice from the prostate nurse I changed to an excellent oncologist to manage my prostate cancer and last week started hormone treatment - Degarelix (Firmagon). (Today I was also offered a place in his research program - but there is always the chance I could just be given a placebo). 

My question is will the hormone treatment prescribed to address prostrate cancer also reduce my prostate size? I don't know if its just a temporary variation but my waterworks problems seem to be already less since the treatment started.

I also don't yet seem to have any hormone therapy side effects (apart from injection site pain for a few days) in spite of the very large size (240mg) of the initial dose - or do the side effects come later? 

 

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JimJimJimJim

Clive

I am not a doctor. Get your advice from your doctor.

Perhaps the following two articles may help you on prostate cancer size and LUTS (Lower Urinary Tract Symptoms, 'waterworks problems'.

 

On ADT side effects onset I can't find any literature, but several members have told us of almost instant symptoms. There are long term side effects as well (on bones and other organs) which won't be visible to you.

Hope this helps.

 

Jim

 

Doctors do report reduced size of prostate on ADT

J Urol. 2002 Jun;167(6):2443-7.

Prostate volume reduction with androgen deprivation therapy before interstitial brachytherapy.

Kucway R1, Vicini F, Huang R, Stromberg J, Gonzalez J, Martinez A.

Author information

Abstract

PURPOSE:

We assessed the degree of prostate downsizing using androgen deprivation, and determined its relation to clinical and pathological variables.

MATERIALS AND METHODS:

From June 1994 to January 2000, 107 patients with prostate cancer received androgen deprivation before interstitial brachytherapy at our hospital. All charts were reviewed for clinical, pathological and treatment related variables. Prostate volume was measured using transrectal ultrasound. All variables were analyzed with regard to the degree of prostate downsizing.

RESULTS:

Mean percent volume reduction of the prostate was 33% after a 3.7-month average duration of androgen deprivation. Larger prostate volume before androgen deprivation and longer deprivation duration statistically correlated with mean percent volume reduction. Simple linear and multiple regression analyses revealed that these 2 variables remained significant predictors of percent volume reduction. Subgroup analysis indicated that a significant difference was seen in patients who received androgen deprivation with luteinizing hormone releasing hormone agonists alone versus those who received treatment with total androgen blockade (luteinizing hormone releasing hormone agonists plus antiandrogens 30% versus 35%, p = 0.04), and when prostate volume before androgen deprivation was less than 50 cc versus larger volumes (30% versus 35%, p = 0.01). Of patients with an initial prostate volume of greater than 50 cc 82% achieved a volume of less than 50 cc after androgen deprivation therapy.

CONCLUSIONS:

Androgen deprivation therapy before brachytherapy is a method of downsizing the prostate to overcome anatomical limitations, including larger gland volume and pubic arch interference.

PMID: 11992054

 

 

Doctors do find ADT helps with LUTS (waterworks problems)

The Influence of Androgen Deprivation Therapy on Prostate Size and Voiding Symptoms in Prostate Cancer Patients in Korea.

Choi H1, Chung H2, Park JY1, Lee JG1, Bae JH1.

Author information

Abstract

PURPOSE:

The goal of this study is to investigate the effects of androgen deprivation therapy (ADT) on total prostate volume and lower urinary tract symptoms (LUTS).

METHODS:

Between January 2007 and June 2014, 110 patients who received androgen deprivation treatment were enrolled in this retrospective study. Clinical parameters and urodynamic parameters along with changes at follow-up were analyzed. Factors such as reduction in prostate volume, changes in LUTS, and prostate volume tertiles were compared 1 year after ADT.

RESULTS:

After ADT, the total International Prostate Symptom Score (IPSS) score decreased from 17.45 to 12.21 and the IPSS voiding subscore decreased from 9.16 to 6.24. Maximal uroflow rate increased from 8.62 to 11.50 mL/sec and residual urine also reduced significantly by 29.34 mL. Change in prostate size was more prominent (-51.14%) in the patients with less than 1 year of ADT (n=21) than those who had more than 1 year of treatment (n=89, -44.12%). The decrease in the IPSS voiding subscore was greater within 1 year of ADT than after 1 year of treatment (-4.10 vs. -2.65). The differences were more significant in the 30-50 g group (n=59) and >50 g group (n=11) than the <30 g group (n=40) of the IPSS voiding subscore improvement (-3.76 , -4.91 vs. -2.10), and maximal uroflow rate improvement (2.78, 2.90 vs 1.49).

CONCLUSION:

ADT resulted in statistically significant clinical improvement in terms of prostate volume, urodynamic parameters, and LUTS for patients with prostate cancer when analyzed by ADT duration and prostate volume.

KEYWORDS:

Androgen Deprivation Therapy; Prostate Neoplasms; Prostate Volume

PMID: 28043112 

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