Re: Side Effects from ADT....was.... PSA is down

[Guest guest]

Terry .. What about your "ticker" ? I thought it was giving you problems according to a previous missive. Are you saying ADT does not make it worse or that you are managing the problem medically ? Sam.1. J Natl Cancer Inst. 2010 Jan 6;102(1):39-46. Epub 2009 Dec 7.Diabetes and cardiovascular disease during androgen deprivation therapy:observational study of veterans with prostate cancer.Keating NL, O'Malley AJ, Freedland SJ, MR.Division of General Internal Medicine, Department of Medicine, Brigham andWomen's Hospital, Boston, MA, USA. keating@...Comment in: J Natl Cancer Inst. 2010 Jan 6;102(1):4-5.BACKGROUND: Previous studies indicate that androgen deprivation therapy forprostate cancer is associated with diabetes and cardiovascular disease amongolder men. We evaluated the relationship between androgen deprivation therapy andincident diabetes and cardiovascular disease in men of all ages with prostatecancer. METHODS: We conducted an observational study of 37,443 population-basedmen who were diagnosed with local or regional prostate cancer in the VeteransHealthcare Administration from January 1, 2001, through December 31, 2004, withfollow-up through December 31, 2005. proportional hazards models were used toassess whether androgen deprivation therapy with gonadotropin-releasing hormone(GnRH) agonists, oral antiandrogens, the combination of the two (ie, combinedandrogen blockade), or orchiectomy was associated with diabetes, coronary heartdisease, myocardial infarction, sudden cardiac death, or stroke, after adjustmentfor patient and tumor characteristics. All statistical tests were two-sided.RESULTS: Overall, 14,597 (39%) of the 37,443 patients were treated with androgen deprivation therapy. Treatment with GnRH agonists was associated withstatistically significantly increased risks of incident diabetes (for GnRHagonist therapy, 159.4 events per 1000 person-years vs 87.5 events for noandrogen deprivation therapy, difference = 71.9, 95% confidence interval [CI] =71.6 to 72.2; adjusted hazard ratio [aHR] = 1.28, 95% CI = 1.19 to 1.38),incident coronary heart disease (aHR = 1.19, 95% CI = 1.10 to 1.28), myocardialinfarction (12.8 events per 1000 person-years for GnRH agonist therapy vs 7.3 forno androgen deprivation therapy, difference = 5.5, 95% CI = 5.4 to 5.6; aHR =1.28, 95% CI = 1.08 to 1.52), sudden cardiac death (aHR = 1.35, 95% CI = 1.18 to 1.54), and stroke (aHR = 1.22, 95% CI = 1.10 to 1.36). Combined androgen blockadewas statistically significantly associated with an increased risk of incidentcoronary heart disease (aHR = 1.27, 95% CI = 1.05 to 1.53), and orchiectomy wasassociated with coronary heart disease (aHR = 1.40, 95% CI = 1.04 to 1.87) andmyocardial infarction (aHR = 2.11, 95% CI = 1.27 to 3.50). Oral antiandrogenmonotherapy was not associated with any outcome studied. CONCLUSION: Androgendeprivation therapy with GnRH agonists was associated with an increased risk ofdiabetes and cardiovascular disease.PMID: 19996060 [PubMed - indexed for MEDLINE] >> Sammy says:> > > > <snip>... when I see in the thread below a problem with side effects from> treatment, I don't think it is right to say it is "no problem". It is a BIG> problem as long as you are taking the Zoladex / Lupron ....I know has> said he does not suffer from "SEs of ADT", but how many men are like him ?> How about a "hands up" ?<snip> > > > > I am on my second round of Zoladex - I had no serious side effects the first> time round and there are none so far on this round.> > > > All the best> > Terry Herbert > > in Melbourne Australia > > Diagnosed '96: Age 54: Stage T2b: PSA 7.2: Gleason 7: No treatment. Jun '07> PSA 42.0 - Bony Metastasis:Started ADT Aug '07: May '08 - stopped ADT. May> '10 PSA 8.20 : Recommenced ADT> > My site is at www.prostatecancerwatchfulwaiting.co.za > > It is a tragedy of the world that no one knows what he doesn't know, and the> less a man knows, the more sure he is that he knows everything. Joyce> Carey> > > > _____ > > From: ProstateCancerSupport > [mailto:ProstateCancerSupport ] On Behalf Of sammy_bates> Sent: Saturday, 7 August 2010 9:09 AM> To: ProstateCancerSupport > Subject: Re: PSA is down> > > > > > > Steve,> > Sorry I have to contradict you here when you say ..> > > (1) There is no need to suffer the SEs of ADT (aka "hormones").> > The fact is that as long as you are on ADT / "hormones" / "TIP" as the links> put it (I call it "castration therapy") you are going to experience "SEs of> ADT" as you put it. [ i.e. side effects of androgen deprivation therapy --> Sorry for all the acronyms to anyone here for the first time.] > > Anyhow, to continue .. This is what I read several times on the PCRI site> where your links point:-> > "Unfortunately there is no way to prevent or treat this problem. [ i.e. "SEs> of ADT"] However, once testosterone deprivation therapy is completed and> testosterone levels return to normal .. "> > So, when I see in the thread below a problem with side effects from> treatment, I don't think it is right to say it is "no problem". It is a BIG> problem as long as you are taking the Zoladex / Lupron, and one that will> always be with many men as long as this damned castration therapy is the> mainstream medical treatment of choice. I have great sympathy for the guy in> the thread (Ralph I think) who let his PSA go up to 1800+ because he just> hated being on castration therapy. > > I know has said he does not suffer from "SEs of ADT", but how many men> are like him ? How about a "hands up" ? I am not for sure. "SEs of ADT" have> always been an issue for me, and indeed have driven me to seek alternative> ways of managing my PC. I too have allowed my PSA to go higher than maybe it> should have in the past. There are other guys who do testosterone with more> success - but anyhow, I am still around after 15 years. The pity is not> many men give testosterone a try, and not many of those who do, effectively> communicate what they are doing.> > Sam.>

[Guest guest]

Sammy,

In my recent researches on Zoladex and Finasteride, I've read that both have been proven to protect against heart attacks... I haven't memorised the research papers, but I was quite happy to find that it was so!

To: ProstateCancerSupport Sent: Saturday, 7 August, 2010 9:30:17Subject: Re: Side Effects from ADT....was.... PSA is down

Terry .. What about your "ticker" ? I thought it was giving you problems according to a previous missive. Are you saying ADT does not make it worse or that you are managing the problem medically ? Sam.1. J Natl Cancer Inst. 2010 Jan 6;102(1):39- 46. Epub 2009 Dec 7.Diabetes and cardiovascular disease during androgen deprivation therapy:observational study of veterans with prostate cancer.Keating NL, O'Malley AJ, Freedland SJ, MR.Division of General Internal Medicine, Department of Medicine, Brigham andWomen's Hospital, Boston, MA, USA. keatinghcp (DOT) med.harvard. eduComment in: J Natl Cancer Inst. 2010 Jan 6;102(1):4-5.BACKGROUND: Previous studies indicate that androgen deprivation therapy forprostate cancer is associated with diabetes and cardiovascular disease amongolder men. We evaluated the relationship between androgen deprivation therapy andincident

diabetes and cardiovascular disease in men of all ages with prostatecancer. METHODS: We conducted an observational study of 37,443 population-basedmen who were diagnosed with local or regional prostate cancer in the VeteransHealthcare Administration from January 1, 2001, through December 31, 2004, withfollow-up through December 31, 2005. proportional hazards models were used toassess whether androgen deprivation therapy with gonadotropin- releasing hormone(GnRH) agonists, oral antiandrogens, the combination of the two (ie, combinedandrogen blockade), or orchiectomy was associated with diabetes, coronary heartdisease, myocardial infarction, sudden cardiac death, or stroke, after adjustmentfor patient and tumor characteristics. All statistical tests were two-sided.RESULTS: Overall, 14,597 (39%) of the 37,443 patients were treated with androgen deprivation therapy. Treatment with GnRH agonists was associated

withstatistically significantly increased risks of incident diabetes (for GnRHagonist therapy, 159.4 events per 1000 person-years vs 87.5 events for noandrogen deprivation therapy, difference = 71.9, 95% confidence interval [CI] =71.6 to 72.2; adjusted hazard ratio [aHR] = 1.28, 95% CI = 1.19 to 1.38),incident coronary heart disease (aHR = 1.19, 95% CI = 1.10 to 1.28), myocardialinfarction (12.8 events per 1000 person-years for GnRH agonist therapy vs 7.3 forno androgen deprivation therapy, difference = 5.5, 95% CI = 5.4 to 5.6; aHR =1.28, 95% CI = 1.08 to 1.52), sudden cardiac death (aHR = 1.35, 95% CI = 1.18 to 1.54), and stroke (aHR = 1.22, 95% CI = 1.10 to 1.36). Combined androgen blockadewas statistically significantly associated with an increased risk of incidentcoronary heart disease (aHR = 1.27, 95% CI = 1.05 to 1.53), and orchiectomy wasassociated with coronary heart disease (aHR = 1.40, 95% CI =

1.04 to 1.87) andmyocardial infarction (aHR = 2.11, 95% CI = 1.27 to 3.50). Oral antiandrogenmonotherapy was not associated with any outcome studied. CONCLUSION: Androgendeprivation therapy with GnRH agonists was associated with an increased risk ofdiabetes and cardiovascular disease.PMID: 19996060 [PubMed - indexed for MEDLINE] >> Sammy says:> > > > <snip>... when I see in the thread below a problem with side effects from> treatment, I don't think it is right to say it is "no problem". It is a BIG> problem as long as you are taking the Zoladex / Lupron ....I know has> said he does not suffer from "SEs of ADT", but how many men are like him ?> How about a "hands up" ?<snip> > > > > I am on my

second round of Zoladex - I had no serious side effects the first> time round and there are none so far on this round.> > > > All the best> > Terry Herbert > > in Melbourne Australia > > Diagnosed '96: Age 54: Stage T2b: PSA 7.2: Gleason 7: No treatment. Jun '07> PSA 42.0 - Bony Metastasis:Started ADT Aug '07: May '08 - stopped ADT. May> '10 PSA 8.20 : Recommenced ADT> > My site is at www.prostatecancerw atchfulwaiting. co.za > > It is a tragedy of the world that no one knows what he doesn't know, and the> less a man knows, the more sure he is that he knows everything. Joyce> Carey> > > > _____ > > From: ProstateCancerSuppo rtyahoogroups (DOT) com> [mailto:ProstateCan cerSupport@ yahoogroups. com] On Behalf Of sammy_bates> Sent: Saturday, 7 August 2010 9:09 AM> To:

ProstateCancerSuppo rtyahoogroups (DOT) com> Subject: [ProstateCancerSupp ort] Re: PSA is down> > > > > > > Steve,> > Sorry I have to contradict you here when you say ..> > > (1) There is no need to suffer the SEs of ADT (aka "hormones").> > The fact is that as long as you are on ADT / "hormones" / "TIP" as the links> put it (I call it "castration therapy") you are going to experience "SEs of> ADT" as you put it. [ i.e. side effects of androgen deprivation therapy --> Sorry for all the acronyms to anyone here for the first time.] > > Anyhow, to continue .. This is what I read several times on the PCRI site> where your links point:-> > "Unfortunately there is no way to prevent or treat this problem. [ i.e. "SEs> of ADT"] However, once testosterone deprivation therapy is completed and>

testosterone levels return to normal .. "> > So, when I see in the thread below a problem with side effects from> treatment, I don't think it is right to say it is "no problem". It is a BIG> problem as long as you are taking the Zoladex / Lupron, and one that will> always be with many men as long as this damned castration therapy is the> mainstream medical treatment of choice. I have great sympathy for the guy in> the thread (Ralph I think) who let his PSA go up to 1800+ because he just> hated being on castration therapy. > > I know has said he does not suffer from "SEs of ADT", but how many men> are like him ? How about a "hands up" ? I am not for sure. "SEs of ADT" have> always been an issue for me, and indeed have driven me to seek alternative> ways of managing my PC. I too have allowed my PSA to go higher than maybe it> should have in the past.

There are other guys who do testosterone with more> success - but anyhow, I am still around after 15 years. The pity is not> many men give testosterone a try, and not many of those who do, effectively> communicate what they are doing.> > Sam.>

[Guest guest]

Terry,Good to hear yout ticker is doing well. You are on the right track with 'ADT lite' but even there it signals problems ahead for some men(1), and they do not have to be particularly old - actually, 'correlation is demonstrated' - six months ADT is all that is needed to show an increase in MI incidents(2). Sam.1. BJU Int. 2010 Mar 4. [Epub ahead of print]Androgen-suppression therapy for prostate cancer and the risk of death in menwith a history of myocardial infarction or stroke. JH, Chen MH, Moran BJ, Braccioforte MH, Dosoretz DE, Salenius S, Katin MJ, Ross R, Choueiri TK, D'Amico AV.Dana-Farber Cancer Institute, Boston, MA, USA.Study Type - Prognosis (inception cohort) Level of Evidence 1b OBJECTIVE Toexamine the effect of short-course androgen-suppression therapy (AST) beforebrachytherapy on all-cause mortality (ACM) rates, stratified by the presence orabsence of a history of myocardial infarction (MI) or stroke. AST is used toreduce prostate size to enable men with favourable-risk prostate cancer toundergo brachytherapy, but no disease-specific benefit has been reported for thispractice, and AST use has been associated with an increased risk of ACM in somemen with pre-existing cardiovascular disease. PATIENTS AND METHODS The studycomprised 12 792 men with favourable-risk disease, i.e. a prostate-specificantigen (PSA) level of <20 ng/mL, Gleason score </=7 and clinical category</=T2c, treated between 1991 and 2007 at community-based medical centres withbrachytherapy +/- neoadjuvant AST. Multivariable regression analysis was usedto assess whether there were significant associations between AST use in men witha history of MI or stroke and the risk of ACM, adjusting for age, treatment year,and known prognostic factors of prostate cancer. RESULTS After a median(interquartile range) follow-up of 3.8 (2.0-5.9) years there were 1557 deaths.The risk of ACM was lower in men with no history of MI or stroke than in thosewith this history, whether AST was used (adjusted hazard ratio 0.79, 95%confidence interval 0.67-0.92; P= 0.003) or not (0.74, 0.65-0.85; P < 0.001).However, men with a history of MI or stroke treated with AST had a greater riskof ACM than those not treated with AST (1.2, 1.05-1.38; P= 0.008). CONCLUSION Theuse of short-course AST in men with a history of MI or stroke is associated with a greater risk of ACM in men with favourable-risk prostate cancer.PMID: 20230380 [PubMed - as supplied by publisher]2. J Clin Oncol. 2007 Jun 10;25(17):2420-5.Influence of androgen suppression therapy for prostate cancer on the frequencyand timing of fatal myocardial infarctions.D'Amico AV, Denham JW, Crook J, Chen MH, Goldhaber SZ, Lamb DS, ph D, Tai KH,Malone S, Ludgate C, Steigler A, Kantoff PW.Departments of Radiation Oncology and Medicine, Cardiovascular Division, Brigham and Women's Hospital and Lank Center for Genitourinary Oncology, Dana-FarberCancer Institute, Boston, MA 02215, USA. adamico@...Comment in: J Clin Oncol. 2007 Nov 20;25(33):5325-6; author reply 5326. Nat Clin Pract Urol. 2008 Apr;5(4):184-5.PURPOSE: We evaluated whether the timing of fatal myocardial infarction (MI) was influenced by the administration of androgen suppression therapy (AST). PATIENTS AND METHODS: The study cohort comprised 1,372 men who were enrolled onto threerandomized trials between February 1995 and June 2001. In the three trials, themen were randomly assigned to receive radiation therapy with 0 versus 3 versus 6,3 versus 8, or 0 versus 6 months of AST. Fine and Gray's regression was used todetermine the clinical factors associated with the time to fatal MI, andestimates of time to fatal MI were calculated using a cumulative incidencemethod. When comparing the cumulative incidence estimates using Gray's k-sample Pvalues, increased weight was ascribed to the earlier data because recovery oftestosterone is expected for most men within 2 years after short-course AST.RESULTS: Men age 65 years or older who received 6 months of AST experiencedshorter times to fatal MIs compared with men in this age group who did notreceive AST (P = .017) and men younger than 65 years (P = .016). No significantdifference (P = .97) was observed in the time to fatal MIs in men age 65 years orolder who received 6 to 8 months of AST compared with 3 months of AST.CONCLUSION: The use of AST is associated with earlier onset of fatal MIs in menage 65 years or older who are treated for 6 months compared with men who are not treated with AST.PMID: 17557956 [PubMed - indexed for MEDLINE]> >> > Sammy says:> > > > > > > > <snip>... when I see in the thread below a problem with side effects from> > treatment, I don't think it is right to say it is "no problem". It is a> BIG> > problem as long as you are taking the Zoladex / Lupron ....I know > has> > said he does not suffer from "SEs of ADT", but how many men are like him ?> > How about a "hands up" ?<snip> > > > > > > > > I am on my second round of Zoladex - I had no serious side effects the> first> > time round and there are none so far on this round.> > > > > > > > All the best> > > > Terry Herbe rt > > > > in Melbourne Australia > > > > Diagnosed '96: Age 54: Stage T2b: PSA 7.2: Gleason 7: No treatment. Jun> '07> > PSA 42.0 - Bony Metastasis:Started ADT Aug '07: May '08 - stopped ADT. May> > '10 PSA 8.20 : Recommenced ADT> > > > My site is at www.prostatecancerwatchfulwaiting.co.za > > > > It is a tragedy of the world that no one knows what he doesn't know, and> the> > less a man knows, the more sure he is that he knows everything. Joyce> > Carey> > > > > > > > _____ > > > > From: ProstateCancerSupport > > [mailto:ProstateCancerSupport ] On Behalf Of sammy_bates> > Sent: Saturday, 7 August 2010 9:09 AM> > To: ProstateCancerSupport > > Subject: Re: PSA is down> > > > > > > > > > > > > > Steve,> > > > Sorry I have to contradict you here when you say ..> > > > > (1) There is no need to suffer the SEs of ADT (aka "hormones").> > > > The fact is that as long as you are on ADT / "hormones" / "TIP" as the> links> > put it (I call it "castration therapy") you are going to experience "SEs> of> > ADT" as you put it. [ i.e. side effects of androgen deprivation therapy --> > Sorry for all the acronyms to anyone here for the first time.] > > > > Anyhow, to continue .. This is what I read several times on the PCRI site> > where your links point:-> > > > "Unfortunately there is no way to prevent or treat this problem. [ i.e.> "SEs> > of ADT"] However, once testosterone deprivation therapy is completed and> > testosterone levels return to normal .. "> > > > So, when I see in the thread below a problem with side effects from> > treatment, I don't think it is right to say it is "no problem". It is a> BIG> > problem as long as you are taking the Zoladex / Lup ron, and one that will> > always be with many men as long as this damned castration therapy is the> > mainstream medical treatment of choice. I have great sympathy for the guy> in> > the thread (Ralph I think) who let his PSA go up to 1800+ because he just> > hated being on castration therapy. > > > > I know has said he does not suffer from "SEs of ADT", but how many> men> > are like him ? How about a "hands up" ? I am not for sure. "SEs of ADT"> have> > always been an issue for me, and indeed have driven me to seek alternative> > ways of managing my PC. I too have allowed my PSA to go higher than maybe> it> > should have in the past. There are other guys who do testosterone with> more> > success - but anyhow, I am still around after 15 years. The pity is not> > many men give testosterone a try, and not many of those who do,> effectively> > communicate what they are doing.> > > > Sam.> >>