After skin cancer, adenocarcinoma of the prostate is the most
common type of cancer for males, afflicting nearly 1 in 9 men in the United
States. For this reason it is useful to know what treatment options are
available and what the potential adverse effects can be. Hence, the motivation
for this two-part article, which is not – as some might think – obsessing over
my own medical issues. Nope, it’s trying to impart information in case other men get PCa (as it’s abbreviated) and they and their significant others have to deal with it.
I will be honest: When the urologist first proposed Firmagon as
one of the ADT solutions to my prostate cancer metastasis (see Part 1), I was
dubious as well as nervous. How could I
not be after reading the dozens of side effects that were likely to descend
upon me in the coming months. From one
medical website, these included:
More common
·
Back pain
·
blurred vision
·
dizziness
·
fever
·
flushing or redness of the skin
·
hard lump
·
headache
·
nervousness
·
pain
·
pounding in the ears
·
slow or fast heartbeat
·
small lumps under the skin
·
swelling
·
unusually warm skin
Less common
·
Bladder pain
·
bloody or cloudy urine
·
chills
·
decrease in testicle size
·
decreased interest in sexual intercourse
·
difficult, burning, or painful urination
·
difficulty in moving
·
frequent urge to urinate
·
inability to have or keep an erection
·
increased sweating
·
loss in sexual ability, desire, drive, or performance
·
lower back or side pain
- Diarrhea
- lack or loss of
strength
- nausea
- night sweats
- swelling of the
breasts or breast soreness
- trouble
sleeping
·
muscle pain or stiffness
·
pain in the joints
I found in the last few months that ensued since the first
injection I got nearly all of them, at one time or another. But the most trying on a consistent basis
have been the night sweats (from hot flashes) sometimes 20 times a night, and
dozens more time during the day. I mean you can be there reading and all of a
sudden it’s as if someone directed a warming radiator at you. Couple that to the back and joint pain,
nipple sensitivity - to the point of taking care just fastening a seat belt - and
it’s not been fun.
But for most guys who have undertaken ADT (such as those in my PCa support group) the
most aggravating changes are: a) the cognitive deterioration, and b)the loss of
one’s male morphology and characteristics as a result of the radical
testosterone decline. And as I argue in
this instalment, I am convinced the two go hand in hand.
In one educational (UCSF) video I watched from 2015,
featuring a female oncologist speaking to patients, I still recall the
plaintive opening cry of one attendee:
“But you are asking us to destroy what makes us men in
order to stop the spread of this cancer! It’s not right!”
The oncologist tried to be as sympathetic as she could as she
responded:
“Yes, we know all too well that is true! But decades of
work have found this is the best way to preserve lives once the cancer has
metastasized, especially to bones. It is the most effective option to
extend life.” (When prostate cancer spreads beyond its local environment,
the first distant sites to be reached are usually lymph nodes and then bones.)
But still not much consolation to the guy, who noted:
“Extend life? Sometimes I wonder if it’s worth it when your breasts are growing out of control, the nipples are sore to the touch, your penis is shriveling to infant size – so you can’t pee standing up anymore - and your testicles are like two small raisins” –
Not to mention as he added, the total lack of sexual capacity – or interest. (Unless one opts for surgery to get a penile implant)
But again, the female researcher was sympathetic and offered
solutions. She told the forlorn guy it
was still essential to try to ‘work’ the penis no matter how small because
oxygenation of those tissues was critical to prevent atrophy. She recommended
penile injections, vacuum therapy or regular use of PDE (phosphodiesterase
5 )
inhibitors. (Like Viagra, Cialis) But
alas, she conceded the PDEs “tend to work poorly in low T environments”. Which, of course, is what ADT is all about.
As for the annoying breast tissue growth (called
gynecomastia) she referred the audience to the UCSF guide on hormone therapy,
which noted several Recommendations:
“A single dose of radiation to the breasts at the start
of treatment can be preventative. Other treatment options include mastectomy
and liposuction. A medication called tamoxifen that blocks estrogen activity
can also be helpful in preventing this symptom.”
So hey, it’s no wonder men on ADT get depressed! Of course, the solution of the medical
industrial complex is to prescribe anti-depressants, i.e. the typical serotonin
re-uptake lot - which also tend to
destroy sexual interest, ability. So for many of us the option becomes do
nothing or tough it out. I mean what choice is there? You either croak in some
horrific manner – say fractured spine then mets in the brain. Or allow your
body to continue being “feminized” via the medical castration of ADT. That is
the price you pay for survival. Apart from a 20% higher risk of developing Alzheimer’s
as some research from UPenn has shown.
As noted in one NIH study:
Of men surviving at least 5 years after diagnosis, 31.3% of those receiving androgen deprivation developed at least least 1 depressive, cognitive, or constitutional diagnosis compared with 23.7% in those who did not
And:
“Sexual dysfunction is a well-documented adverse effect of
androgen deprivation However, there is
increasing recognition of a spectrum of other less specific adverse effects
such as depression, anxiety, malaise, fatigue, and memory difficulties, which
some authors have termed the androgen deprivation syndrome.”
Also noted, the older the patient the more likely he is to suffer “comorbidities” and cognitive dysfunction, because of age. To make clear the degree of cognitive ‘fuzz’ let me recite one recent example. About 2 months ago after filling the coffee machine one morning I noted the water overflowing from the top. I had evidently forgotten I’d already filled it the night before
Whether the masculine deterioration from ADT is a cause or effect of the related syndrome may never be solved. But what is alarming, and may contribute to depression, is the gradual realization some form of dementia may be associated with the therapy. A study, in JAMA Network Open in 2019 exposed the risks and may have uncovered the most potent basis for androgen deprivation syndrome.
The
study included 154,089 men whose average age was 74 and who had diagnoses of
prostate cancer. Of these, 62,330 received ADT and the rest did not. The
study:
“found a link between drugs commonly used for hormone therapy and an increased risk of developing dementia including Alzheimer's disease. The study adjusted for socioeconomic status, age, race, severity of prostate cancer and other factors.”
I am nowhere near that take – yet- and am hoping my regimen of regular exercise (weights, speed walking, stair climbing) combined with blogging- writing books (the most recent, Excursions in Advanced Mathematics and Essays from Brane Space) will sustain some measure of quality of life along with slowing of the cancer. Also, playing up to 7 chess games a day vs. an A.I. algorithm.
But one conclusion I have come to that affects all men diagnosed with PCa is that ADT should be postponed as long as possible given the syndrome is clearly real. Certainly, given the risks it should not be started if the cancer is localized only, confined to the capsule and the Gleason scores are relatively low, e.g. 3s, or even 3+4.
It’s
also well to bear in mind the goal of lowering PSA, while laudable, is not the
be-all and end all. This is given that it’s only affected by androgen-sensitive
cells. Meanwhile the growth of androgen insensitive cells will not be halted,
and these are often among the most malignant. (Noted in the text: Dr.
Patrick Walsh’s Guide To Surviving Prostate Cancer’.)
A more realistic goal is to keep the testosterone (‘T’) as low as feasible for as long as possible to suppress tumor growth. The ideal end objective is to reach what’s called “T nadir”- which I am close to now with a T » 4 ng/DL.
For those interested, the link below has a superb video featuring two Canadian authors of the foremost book on ADT and coping with the side effects:
While speaking to reporters Monday, President Donald Trump expressed surprise over the recent disclosure of former President Joe Biden's advanced prostate cancer diagnosis, suggesting that it could have been present for several years.
Despite initially offering well-wishes to the Biden family in response to a question, Trump hinted that the information might have been withheld during Biden’s presidency.
"I'm surprised that the public wasn't notified a long time ago, because to get to stage 9, that's a long time," the president said.
The diagnosis, which was confirmed on Sunday, revealed that Biden has an aggressive form of prostate cancer with a Gleason score of 9, indicating a high-grade tumor. The cancer has metastasized to the bones, and Biden is currently reviewing treatment options with his medical team, per the family's statement.
— from Robert Reich's Substack
Friends,
I’m truly sorry that Joe Biden has an aggressive form of prostate cancer.
But the Biden news that’s been dominating headlines, exciting columnists, lighting up social media, and grinding up endless podcast hours has been something else: a so-called “cover-up” of the extent of Biden’s declining cognition before he resigned.
(Unless you’re Donald Trump Jr., in which case you suspect that even Biden’s prostate cancer was covered up.)
In their explosive new book out today, “Original Sin,” Jake Tapper and Alex Thompson call Biden’s aide’s refusal to admit how badly Biden’s mental capacities had deteriorated a “cover-up.” The book details Biden’s cognitive lapses and an alleged effort by aides to conceal them from the public ahead of his decision to end his re-election bid.
The U.S. Preventive Services Task Force, which makes
medical recommendations about preventive services such as screenings,
recommends against screening in men 70 years and older. For men ages 55 to 69,
the decision should be an individual one, it says.
The guidelines note that “many men will experience potential
harms of screening, including false-positive results that require additional
testing and possible prostate biopsy; overdiagnosis and overtreatment; and
treatment complications, such as incontinence and erectile dysfunction.”
The American Cancer Society does not recommend routine
testing for prostate cancer for men of any age. It recommends that men discuss
screening with their provider at age 40 for those with more than one
first-degree relative with prostate cancer at an early age.
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