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Pre-Treatment Concerns

Charles (Chuck) Maack

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Pre-Treatment Concerns


Before any treatment is considered, it is extremely important the physician determine from the patient any other health issues that patient may be experiencing or has experienced other than that for which current treatment is being planned.  A variety of blood and other tests should be considered to hopefully alert the physician to any health issues the patient may be experiencing but unaware.  Prescribing drugs or treatment without due diligence could have harmful results for the patient.  This is important and the patient, as well, should be certain to provide the physician a listing of any other health issues as well as medications prescribed for those other health issues.


The following are just a meager sampling of what the physician and patient should be concerned as regards treatment for prostate cancer.  The side effects of many drugs are so vast that both physicians and patients should take the important time to research, study, and be aware of any medications prescribed.  Important to the patient is being made aware so not surprised when side effects are experienced.


Lupron or any agonist/antagonist: Before testosterone reducing drugs (Androgen Deprivation Therapy/ADT) are prescribed/administered, it is important to be aware if the patient has or is experiencing any cardiovascular issues since if so, the physician prescribing the medication should first contact and discuss the patient’s issues with the patient’s Cardiologist.  These medications can cause a variety of side effects and the patient should be forewarned so not surprised when occurring.  Most side effects can be remedied.


Casodex/bicalutamide, Eulexin/flutamide, Nilandron/nilutamide: These drugs can cause breast enlargement, so the patient should be forewarned and consider radiation to the breast area or prescribing Arimidex (anastrozole) or Aromasin (exemestane) prior to proceeding to prevent this issue.  The patient should be made aware that, like the agonists and antagonist mentioned above, these medications can also cause hot flashes, sexual disfunction, and overtime loss of bone density.  Since these medications can be toxic to the liver, it is important the physician is made aware if any liver issues are present.


Avodart/dutasteride or Proscar/finasteride: Before the 5Alpha Reductase (5AR) inhibitor dutasteride/Avodart or finasteride/Proscar is prescribed it is important to be aware if the patient has or is experiencing any liver issues since, if so, these drugs should not be prescribed. Like antiandrogens, these medications can cause decreased libido, erectile dysfunction, and decreased ejaculate.  The effects are usually mild and can improve over time.


Zytiga/abiraterone: how many are aware of the percentage of deaths that have occurred with the administration of Zytiga/abiraterone to patients with already present cardiovascular disease (CVD)?  How many even pre-determine if the patient is experiencing CVD? How many patients even reveal or know that they have CVD? Yet, the prescribing of Zytiga is common-place when metastasized castrate-resistant prostate cancer (mCRPC) is evident and recent studies have only now brought attention to this important concern. (“Compared with the 15.8% crude 6-month post-abiraterone mortality rate for those with no CVD, the rate was higher for each of the pre-existing CVD categories the researchers assessed: ischemic heart disease (21.4%), stroke (22.1%), congestive heart failure (23.4%), atrial fibrillation (24.4%), and acute myocardial infarction (25.6%). https://tinyurl.com/y2b7cwc5 - https://tinyurl.com/y5vqof75


Xtandi/enzalutamide: this antiandrogen recently prescribed often has a large variety of side effects.  In looking up this medication, side effects can include back pain, joint aches, musculoskeletal pain. Diarrhea. Hot flashes. Peripheral edema (swelling in your hand, arms, legs, or feet). Low white blood cell count. Headache. Upper respiratory tract infection. Dizziness. Thus, important the patient is made aware of what he may experience.


Sipuleucel-T/Provenge: If central venous catheter use can be avoided, perhaps complications such as line infections can be decreased. In addition, patients at high risk for thromboembolic events or with multiple risk factors for cerebrovascular or myocardial events may not be ideal candidates for Sipuleucel-T.


Blood Thinners: If prescribed a blood thinner such as warfarin, Eliquis, or similar, it is important to avoid adding aspirin or Vitamin E or certain herbal supplements that also are blood thinning products.  If surgery is scheduled, your surgeon should be made aware of these products so the appropriate time to stop their use is determined prior to that surgery.


So much important information every patient should be aware, but more often are not.

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Hi Chuck,

What a great article. As someone who has experienced CVD - possibly because insufficient thought was given to my situation prior to a new treatment being prescribed, I am very conscious of the need to repeatedly draw this matter to the attention of other patients.

Side effects and compatibility with existing medications is something every patient needs to discuss with their medico each and every time their medication is added to or changed.

My own experience is:- if I don’t initiate the discussion regarding these matters - they are not always discussed.



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