Johns Hopkins on ADT

Excerpts from their February “Health After 50” Medical Letter:

Testosterone deprivation causes impotence, osteoporosis, and heart
disease. Recent ADT cardiovascular studies have made doctors rethink who
should pursue ADT. Without careful monitoring and preventive care, men >
65 on ADT for six months are at increased risk of heart attack.

ADT bone loss will occur, especially during the first year. Get your BMD
baseline measured before starting ADT, take 1-1.5 gms of calcium with
Vit D daily, and perform strength training exercises to *reduce* bone
loss. The extra threat of ADT probably overrides the increasingly strong
and broad concerns about biphosponates such as Fosamax and its numerous
problems such as brittle new bone layup.

ADT initiates and/or enhances Type 2 diabetes or prediabetes within
three months. This in turn increases risks of heart disease, vision
loss, nerve damage, and maybe tumor growth. Obtain blood sugar and lipid
profiles before beginning ADT and keep them up.

Estrogen or progesterone work best to combat hot flashes, but should be
reserved for severe cases of hot flashes.

Libido and sexual function usually return within a year, especially in
younger pts, after ceasing ADT. This can be mitigated by IADT, and is
recommended for some pts with rapidly rising PSA but no mets. IADT may
be as effective as continuous ADT, pending further research.

Few men on such drugs as Lupron and Zoladex experience gynaecomastia,
but men on antiandrogens such as Casodex frequently experience it
significantly.

ADT coincides with a peridontal disease risk increase from 4% to 80%.
Get frequent, careful, focused dental care if on ADT. [Maybe that
partially explains the increased CVD risk.]

Anemia is common among men on ADT.

One recent study shows that the ADT Syndrome, common w/ADT and including
fatigue, depression, and trouble concentrating, may not result directly
from ADT, but rather from T suppression, advanced age, advanced cancer,
and/or psychological impacts].

Wives experience emotional impacts similar to and often stronger than
their husbands on ADT … a good incentive to involve wives in our support
programs.

I.P.

On January 30, Señor "Freely" wrote:

> Excerpts from their February “Health After 50” Medical Letter:
>
> Testosterone deprivation causes impotence, osteoporosis, and heart
> disease. Recent ADT cardiovascular studies have made doctors rethink who
> should pursue ADT. Without careful monitoring and preventive care, men >
> 65 on ADT for six months are at increased risk of heart attack.

Other than a perhaps overly-broad argument that the declaration that ADT
*causes* this or that SE without explaining that an individual's
experience would not necessarily include each and every SE, and also
failing to note that there are means available to mitigate such SEs that
an individual might experience, and that if all else fails the patient
can simply stop ADT, and, lastly, that the SEs of the alternatives might
also be unacceptable -- I can't argue with JH.

Here's an example of those anecdotes I criticize: I began my struggle
almost five years ago with a dx of extensive Gleason 9 on the R plus a
smaller Gleason 8 on the L, relatively low PSA of 5.7 ng/mL. The primary
reason I"m still here to rant & rave & annoy Señor "Freely" is that I
had adjuvant ADT for > a year. Yes, I experienced some SEs. But they
were worth the results.

Which include the fact that I am able occasionally to be of service to
my brothers and sisters in adversity.

Regards,

Steve J

"Often, the surest way to convey misinformation is to tell the strict
truth."
--Mark Twain

"I.P. Freely" <fuhgheddaboutit@noway.nohow> wrote in message
news:en7oj.40$az7.28@newsfe07.lga...
> Excerpts from their February “Health After 50” Medical Letter:
>
> Testosterone deprivation causes impotence, osteoporosis, and heart
> disease. Recent ADT cardiovascular studies have made doctors rethink who
> should pursue ADT. Without careful monitoring and preventive care, men >
> 65 on ADT for six months are at increased risk of heart attack.
.... etc,,,

> Wives experience emotional impacts similar to and often stronger than
> their husbands on ADT … a good incentive to involve wives in our support
> programs.
>
> I.P.

I can't deny that some of us experience some of theses effects but nobody
experiences them all (not that you asserted that they do).

I am reminded of one of the funniest TV commercials I have seen. It is
about investing in a pharmaceutical company, "Gene Enterprises" and it goes
like this:

"Gene Enterprises harnessed the power of the human gene, but there are a few
side effects. Aside from "Not appropriate for women," which appears in text
as the woman in the commercial dances around a field, there's "itchy rashes,
full body hair loss, projectile vomiting, gigantic eyeball, the condition
known as 'hot-dog fingers', children born with the head of a golden
retriever, seeing the dead, bone liquefaction, possession by the Prince of
Darkness, tail growth, elderly pregnancy,"

I don't mean to trivialize the discussion. ADT does indeed have some
unpleasant and potentially harmful side effects but it can kick the crap out
of PCa at least for a time. My PSA went from 1.6 to undetectable on Lupron
and I'm prepared to suck it up and pay the price in side effects.

On Jan 30, 6:12 pm, "I.P. Freely" <fuhgheddabou...@noway.nohow> wrote:
> Excerpts from their February "Health After 50" Medical Letter:
>
> Testosterone deprivation causes impotence, osteoporosis, and heart
> disease. Recent ADT cardiovascular studies have made doctors rethink who
> should pursue ADT. Without careful monitoring and preventive care, men >
> 65 on ADT for six months are at increased risk of heart attack.
>
> ADT bone loss will occur, especially during the first year. Get your BMD
> baseline measured before starting ADT, take 1-1.5 gms of calcium with
> Vit D daily, and perform strength training exercises to *reduce* bone
> loss. The extra threat of ADT probably overrides the increasingly strong
> and broad concerns about biphosponates such as Fosamax and its numerous
> problems such as brittle new bone layup.
>
> ADT initiates and/or enhances Type 2 diabetes or prediabetes within
> three months. This in turn increases risks of heart disease, vision
> loss, nerve damage, and maybe tumor growth. Obtain blood sugar and lipid
> profiles before beginning ADT and keep them up.
>
> Estrogen or progesterone work best to combat hot flashes, but should be
> reserved for severe cases of hot flashes.
>
> Libido and sexual function usually return within a year, especially in
> younger pts, after ceasing ADT. This can be mitigated by IADT, and is
> recommended for some pts with rapidly rising PSA but no mets. IADT may
> be as effective as continuous ADT, pending further research.
>
> Few men on such drugs as Lupron and Zoladex experience gynaecomastia,
> but men on antiandrogens such as Casodex frequently experience it
> significantly.
>
> ADT coincides with a peridontal disease risk increase from 4% to 80%.
> Get frequent, careful, focused dental care if on ADT. [Maybe that
> partially explains the increased CVD risk.]
>
> Anemia is common among men on ADT.
>
> One recent study shows that the ADT Syndrome, common w/ADT and including
> fatigue, depression, and trouble concentrating, may not result directly
> from ADT, but rather from T suppression, advanced age, advanced cancer,
> and/or psychological impacts].
>
> Wives experience emotional impacts similar to and often stronger than
> their husbands on ADT ... a good incentive to involve wives in our support
> programs.
>
> I.P.

Can't wait to start but beats the alternative.

On Jan 30, 7:43 pm, DominicM <dmarr...@gmail.com> wrote:
>
> Can't wait to start but beats the alternative.

Dominic,

Since all of the animal studies ever published (all one of them)
demonstrate that intermittent ADT followed by high levels of T plus
low levels of DHT is about 5 times more effective than continual ADT
(and may be even more effective than that in men, according to Dr.
Leibowitz's web site, but his work has yet to be published), it is
hard to justify the statement that "it beats the alternative".

Ed Friedman

On Jan 30, 9:20 pm, e...@math.uchicago.edu wrote:
> ...
> Since all of the animal studies ever published (all one of them)
> demonstrate that intermittent ADT followed by high levels of T plus
> low levels of DHT is about 5 times more effective than continual ADT
> (and may be even more effective than that in men, according to Dr.
> Leibowitz's web site, but his work has yet to be published), it is
> hard to justify the statement that "it beats the alternative".
>
> Ed Friedman

Ed,

Do you have any idea why Dr. Leibowitz has not published
his findings?

Thanks.

Alan

Joe Price wrote:
> ADT does indeed have some
> unpleasant and potentially harmful side effects but it can kick the crap out
> of PCa at least for a time. My PSA went from 1.6 to undetectable on Lupron
> and I'm prepared to suck it up and pay the price in side effects.

Well, at least ADT kicks the crap out of *PSA*. What it does to our
*cancer* is highly individual.

I.P.

DominicM wrote:

> Can't wait to start but beats the alternative.

The alternative is no ADT. Which beats which depends on its intended
effect on our cancer, its unintended effects on our bodies and minds,
and our criteria.

I.P.

On Jan 30, 9:20*pm, e...@math.uchicago.edu wrote:
> On Jan 30, 7:43 pm, DominicM <dmarr...@gmail.com> wrote:
>
>
>
> > Can't wait to start but beats the alternative.
>
> Dominic,
>
> Since all of the animal studies ever published (all one of them)
> demonstrate that intermittent ADT followed by high levels of T plus
> low levels of DHT is about 5 times more effective than continual ADT
> (and may be even more effective than that in men, according to Dr.
> Leibowitz's web site, but his work has yet to be published), it is
> hard to justify the statement that "it beats the alternative".
>
> Ed Friedman

Thanks Ed . When I got my second opinion at Hopkins they weren't big
on intermittant nor were they big advocates of a complete blockade
however I am likely to go into a clinical study that I'll get
a blockade and possibly chemo. Unless I decide not to do the study.
Stay tuned.

On Jan 31, 5:11*pm, "I.P. Freely" <fuhgheddabou...@noway.nohow> wrote:
> DominicM wrote:
> > Can't wait to start but beats the alternative.
>
> The alternative is no ADT. Which beats which depends on its intended
> effect on our cancer, its unintended effects on our bodies and minds,
> and our criteria.
>
> I.P.

If I understand Dominic's meaning, then there are other alternatives
such as estrogen...ron

On Jan 31, 3:04 pm, Alan Meyer <amey...@yahoo.com> wrote:
>
> Ed,
>
> Do you have any idea why Dr. Leibowitz has not published
> his findings?
>
> Thanks.
>
> Alan

Alan,

I don't know for sure, but one of the problems is that Dr. Leibowitz
will never do a double-blind study, i.e., deny any of his patients
what he considers the optimum treatment. Another problem is that he
hasn't been doing it enough years to determine the long-term effect.
Also, using T under any circumstances for treating PC is considered
taboo, and many doctors refuse to believe Dr. Leibowitz's results.
This makes it less likely that he can get his work published in a peer
reviewed journal. Let me pass on to you an observation about Dr.
Leibowitz's findings from a PC "expert" which Ralph V was kind enough
to pass on to me.

"My personal bias is that massive testosterone doses not have much to
do with the well-known fact that men with prostate cancer can have
long remissions after induction testosterone blockade with or without
chemotherapy. Based on our study published in the Journal of
Urology, higher testosterone tends to cause shorter, not longer
remissions. Remember, Bob treats hundreds of patients. The fact that
a mere 8 of them have had exceptionally long remissions only tells us
that prostate cancer is a heterogenous condition and that a variety
of outcomes can be expected."

Obviously, I disagree with this "expert", and if you examine the PSA
doubling times of all of the patients' case histories I'm pretty sure
that barring a sharp rise in PSAD, there is no chance that any of his
patients that he listed as being treated with high T/low DHT are in
danger of dying before the age of 100.

Ed

Hi Ed,

Dr. Derek Raghavan of Taussig Cancer Institute at the Cleveland Clinic is
suggesting a treatment regime for my brother that has similar numbers as
Dominic, of taking a bicalutamide initially and nothing more if his immune
system can keep his psa under 30 n/ml. Should his psa exceed 30 n/ml then
he would add LHRH agonist. He states that this regime is not common for
most urologist and oncologist.

Have you heard of anyone else trying this protocol and know if they had
any success?

Ron S.

--
Message posted using http://www.talkaboutsupport.com/grou...ncer.prostate/
More information at http://www.talkaboutsupport.com/faq.html

On Feb 1, 6:07 am, "ronju99" <jlsp...@nospam.verizon.net> wrote:
> Hi Ed,
>
> Dr. Derek Raghavan of Taussig Cancer Institute at the Cleveland Clinic is
> suggesting a treatment regime for my brother that has similar numbers as
> Dominic, of taking a bicalutamide initially and nothing more if his immune
> system can keep his psa under 30 n/ml. Should his psa exceed 30 n/ml then
> he would add LHRH agonist. He states that this regime is not common for
> most urologist and oncologist.
>
> Have you heard of anyone else trying this protocol and know if they had
> any success?
>
> Ron S.
>

Ron,

A recent article in Nature Clinical Practice Urology 3:408-409, 2006
concluded "Adjuvant bicalutamide provided no benefit to patients with
localized prostate cancer, but improved PFS in patients with locally
advanced disease, and appeared to increase overall survival in select
patients.". Reading the article, the only patients that had improved
survival with bicalutamide were those receiving radiotherapy for
locally advanced disease.

As I've said before, the animal studies show that by far the best
treatment for PCa is intermittent ADT followed by high T/low DHT.
Doctors stick with continual ADT because that is what others do and
what guarantees no malpractice suits. If nobody had ever done
continual ADT in humans and doctors had to decide from scratch using
the scientific information available today which treatment was better
- continual ADT or intermittent ADT followed by high T/low DHT, it is
hard to believe that any hospital ethics committee would permit humans
to undergo continual ADT, since the only animal study done to date
demonstrates that continual ADT is ~5 times worse than the high T/low
DHT protocol.

Ed Friedman

Who is the PC expert you have quoted?

<ed@math.uchicago.edu> wrote in message
news:fc0207ff-fc01-4dfb-8a76-54be80e0a77f@i3g2000hsf.googlegroups.com...
> On Jan 31, 3:04 pm, Alan Meyer <amey...@yahoo.com> wrote:
>>
>> Ed,
>>
>> Do you have any idea why Dr. Leibowitz has not published
>> his findings?
>>
>> Thanks.
>>
>> Alan
>
> Alan,
>
> I don't know for sure, but one of the problems is that Dr. Leibowitz
> will never do a double-blind study, i.e., deny any of his patients
> what he considers the optimum treatment. Another problem is that he
> hasn't been doing it enough years to determine the long-term effect.
> Also, using T under any circumstances for treating PC is considered
> taboo, and many doctors refuse to believe Dr. Leibowitz's results.
> This makes it less likely that he can get his work published in a peer
> reviewed journal. Let me pass on to you an observation about Dr.
> Leibowitz's findings from a PC "expert" which Ralph V was kind enough
> to pass on to me.
>
> "My personal bias is that massive testosterone doses not have much to
> do with the well-known fact that men with prostate cancer can have
> long remissions after induction testosterone blockade with or without
> chemotherapy. Based on our study published in the Journal of
> Urology, higher testosterone tends to cause shorter, not longer
> remissions. Remember, Bob treats hundreds of patients. The fact that
> a mere 8 of them have had exceptionally long remissions only tells us
> that prostate cancer is a heterogenous condition and that a variety
> of outcomes can be expected."
>
> Obviously, I disagree with this "expert", and if you examine the PSA
> doubling times of all of the patients' case histories I'm pretty sure
> that barring a sharp rise in PSAD, there is no chance that any of his
> patients that he listed as being treated with high T/low DHT are in
> danger of dying before the age of 100.
>
> Ed

ed@math.uchicago.edu wrote:
> On Jan 31, 3:04 pm, Alan Meyer <amey...@yahoo.com> wrote:
>> Ed,
>>
>> Do you have any idea why Dr. Leibowitz has not published
>> his findings?
>>
>> Thanks.
>>
>> Alan
>
> Alan,
>
> I don't know for sure, but one of the problems is that Dr. Leibowitz
> will never do a double-blind study, i.e., deny any of his patients
> what he considers the optimum treatment.

Wouldn't he accomplish greater good if he bit the bullet, conducted a
study anyway, and convinced the oncology world of the validity of his
technique?

I.P.

On Feb 2, 10:55 am, "Bert" <BertXav...@yahoo.com> wrote:
> Who is the PC expert you have quoted?
>

Bert,

I have no idea. Ralph was the one who contacted the experts and he
passed the comments along to me with no mention of the names of the
doctors who responded.

Ed Friedman

On Feb 2, 12:53 pm, "I.P. Freely" <fuhgheddabou...@noway.nohow> wrote:
>
> Wouldn't he accomplish greater good if he bit the bullet, conducted a
> study anyway, and convinced the oncology world of the validity of his
> technique?
>
> I.P.

I.P.

I agree with you, but such things are beyond my ability to control.
Also, I seriously doubt that any study he did would convince the
oncology world of anything. Medicine is notoriously slow to change.
The most recent example of it taking 15 years for doctors to
acknowledge that ulcers were caused by bacteria, even though the data
was irrefutable as of day 1 illustrates that point. When you consider
that doctors are brainwashed in medical school to demonize T with
regards to PCa, it would probably take quite a few decades to change
their minds.

Another thing that would be great is if animal researchers followed up
on the study showing that intermittent ADT followed by high T/low DHT
was ~5 times better than continual ADT. Considering the study was
done at Northwestern University (not a rinky dink school by any
means), there is no excuse for the blindness being shown by the rest
of the researchers throughout the world. It is almost as if they
really don't care how many people die unnecessarily from prostate
cancer. In the mean time, many of them waste their time searching for
a drug to get FDA approval by prolonging the lives of doomed men by a
few months. If I were a cynic, I'd say that personal profit trumps
scientific advances in today's world.

Ed Friedman

ed@math.uchicago.edu wrote:
> If I were a cynic, I'd say that personal profit trumps
> scientific advances in today's world.

Cynic ... or realist?

I don't generally pay much attention to unproven remedies, but I will
keep asking my oncs about, and following, Bob's and your work because
a) My PC will probably return.
b) SRT is well under 15% likely to help me.
c) I'd need proof of several ADT facts relevant to my own case to
subject myself to ADT.
d) The other new imminent fixes such as immunology are at least 3-5
years away.

I.P.

On Jan 30, 9:20*pm, e...@math.uchicago.edu wrote:
> On Jan 30, 7:43 pm, DominicM <dmarr...@gmail.com> wrote:
>
>
>
> > Can't wait to start but beats the alternative.
>
> Dominic,
>
> Since all of the animal studies ever published (all one of them)
> demonstrate that intermittent ADT followed by high levels of T plus
> low levels of DHT is about 5 times more effective than continual ADT
> (and may be even more effective than that in men, according to Dr.
> Leibowitz's web site, but his work has yet to be published), it is
> hard to justify the statement that "it beats the alternative".
>
> Ed Friedman

Let me clarify what I meant (sorry for not doing sooner). Regardless
of potential SE's whether antiandrogen approach or complete blockade
or intermittant etc there will be SE's unless I get lucky.
At the age of 51, not pursuing therapy with a doubling time of about
3mo's is not acceptable alternative for me. I'll suck it up with the
risk of potential SE's to hopefully arrest my PSA and lower my risk of
metastatic disease.

I'll find out in two weeks whether I enter a chemo and blockade arm of
trial or just the blockade. Wish me luck as I battle on.

DominicM wrote:
> I'll suck it up with the risk of potential SE's

ADT needn't be a "risk", in the sense of an unknown. You can always back
out if the SEs you experience are intolerable and untreatable. That
option not only reduces your risk (of unknowns) but also gives you some
control over them, even if you choose not to stop the ADT. You're young
enough that your T should recover if you stop the ADT for whatever reason.


> to hopefully arrest my PSA and lower my risk of metastatic disease.

ADT doesn't lower the risk of mets. It just delays it for an unknown
period by suppressing the androgen-dependent portion of your cancer --
and your PSA -- while the androgen-independent portion marches on under
the cover of suppressed PSA.

> Wish me luck as I battle on.

Your key word is "battle". It's all we can do, and each pt defines his
own battle priorities and plan. Yours sound fine to me.

I.P.