Reprise: Things That Puzzle Me About PCa # 14 in an unlimited series

[Guest guest]

Some time last year I posted a piece (which you can

read on my site at http://www.yananow.org/Puzzle14.htm

) in this, and other Forums. I was hoping to get some good discussions going on

the potential for ADT (Androgen Deprivation Therapy) to be used in appropriate

cases of early stage prostate cancer as part of a strategy of managing what is

often an indolent disease. Predictably most of the responses were to the effect

that ADT had too many potential side effects – mainly related to thrombosis

and heart failure. Many of the studies quoted were small and over a short

period, possibly because most of the studies were of older, very ill men who

had advanced prostate cancer and androgen independent prostate cancer. There

are, naturally, other studies that demonstrate less potential hazards, but none

of the studies were of young men with early stage disease.

It is interesting therefore to see Dr Labrie’s

contribution in the September issue of Choices – the publication published

by PAACT (Patient Advocts For Advance Cancer Treatment) which is available at http://www.paactusa.org/index_files/Page2406.htm

.. He says in his introduction:

<snip> The main objective of physicians managing

patients suffering from any type of cancer is to permanently free them from the

disease. It is thus a major progress to see that androgen blockade is now

increasingly recognized as curative, conditional to its use in localized (when

it is curable) instead of advanced and metastatic (when it has become

non-curable) disease. This news is particularly timely since more than 95% of

patients can now be diagnosed by simple PSA (prostatic-specific antigen)

screening and can thus be treated at the localized and only potentially curable

stage ……. <snip>

I’m was not aware that there was ANY recognition that ADT

(Androgen Deprivation Therapy) could ever be curative, let alone an increasing recognition

of this. Dr Labrie goes on to expand on this point:

<SNIP> Application to localized prostate cancer

of conclusions derived from advanced disease and which do not apply to

localized disease. As well indicated by Professors Akaza and Namiki ….the

erroneous belief of a temporary efficacy of androgen blockade due to the

relatively rapid development of resistance to treatment is a characteristic

typical and limited to advanced and metastatic disease. There have never been

valid reasons to apply to localized prostate cancer these observations of

resistance to treatment which exclusively belong to advanced disease. In fact,

contrary to the situation in metastatic prostate cancer, a continous and very

longterm positive response with the high probability of a cure is observed in

localized disease ……when optimal androgen blockade or CAB is used.

This possibility of cure is however conditional to the start of CAB

sufficiently early at time of diagnosis …..The conclusion that androgen

blockade can be curative and does not simply delay progression has been reached

in many studies including a meta-analysis of the controlled clinical trials

performed as adjuvant hormonal treatment in non-metastatic prostate cancer

(Fleshner, Keane et al. 2007). The author of this metanalysis concluded that

androgen blockade given as adjuvant to surgery or radiotherapy should be

classified as a treatment of curative intent for patients with poor prognosis

nonmetastatic prostate cancer. It should be mentioned that such positive

results could even be observed using a non-optimal androgen blockade, namely

monotherapy, while much better results are achieved with CAB without additional

negative effects. <SNIP>

Of course this results in my being more puzzled than

ever before. Could Dr Labrie with all his knowledge be as wrong as me?

All the best

Prostate men need enlightening, not frightening

Terry Herbert

- diagnosed in 1996 and still going strong

Read A Strange Place for unbiased information at http://www.yananow.org/StrangePlace/index.html