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When treatment stops working, blame resistance


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Jim Marshall (not a doctor) said ...

Paul can't post this from where he is now, so he asked me to post it for him.


This article is a great summary of treatment options, but contains (in very large print) a true, but misleading statement about evidence of when to start ADT with rising PSA.


One doctor advises:

"Long-term continuous ADT should not be started until you have actual, visible metastases" 


"There is no scientific proof showing a benefit to starting it just because you have a rising PSA."

This last statement is misleading because it does not give the complete picture because:

There is also no scientific proof showing there is NOT a benefit to starting it just because you have a rising PSA.[Jim, not a doctor]


In the words of a recent key study:

In summary, our study provides evidence on the when to start ADT question. In the absence of randomized trial results, our findings suggest that starting ADT at PSA relapse does not have a major impact on overall survival compared with deferred ADT initiation at disease progression. (Garcia-Albeniz, 2015)


In other words, there is no clear evidence either way. So, one doctor may recommend early ADT, another later ADT.


Your doctor's decision will be based on a number of factors about your situation, but the two factors that have been shown to have the greatest effect on your outlook are Gleason score and PSA doubling time (the time it takes your PSA to double). Higher Gleason score, and lower doubling time often indicate a more aggressive cancer, which may affect your doctor's advice to you.


... end Jim


You can find the article here:


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My personal attitude to delay commencement of ADT was based on earlier evidence that there was no hurry to do so. My PSA had been rising slowly for several years but got a hurry on last year.  A PET scan (for another reason) showed recurrence in the prostate but not elsewhere. This fact was shown 4 years ago at TURP.

ADT was commenced for bleeding.That ceased after one week.

i am into my exercise program with a vengeance to avoid weakness and bone density loss.

Bruce (once a radiation oncologist)

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Well the TOAD study published in June 2016,  (http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(16)00107-8/abstract) suggests that there is a benefit to starting ADT as soon as possible (after recurrence).


Specifically "Immediate receipt of androgen-deprivation therapy significantly improved overall survival compared with delayed intervention in men with PSA-relapsed or non-curable prostate cancer. The results provide benchmark evidence of survival rates and morbidity to discuss with men when considering their treatment options."


I am aware that some Oncologists are not yet convinced.

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As a member of the Advanced Group, I am sorry to hear Paul is in hospital.

Paul’s contribution to the Forums over the years has been magnificent. I am confident Paul would have touched more members than he realises.

May you have a speedy recovery, Paul, to better health than you are experiencing at the moment.  

Thank you for your absolute dedication to men with prostate cancer.  

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Heartily agree!

Paul has made an amazing contribution to the peace of mind of many men with prostate cancer, and those who care for them.

And the story continues, even from his hospital bed!



We all look forward to the day (hopefully shortly) when you rejoin us.

Thanks, mate.



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I'm very grateful for all the support & encouragement that I 've received . Sharing the journey makes it easier.

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Hi Paul,

Hope things are improving and if not home yet you will be shortly.

Thanks very much for your active participation and support to members. It is much appreciated contribution such as yours helps greatly in making the APC forum a success.

Keep smiling.



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