ADT - Hormone Therapy was........ Running out of ideas

[Guest guest]

The point that Aubrey was trying to make

in his reference to ADT (Androgen Deprivation Therapy) and high Gleason Grade

tumours is simply that the higher the Grade, the greater the chance is that the

disease is out of the prostate gland and is systemic or even metastasized. (These

terms are not synonymous and there are no agreed definitions of them. By way of

analogy, a systemic disease might be compared to a garden where the seeds of

weeds are lying dormant : a metastasized disease would be where the weeds have

taken root and are growing)

If the disease is systemic or metastasized

then a commonly held view is that there is no point in attacking the disease at

one point – the prostate gland – but that it should be attacked

systemically – by ADT (Androgen Deprivation Therapy) initially.

So, as Dr Strum says, in his paper

Strategy for Success ( http://prostate-cancer.org/education/riskases/Strum_StrategyOfSuccess1.html

) it is vital to try to get the greatest understanding possible of the nature

and state of the disease before deciding on treatment. One of the many tools

(most of which, regrettably are not used by doctors or men diagnosed with prostate

cancer) is the Partin Tables which can be found at http://urology.jhu.edu/prostate/partintables.php

.. As you will see if you go there, you can enter the basic details of

your diagnosis and get an indication of the probability of the disease being

contained. So, if we look at a man with a T1c diagnosis, a PSA under 10 ng/ml

and Gleason Score of 8 we get this snapshot:

Probability of

Disease being organ

confined: 51% ( Range 41% -59%)

Extraprostatic extension: 34% (Range 26% - 42%)

Seminal Vesicle Invasion: 12% (8% - 19%)

Lymph Node Invasion: 3% (1% - 5%)

So there is a 50/50 chance of the disease

being organ confined. Other tests and other information might refine some of

these figures.

If the disease is not organ confined or if

it is systemic or metastasized, the reason that local treatment is

contra-indicated by many is that all such treatments are debilitating and

can allow systemic disease to be come metastasized (the weeds take root and

start growing) or the metastasized disease to develop faster than it might have

done. There are many theories as to why this should happen which would take too

much room now to sum up, but those are the basic theories.

As to ADT (Androgen Deprivation Therapy), I

would disagree with Louis who says <snip> ADT is NEVER

a cure. It is a temporary palliative. It may be used as an adjunct therapy

prior to radiation or brachytherapy to shrink the prostate prior to treatment.

It is also a backstop in case any of the major treatment modalities fail. <snip>

and Allan Meyer who says <snip> ADT works for an average of 18 months

before PSA starts to rise again. <snip>

Chuck Maack, for example,

who posts here and whose story is at http://www.yananow.net/Mentors/M.htm has been on ADT for more than five years, very

successfully. Another Yana Mentor is Doug whose story is at http://www.yananow.net/Mentors/DougA.htm

and is even more remarkable. After Surgery and Radiation ‘failed’,

Doug went onto ADT for 18 months starting in 1996 and stopping in 1997,

since when he has had an undetectable PSA. Is he cured? By any current

definitions he certainly is. Anyone interested in men who tell their stories

about using hormone therapy can find them here http://www.yananow.net/Experiences.html#hormone

Bill, you say <snip>

With ADT in mind, would you please refer to your notes and explain what the

dif. is between an androgen depletion drug vs a chemo (which I understand

attacks the mets anywhere and is used post ADT regimen?) <snip>

Perhaps you might find it

useful to read this part of a small manual I wrote, which I am revising with

the intention of re-publishing, at http://www.yananow.net/StrangePlace/desert.html#hormone

which describes the four basic approaches that are taken with ADT. The

essential difference between ADT and chemotherapy is that ADT is aimed at

reducing the “fuel” of prostate cancer, essentially the testosterone

derivative known as DHT – dihydrotestosterone. The theory behind chemotherapy

on the other hand is that the highly poisonous chemicals, which kill ALL cells

will be taken up at a faster rate by unhealthy tumour cells which will die and

the healthy cells that remain will, because they have absorbed a lower dose, be

able to survive and re-generate. As you will appreciate it is a fine balancing

act to avpid curing the disease but killing the patient. Cells like hair are

damaged by chemotherapy because they are also fast growing and absorb higher

doses.

Finally, can I just say, to Allan Meyer,

who says <snip> But even if

ADT works for 4 years, and secondary treatments work for another 2 years, the

55 year old who wrote in would be only 61 when his PSA went out of control and

he could expect only another few years. He'd very likely be dead by 65. <snip>

that making such extrapolations from some very rubbery data might not be very

helpful. I have been told consistently for the past eleven years since I was

diagnosed at 54 that I might have three to five years before I die.

I started on ADT three months ago and am fairly confident that I might make

another ten or eleven years.

I think that the warnings

I have received have been from doctors who are even less numerate than I am and

who do not understand the nature of a statistical median and have no idea of

the statistical range of the figures to which they refer. I am no statistician

and so I found Jay Gould’s wonderful essay The Median Isn’t

The Message at http://tinyurl.com/6nwg7

a great help and comfort.

All the best

Terry Herbert

I have no medical

qualifications but I was diagnosed in ‘96: and have learned a bit since

then.

My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za

Dr

“Snuffy” Myers : " As a physician, I am painfully aware that most of

the decisions we make with regard to prostate cancer are made with inadequate

data "