More on ADT

Seniors May Increase Risk of Heart Disease from Prostate Cancer Treatment

Longer they received ADT, the sooner they were likely to die

Feb. 26, 2007 - One of the most common treatments for prostate cancer -
androgen deprivation therapy - may increase the risk of death from heart
disease in senior citizens over age 65, according to a new study by
researchers at Dana-Farber Cancer Institute, Brigham and Women's Hospital
and other institutions.

Although the findings need to be confirmed in clinical trials, the study
authors state that oncologists should weigh the benefits of androgen
deprivation therapy, or ADT, against the risk of heart problems in older
prostate cancer patients. The study results were based on data from CaPSURE,
a national registry of men with prostate cancer.

The researchers presented their study at the Prostate Cancer Symposium in
Orlando, Fla., on Saturday. The symposium is sponsored by the American
Society of Clinical Oncology, the American Society for Therapeutic Radiology
and Oncology and the Society of Urologic Oncology.

The goal of ADT is to block the level of circulating androgens (male
hormones), which can fuel the growth of prostate cancers. "Androgen
deprivation therapy is associated with elevated body mass index, increased
body fat deposits and diabetes, all of which raise the risk of death from
heart diseased," explains the study's lead author, Henry Tsai, MD, a
resident physician at Dana-Farber, Brigham and Women's and the Harvard
Radiation Oncology Program.

"Although our findings demonstrated that older men receiving this treatment
may be at increased risk, even after taking into account other
cardiovascular risk factors, a prospective clinical trial would be needed to
confirm a cause-and-effect relationship."

Drawing on the CaPSURE database, Tsai and his colleagues compared the number
of cardiac-related deaths among 735 men with localized prostate cancer who
received ADT and among 2,901 men with the disease whose treatment did not
include ADT.

After factoring in other known risks for cardiovascular disease (such as
diabetes, hypertension, body mass index and smoking), researchers found that
the longer patients received ADT, the sooner they were likely to die from
heart disease. When the researchers analyzed the data by patients' age, the
link between ADT use and death from heart disease was significant in
patients over age 65, but not in those under 65. After five years, 3 percent
of older men who received androgen deprivation therapy died of cardiac
causes, compared with only 0.9 percent of men who did not receive the
therapy.

"These findings should help oncologists determine which older patients are
the best candidates for ADT," Tsai remarks. "If a patient is at high risk of
cardiovascular disease, it would be advisable for an oncologist to discuss
the pros and cons of ADT treatment with him before proceeding on a course of
treatment."

Editor's Notes:

Co-authors of the study include Anthony D'Amico, MD, PhD, of Dana-Farber and
Brigham and Women's, Ming-Hui Chen, PhD, of the University of Connecticut,
and Natalia Sadetsky, MD, MPH, and Peter R. Carroll, MD, both of the
University of California, San Francisco.

The CaPSURE database is a research collaboration between TAP Pharmaceutical
Products, Inc., and the University California, San Francisco, Department of
Urology. The study was funded in part by the CaPSURE Scholars Program in
Prostate Cancer Outcomes Research.

Dana-Farber Cancer Institute (www.danafarber.org) is a principal teaching
affiliate of the Harvard Medical School and is among the leading cancer
research and care centers in the United States. It is a founding member of
the Dana-Farber/Harvard Cancer Center (DF/HCC), designated a comprehensive
cancer center by the National Cancer Institute.

Brigham and Women's Hospital is a 747-bed nonprofit teaching affiliate of
Harvard Medical School and a founding member of Partners HealthCare System,
an integrated health care delivery network. BWH is committed to excellence
in patient care with expertise in virtually every specialty of medicine and
surgery. The BWH medical preeminence dates back to 1832 and today that rich
history in clinical care is coupled with its national leadership in quality
improvement and patient safety initiatives, dedication to educating and
training health care professionals, and strength in biomedical research.
With $370M in funding and more than 500 research scientists, BWH is an
acclaimed leader in clinical, basic and epidemiological investigation -
including the landmark Nurses Health Study, Physicians Health Studies, and
the Women's Health Initiative. For more information about BWH, please visit:
www.brighamandwomens.org.

Tom Cular wrote:
> Seniors May Increase Risk of Heart Disease from Prostate Cancer Treatment
>
> Longer they received ADT, the sooner they were likely to die

I'll be very curious to see how much that impact would increase when
researchers add the deaths accelerated by other ADT-induced or
-exacerbated SEs such as diabetes, stroke, osteoporosis, depression,
chronic sleep deprivation, etc.

I.P.

On February 27, Tom Cular posted:

> Seniors May Increase Risk of Heart Disease from Prostate Cancer
> Treatment
>
> Longer they received ADT, the sooner they were likely to die

(snip)

Before looking upwards for the falling sky, it would be well to re-read
the following from this report:

> "Although our findings demonstrated that older men receiving this
> treatment may be at increased risk, even after taking into account
> other cardiovascular risk factors, a prospective clinical trial would
> be needed to confirm a cause-and-effect relationship."

Regards,

Steve J

"Digressions, objections, delight in mockery, carefree mistrust are
signs of health; everything unconditional belongs in pathology."
--Friedrich Nietzsche

Further to my earlier post on this topic.

Tom Cular wrote:

> Seniors May Increase Risk of Heart Disease from Prostate Cancer Treatment
>
> Longer they received ADT, the sooner they were likely to die

I believe that it is always best to seek out the source of these press
releases.

The abstract is entitled, "Androgen deprivation therapy for prostate
cancer and the risk of cardiac mortality."
.........and is to be found on the ASCO site at: http://tinyurl.com/32vg7d

A heads-up at worst. The hypothesis is unproven.

The conclusion of the abstract: "A longer duration of ADT for the
treatment of prostate cancer was significantly associated with a
modestly increased risk of cardiac death in men over age 65. These
results support the association of ADT use and cardiac mortality, but
proof of cause and effect requires prospective validation."

Regards,

Steve J

"The thing is to expect nothing in particular, but (to) be aware of the lack
of enforceable guarantees or enforceable contracts with
nature/god/entropy as to the condition or durability of our bodies."
-- Brian Brunner, PCa survivor, December 12, 2005 on The Prostate
Problems Mailing List
Thank you, Brian.

Steve,
I agree that this is but one very small study completed by a small group
of research folks based upon a rather small group of subjects. The folks who
presented the opinion seem to have decent credentials and I believe they are
worth listening to (not necessarily taking what they have to say as gospel).
Anecdotally; I did not have any "noticeable" cardiac issues until I had been
on Lupron for about a year; obviously there were issues prior to ADT, but
I'm convinced that ADT exacerbated them.

Tom


"Steve Jordan" <mycroftscj1@cox.net> wrote in message
news:wy%Eh.51354$iE2.774@newsfe10.phx...
> Further to my earlier post on this topic.
>
> Tom Cular wrote:
>
>> Seniors May Increase Risk of Heart Disease from Prostate Cancer Treatment
>>
>> Longer they received ADT, the sooner they were likely to die
>
> I believe that it is always best to seek out the source of these press
> releases.
>
> The abstract is entitled, "Androgen deprivation therapy for prostate
> cancer and the risk of cardiac mortality."
> ........and is to be found on the ASCO site at: http://tinyurl.com/32vg7d
>
> A heads-up at worst. The hypothesis is unproven.
>
> The conclusion of the abstract: "A longer duration of ADT for the
> treatment of prostate cancer was significantly associated with a modestly
> increased risk of cardiac death in men over age 65. These results support
> the association of ADT use and cardiac mortality, but proof of cause and
> effect requires prospective validation."
>
> Regards,
>
> Steve J
>
> "The thing is to expect nothing in particular, but (to) be aware of the
> lack
> of enforceable guarantees or enforceable contracts with
> nature/god/entropy as to the condition or durability of our bodies."
> -- Brian Brunner, PCa survivor, December 12, 2005 on The Prostate Problems
> Mailing List
> Thank you, Brian.

On Feb 27, 8:00 pm, "Tom Cular" <tho...@verizon.net> wrote:
> Steve,
> I agree that this is but one very small study completed by a small group
> of research folks based upon a rather small group of subjects. The folks who
> presented the opinion seem to have decent credentials and I believe they are
> worth listening to (not necessarily taking what they have to say as gospel).
> Anecdotally; I did not have any "noticeable" cardiac issues until I had been
> on Lupron for about a year; obviously there were issues prior to ADT, but
> I'm convinced that ADT exacerbated them.
>

I'm sure it's a problem. After 5 months on Lupron, I clocked a
fasting blood sugar of 300 (A1c of 11) and 800 Triglycerides.
Previously my fasting sugar was in the 120-130 range and my
Triglycerides were normal.

6 months after going off Lupron my Triglycerides were normal again and
my fasting blood sugar (on one 850 glucophage/day) was below 120. It
wobbles around but I am hoping that if I get a little more weight off
and amp up my exercise, I can drop the glucophage.

With those sugars and Triglycerides pounding the liver, heart, etc,
something else is bound to fail.

-kh Before they give you Lupron, get a full blood chemistry and
another a few months after the shot. Compare the results.

Tom Cular wrote:
> I did not have any "noticeable" cardiac issues until I had been
> on Lupron for about a year; obviously there were issues prior to ADT, but
> I'm convinced that ADT exacerbated them.

It comes as no surprise, given ADT's frequent significant impacts on
such heart threats as cholesterol, triglycerides, blood sugar, blood
pressure, sleep, and depression, according to . . . ahem . . . Strum.

I.P.

On February 27, Mike Freely wrote:

Quoting Tom Cular:

>> I did not have any "noticeable" cardiac issues until I had been on
>> Lupron for about a year; obviously there were issues prior to ADT, but
>> I'm convinced that ADT exacerbated them.

Mikey mooed:

> It comes as no surprise, given ADT's frequent significant impacts on
> such heart threats as cholesterol, triglycerides, blood sugar, blood
> pressure, sleep, and depression, according to . . . ahem . . . Strum.

As usual, Mike Freely carefully omits mentioning the various things that
can be done to alleviate such SEs as a particular patient might
experience. They are laid out by...ahem...Strum.

My source is http://www.prostate-cancer.org/educa...Strum_ADS.html

What's his?

Not a surprise; he would then be giving a full report. Such would be
adverse to his position that ADT is awful awful and his decision to
decline the tx is validated. Can't have that, dontcha know. That's what
it's all about: validating his choices.

Meanwhile, he misleads the new folks.

Ho.

Also Hum.

Regards,

Steve J

"His simple word is worthless; and to embellish it with his oath would
merely make it picturesque, not valuable."
--Mark Twain

On Feb 27, 10:47 pm, Steve Jordan <mycrofts...@cox.net> wrote:

>
> Meanwhile, he misleads the new folks.
>
> Ho.
>
> Also Hum.

As I'm in this thread, I should clarify my point. Lupron is powerful
stuff.

The good news is that it drove my PSA to undetectable levels. The bad
news is that it ran my fasting blood sugar to 300 and Triglycerides to
800. I had other side effects, joint pain, dizziness, all well
documented.

My doc's didn't prep me for it. A full-up blood panel before the shot
as a baseline and regular full-up panels would have caught my problems
early.

I may have to go back on Lupron. If so, I will do so reluctantly but
with a better understanding of the side effects. I will ask for a
full blood panel and if my insurance won't cover it, I'll pay for it
myself.

If any chemistry goes berzerk, I'll be at the docs and we'll work out
a solution.

The problem is that those numbers 300 and 800 aren't just numbers,
they are vitals, those chemistries slam your organs and if allowed to
persist, cause cascading failures.

As long as the docs are watching the chemistries, then you and they
can make an educated trade-off. "We'll go with the Lupron for 12
months and manage the sugars or whatever by other means."

As for the joint pain, hot flashes, those are a nit compared to a 300
fasting blood sugar.

-kh

kh wrote:

> If any chemistry goes berzerk, I'll be at the docs and we'll work out
> a solution.

I chuckled when at first I presumed "be at" had an accidental space in it.

>
> The problem is that those numbers 300 and 800 aren't just numbers,
> they are vitals, those chemistries slam your organs and if allowed to
> persist, cause cascading failures.
>
> As long as the docs are watching the chemistries, then you and they
> can make an educated trade-off. "We'll go with the Lupron for 12
> months and manage the sugars or whatever by other means."
>
> As for the joint pain, hot flashes, those are a nit compared to a 300
> fasting blood sugar.

Your docs should have been all over your blood sugar from Day One,
because they were forewarned by your pre-ADT warning level of 115.

I.P.

On Feb 28, 12:30 pm, "I.P. Freely" <fuhgheddabou...@noway.nohow>
wrote:
> kh wrote:
> > If any chemistry goes berzerk, I'll be at the docs and we'll work out
> > a solution.
>
> I chuckled when at first I presumed "be at" had an accidental space in it.
>

That is funny!!!! For many situations, I am tempted by violence and
direct solutions. I don't give in to those thoughts though.

> Your docs should have been all over your blood sugar from Day One,
> because they were forewarned by your pre-ADT warning level of 115.

pre-Lupron, my primary care doc was starting to explore diabetes
treatment. The first step was a recommendation that I lose 30
pounds.

The Lupron-sugar connection was not understood by any of the docs.
The Uro who gave me the shot, the rad-doc who laid out the treatment,
nor my primary care doc who pulled out his PDR when I asked about
Lupron and sugar.

I keep harping about this because I explicitly asked all three about
the connection and they didn't think there was one. I also asked the
two nurse-educators at the Diabetes school and they did not think
there was a Lupron-sugar connection.

-kh

kh wrote:

> I keep harping about this because I explicitly asked all three about
> the connection and they didn't think there was one. I also asked the
> two nurse-educators at the Diabetes school and they did not think
> there was a Lupron-sugar connection.

I'd demand these people cite the data they believe opposes the field of
oncology. I'd also ask them if they've heard of such modern inventions
as computers, the Internet, the PDR, patient information sheets, or
books. I'd also find different doctors. Let me guess . . . they're VA docs.

I.P.