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My thoughts on my ADT side effects - Russ


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Following a recent post in this forum, Paul Edwards and I had a discussion about the side effects of androgen deprivation therapy. He suggested that I should do a post about it.  So here is a small part of my 14 year journey of metastatic PC..


Original diagnosis  JAN 2000  PSA 39 ng/dl


 I did intermittent ADT from 2000 till 2006 with great success life style wise.


I would wait till PSA rose to 20 ng/dl before recommencing ADT, till the lowest reading plateaued.  Initially 10 Months, then time frame reduced each cycle by approx 2-4 weeks. 


2006/7 Had to add 150 mg Bicalutamide in conjunction with Intravenous Zometa 3 weekly till 2008 then 4 weekly till 2010 when my unbelievable Oncologist passed away.  What a great loss to so many!  The younger Medicos did not agree with continuous use of IV Bisphosphonates.


Clinical Practises around the world had found by experience, that Bone pain was reduced and cancer growth was slowed dramatically, though no trials had been carried out to substantiate , (As long as you're aware of, and maintain, Jaw and Teeth health, to minimise any potential Osteonecrosis of the Jaw).  This is what I call" Individual Patient " care.


In my own heart I believe the cessation of Bisphosphonates was the cause of my accelerated bone deteriation, 


Spinal Stenosis attacked (Dec. 2011) and left me in Pain like I had never experienced in all my life, from walking to flat on the back, in three days, seems I was but one step from a paraplegic.


[spinal stenosis is a narrowing of spaces in the spine that results in pressure on the spinal cord and/or nerve roots,  Symptoms include  pain, numbness and loss of motor control.]


Which was saved with Spinal Laminectomy surgery carried out in time.


May 2013 induced to use Chemical poisoning, Taxadere plus Prednisone, "to TRY and KILL SOME Cancer CELLS" (Medical Dr's Language) Oct 2013 ceased use because of poor results and physical health deterioration. 


Next step, Abiraterone Acetate. ZYTIGA commenced end Oct 2013. Had to cease that  Dec.2013 when Liver readings blew off the planet. Blood readings have improved marginally but fluid build up in body still a problem.


2014- Beast within is on the run again. Seems lumbar region above previous surgery is repeating original experience.  Don't wish to travel that route again, but to be able continue seems pain will force a decision to submit once more to an experience not desired.


Will reconsider in June, reuse of Zytiga, at a low rate at commencement.


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I would like to add my paper on the subject of ADT Side Effects for those interested:'


ADT SIDE EFFECTS* http://tinyurl.com/3p9pl3p

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Russ's story highlights the importance of Bone Integrity.


Androgen deprivation therapy causes impaired bone integrity. 


It is well established that men receiving ADT for their prostate cancer have an increased risk of fracture.  Further, within the first 5 years of therapy 20% of men will sustain a fracture.  Shahinian VB, Kuo YF, Freeman JL, Goodwin JS. Risk of fracture after androgen deprivation for prostate cancer. N Engl J Med 2005; 352: 154--164


Doctors need to institute an effective program for skeletal health for any patient on ADT.  This should include monitoring bone density annually.


I’ve found the chapter on Bone Integrity in Dr Stephen Strum’s ebook “Prostate Cancer. Essential Concepts for Survival” very useful.


As Russ mentions, Osteonecrosis of the Jaw is a potential risk when using bisphosphonates.  A dental check should always be carried out before starting on bisphosphonates.


Given recent studies that long term use of bisphosphonates may have adverse effects, I can understand why the young medicos that Russ mentions might feel a tad nervous.  It's been suggested that long-term bisphosphonate use may result in over-suppression of bone turnover which results in atypical fractures as micro-cracks in the bone are unable to heal.

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According to a paper presented to this year's American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium "Prevalent of Fractures among men with stage IV prostate cancer" J Clin Oncol 32, 2014 (suppl 4), in a study of nearly 10,000 men, 92% of them did not receive bone density testing at any time post diagnosis despite the fact that 67% of the men received ADT.


I wonder whether the position in Australia is similar? 



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