8 ms·

Common prostate cancer treatment linked to later dementia, researcher says

152 points by CapitalistCartr 10y ago

go_prodev 10y ago
Is ADT in any way similar to finasteride (anti-androgen for hair loss and prostate enlargement)?
- msamwald 10y ago
  That was also my first question. I looked at the original paper [1], the medication names they used to identify individuals on androgen deprivation therapy are listed in the 'eAppendix': Leuprolide, goserelin, triptorelin, histrelin, Degarelix, flutamide, bicalutamide, nilutamide, Enzalutamide, Cyproterone acetate, Lupron, Zoladex, Trelstar, Vantas, Firmagon, Eulexin, Casodex, Nilandron, Xtandi, Nizoral, Androcur, Eligard, Cyprostat, Anandron, Flutamin, Cytomid, Cosudex, Calutide, Kalumid So relax, finasteride does not seem to be on the list. [1] http://jamanetwork.com/journals/jamaoncology/fullarticle/2569059 http://jamanetwork.com/journals/jamaoncology/fullarticle/256... (probably paywalled)
  - spatulan 10y ago
    I'm on Cyproterone Acetate. Does it say anywhere in the paper if certain anti-androgens are worse than others?
    - msamwald 10y ago
      No, all of the medications seem to be lumped together.
  - chmaynard 10y ago
    > Leuprolide, goserelin, triptorelin, histrelin, Degarelix, flutamide, bicalutamide, nilutamide, Enzalutamide, Cyproterone acetate, Lupron, Zoladex, Trelstar, Vantas, Firmagon, Eulexin, Casodex, Nilandron, Xtandi, Nizoral, Androcur, Eligard, Cyprostat, Anandron, Flutamin, Cytomid, Cosudex, Calutide, Kalumid The number of medications in this list (29) is rather striking. Assuming the FDA approved all of these drugs to treat a single condition, this treatment must be VERY profitable!
  - slyrus 10y ago
    It's annoying how the press release manages to have links for the institutions involved, the authors, various initiatives and departments, but not for the paper itself. Surely encouraging folks to read the work should be as important as trumpeting the fact that the work was done.
- delecti 10y ago
  ADT is Androgen deprivation therapy, a superset of using anti-androgens. And Finasteride is only kinda an anti-androgen itself. It blocks conversion of some Testosterone to DHT, which is another androgen which is more potent WRT hair loss, body hair growth, and prostate problems, but I believe less potent WRT other effects of androgens.
- deleted 10y ago
  [deleted]
- raverbashing 10y ago
  Finasteride doesn't affect testosterone, but DHT, so maybe not? (It affects conversion of Test. in DHT)
- wavegeek 10y ago
  5 alpha reductase inhibiters like Finasterade slow the conversion of Testosterone to DHT, which is a more potent androgen. This conversion occurs in the skin, liver, prostate and retina. Using a 5aR inhibiter mostly affects those organs alone. There would be a slight decrease in effective Testosterone levels and these drugs can sometimes affect libido and erectile function. But the reduction will be minor compared to hormone ablation (HAT), which takes you close to zero. HAT affects you in many ways: mood, bone loss, muscle loss are the main ones. To which we can now add dementia.
adrianN 10y ago
What factors decide whether ADT is done? I doubt it's random. Maybe those differences explain the dementia differences?
- dumbmatter 10y ago
  This article actually does a decent job of explaining the limitations of retrospective analysis, unlike most articles about retrospective studies. See the "Retrospective complements prospective" section at the end.
wjnc 10y ago
Good read. Been through exactly this with my father. Obviously no causality, he could have started dementia without the treatment, but gives some backstory to what my family went through. One important point is that the hormones probably add more life than they take. You don't start on hormones AFAIK before they figure they can't cure you anymore. It's then about prolonging life. First to admit that dementia is horrible as well, but for most patients a risk worth taking. Further reading: -99% survival in 10 yrs regardless of initial treatment in the dataset (in article)? -It seems there is a subset where ADT is first treatment. That is at odds with what our oncologist told us iirc. ADT prolonges, but does not cure. Makes some sense to prescribe ADT if alternatives are too heavy, but that is at odds with the 99% 10 yr survival. As an actuary: only children have 99% 10 yr survival (guesstimate). Went to the article. Not paywalled (nice). They include common logic comparisons and stuff. Love the approach to text processing. But no basic data tables? Death should be really common when studying 60-70-80 yr olds. Gleason score mostly 6 or higher. That gives you a 30%+ baseline of dying (ballpark, Google). Next thought: data gathering conditional on survival. Only if there is a follow-up, you can be included. That still makes sense re the study (relative chance of dementia), but makes interpretation harder. It's an analysis in one branche of the probability tree. ADT might make your dementia chance 100% if nothing else kills you first. Still a nice study. Just don't think of this if you've just been diagnosed. Draw the entire tree. You need to survive first.
- pfarnsworth 10y ago
  My mother is suffering from dementia right now and my family is trying to deal with it. One of my closest friends is also dealing with this with his mother, who was just put into an institution where she can't leave the floor because she wanders. It's the cruelest disease, cancer is more merciful at this age.
  - anigbrowl 10y ago
    I could not agree more. Not only is dementia horribly corrosive for the family, it's frightening and confusing for the patient in most circumstances. By far the most depressing cases I dealt with as a nurse's aide were those patients who were still physically healthy and strong but suffering from dementia, because they were the most likely to need to be manhandled if they wandered away or got into an altercation with the nurses. I still remember the fear and confusion in some patients' eyes 30 years later and have no desire to experience that.
jmcgough 10y ago
Wonder if this translates over to hormone replacement therapy in transgender people :\
- said 10y ago
  It's plausible that this would negatively impact transgender women, considering dementia is associated with lower testosterone levels in men. Please see: https://news.ycombinator.com/item?id=12708367 https://news.ycombinator.com/item?id=12708367
  - stormbrew 10y ago
    Disclaimer: IANAD. That's not necessarily a relevant comparison since the goal of HRT in trans women is not simply to lower testosterone, but also to raise estrogen (and sometimes progesterone) to female levels. Trans women on HRT are not hormonally like cis men (including men on ADT), so extrapolating any effect of sex hormone from cis men to trans women is going to lead you astray.
- auganov 10y ago
  Well women are generally much likelier to get dementias. Close to 2x the risk (as compared to males) too I think. A quick google search shows there's studies suggesting giving women testosterone could help with dementia.
  - pervycreeper 10y ago
    That's a consequence of their increased empirical longevity.
alejohausner 10y ago
I find this depressing. As far as I know chemical castration (another name for this treatment) tends to increase deaths from cancer and other causes! That's what table 2 tells me in this[1] retrospective study. It all seems backwards and wrongheaded. 1.10.1200/JCO.2013.54.2043, or Google "Effectiveness of primary androgen deprivation therapy"
said 10y ago
Dementia is associated with low levels of testosterone in men. [1] Unfortunately, (over-the-counter) DHEA seems to have no effect on Alzheimer's, [2] though I'm not sure about other forms of dementia. [1]: https://www.ncbi.nlm.nih.gov/pubmed/24035146 https://www.ncbi.nlm.nih.gov/pubmed/24035146 [2]: https://www.aan.com/PressRoom/Home/PressRelease/39 https://www.aan.com/PressRoom/Home/PressRelease/39 and https://www.ncbi.nlm.nih.gov/pubmed/16977674 https://www.ncbi.nlm.nih.gov/pubmed/16977674
- orthoganol 10y ago
  If [1] is established, it's disturbing it's never mentioned regarding Propecia, a hair loss treatment a significant percentage of men I know take.
  - ClassyJacket 10y ago
    I take it. Does this mean I should stop?
    - orthoganol 10y ago
      I should have searched for Finasteride before commenting, there is some discussion further down.
zizzles 10y ago
Not surprising. Trying to overcome faulty genetics with medication is a double edged sword. You are almost always trading one issue for another, tit for tat. Prostate cancer medication? Enjoy dementia. Chemotherapy treatment for cancer? Enjoy having healthy cells destroyed. SSRI for depression? Linked with autism in pregnancy, heart disease, numerous other issues. Steroids for improved performance? Gynecomastia. Ball shrinkage. Acne because of raised hormones. Accutane to fix acne? Liver problems. Crohns. Finasteride to retain your hair? Lowered DHT levels, diminished sexual drive. That's just the tip of the iceberg. Mother nature seems to be an unstoppable force.
- themodelplumber 10y ago
  Lift weights and cut calories? Accusations of steroid use for the rest of your days. Life is hard, man.
- mjb 10y ago
  No, that's not true. A huge number of medical treatments and interventions have been developed - mostly over the last 100 years - that are way more beneficial than they are risky. Some treatments have side-effects. Some have unexpected, or long-term side effects. Some have awful life-altering side-effects. That's all true. But to say "mother nature is an unstoppable force" to support the idea that all medical treatment does equal harm and good is crazy. Health interventions - from clean food and water to drugs and surgery - have improved and lengthened the lives of billions over the last century.
  - Alex3917 10y ago
    > Health interventions - from clean food and water to drugs and surgery - have improved and lengthened the lives of billions over the last century. Public health interventions, such as clean water and vaccines, have lengthened life expectancy. Drugs haven't made much of an impact though.
    - NoPiece 10y ago
      Antibiotics?
randcraw 10y ago
No doubt there are confounding factors to the influence of ADT, such as surgery, radiation, or other support meds. But the impact of long term exposure to cancer cells can't be discounted either. Because slow growing cancer is a fairly recent phenomenon, I suspect living with active cancer for 5-10 years is probably not well documented or fully quantified yet. The effects of such stress on the immune system alone must lead to uncharted waters. There's other evidence that persistent inflammation (or protein glycosylation?) may accelerate dementia, as suggested by the ~45% protective effect of Actos (pioglitazone) against dementia, for both those with and without diabetes. http://www.nytimes.com/2006/07/17/health/17alzheimer.html?_r=0 http://www.nytimes.com/2006/07/17/health/17alzheimer.html?_r...
nylonstrung 10y ago
It is becoming increasingly obvious that androgen deprivation has massive neurological effects. I seriously think there should be some inquiry into whether it is a driver for the epidemic of post-transition MTF trans suicides
- teslabox 10y ago
  > It is becoming increasingly obvious that androgen deprivation has massive neurological effects. Progesterone USP is both a pro-hormone and a neurosteroid [1]. The science literature commonly confuses Progesterone USP with various "progestins" (xeno-hormones), so there is much confusion on the effects of this substance vs the fakes. > I seriously think there should be some inquiry into whether it is a driver for the epidemic of post-transition MTF trans suicides At one point I made a progesterone supplement, which I sold on Amazon - topical progesterone formulas are grandfathered as non-prescription because they are safe, and because the substance was available before the food & drug act was passed. My best customer was "Billie", whom I never met, but who I'm certain was MTF. SHe emailed me recently when she ran out of her last purchase - I told her what to buy instead. MTF probably usually do poorly post-transition because they only supplement with "the heart attack hormone"/"The Cancer Hormone" - Estrogen. Progesterone USP is essential for balancing the toxic effects of any kind of estrogen/xeno-estrogen. Fertile women are protected from their estrogen load because their bodies produce large amounts of Progesterone during the second half of the cycle. [1] https://www.ncbi.nlm.nih.gov/pubmed/11108866 https://www.ncbi.nlm.nih.gov/pubmed/11108866 edit: gender pronouns
  - jauer 10y ago
    I've noticed a patient-driven push to add Progesterone to transwomen HRT based on anecdotes about mood, sex drive, and breast development. Alas there isn't much research into trans health.
v0x 10y ago
Part of the Stanford article is highly misleading. They say: "That study, published in September in The New England Journal of Medicine, revealed that prostate cancer patients randomized to either active monitoring, surgery or radiation therapy all had the same risk of death from the cancer after 10 years. Ninety-nine percent of men in the study survived regardless of initial treatment. These startling results suggest that active monitoring of prostate cancer patients may be as good as early radical treatment and may cause fewer side effects." In the actual NEJM study they reference, though, the conclusions are the exact opposite: "...death from prostate cancer occurred in 8 of the 545 men assigned to active monitoring, 5 of the 553 men assigned to surgery, and 4 of the 545 men assigned to radiotherapy" "For today, we can conclude on the basis of level 1 evidence that PSA monitoring, as compared with treatment of early prostate cancer, leads to increased metastasis. Therefore, if a man wishes to avoid metastatic prostate cancer and the side effects of its treatment, monitoring should be considered only if he has life-shortening coexisting disease such that his life expectancy is less than the 10-year median follow-up of the current study..." http://www.nejm.org/doi/full/10.1056/NEJMe1610395#t=article http://www.nejm.org/doi/full/10.1056/NEJMe1610395#t=article
- pcrh 10y ago
  From the article: "causality between an increase in metastatic disease and the use of active monitoring versus treatment was established." The notion that monitoring PSA levels can per se increase the risk of metastasis is ridiculous. It's far more likely that some other factor caused the increased incidence of metastases.
  - v0x 10y ago
    They are just saying that metastasis occurs more frequently with monitoring as compared to active treatment, not that PSA testing itself causes metastasis.
    - pcrh 10y ago
      Ah yes, you're correct...
  - 10y ago
alabamamike 10y ago
Ugh, leaving us guys with a tough choice: Do we want to pee or think?
bawana 10y ago
Steroid deprivation in general leads to depression- post partum depression, etc. Steroid administration leads to a type of 'euphoria' or well being - 'steroid high'. The link between steroid levels and mental status is an old story. The question becomes what was the patient's testosterone before ablation was initiated and how far did it fall. This value may be the more relevant predictor. So, patients who already have a low T(<150) might not be at risk for altered cognitive function though no one has really looked at this.
petronic 10y ago
My father's currently 9 months into an 18 month course of Lupron (paired with an earlier course of radiation) for advanced, inoperable prostate cancer. He won't get his next 3-month shot until December. I've already shared this study with him and asked him to talk about it with his oncologist. At this point, is there anything else that he can do with this information?

go_prodev 10y ago

Is ADT in any way similar to finasteride (anti-androgen for hair loss and prostate enlargement)?

msamwald 10y ago
That was also my first question. I looked at the original paper [1], the medication names they used to identify individuals on androgen deprivation therapy are listed in the 'eAppendix': Leuprolide, goserelin, triptorelin, histrelin, Degarelix, flutamide, bicalutamide, nilutamide, Enzalutamide, Cyproterone acetate, Lupron, Zoladex, Trelstar, Vantas, Firmagon, Eulexin, Casodex, Nilandron, Xtandi, Nizoral, Androcur, Eligard, Cyprostat, Anandron, Flutamin, Cytomid, Cosudex, Calutide, Kalumid So relax, finasteride does not seem to be on the list. [1] http://jamanetwork.com/journals/jamaoncology/fullarticle/2569059 http://jamanetwork.com/journals/jamaoncology/fullarticle/256... (probably paywalled)
- spatulan 10y ago
  I'm on Cyproterone Acetate. Does it say anywhere in the paper if certain anti-androgens are worse than others?
  - msamwald 10y ago
    No, all of the medications seem to be lumped together.
- chmaynard 10y ago
  > Leuprolide, goserelin, triptorelin, histrelin, Degarelix, flutamide, bicalutamide, nilutamide, Enzalutamide, Cyproterone acetate, Lupron, Zoladex, Trelstar, Vantas, Firmagon, Eulexin, Casodex, Nilandron, Xtandi, Nizoral, Androcur, Eligard, Cyprostat, Anandron, Flutamin, Cytomid, Cosudex, Calutide, Kalumid The number of medications in this list (29) is rather striking. Assuming the FDA approved all of these drugs to treat a single condition, this treatment must be VERY profitable!
- slyrus 10y ago
  It's annoying how the press release manages to have links for the institutions involved, the authors, various initiatives and departments, but not for the paper itself. Surely encouraging folks to read the work should be as important as trumpeting the fact that the work was done.
delecti 10y ago
ADT is Androgen deprivation therapy, a superset of using anti-androgens. And Finasteride is only kinda an anti-androgen itself. It blocks conversion of some Testosterone to DHT, which is another androgen which is more potent WRT hair loss, body hair growth, and prostate problems, but I believe less potent WRT other effects of androgens.
deleted 10y ago
[deleted]
raverbashing 10y ago
Finasteride doesn't affect testosterone, but DHT, so maybe not? (It affects conversion of Test. in DHT)
wavegeek 10y ago
5 alpha reductase inhibiters like Finasterade slow the conversion of Testosterone to DHT, which is a more potent androgen. This conversion occurs in the skin, liver, prostate and retina. Using a 5aR inhibiter mostly affects those organs alone. There would be a slight decrease in effective Testosterone levels and these drugs can sometimes affect libido and erectile function. But the reduction will be minor compared to hormone ablation (HAT), which takes you close to zero. HAT affects you in many ways: mood, bone loss, muscle loss are the main ones. To which we can now add dementia.

adrianN 10y ago

What factors decide whether ADT is done? I doubt it's random. Maybe those differences explain the dementia differences?

dumbmatter 10y ago
This article actually does a decent job of explaining the limitations of retrospective analysis, unlike most articles about retrospective studies. See the "Retrospective complements prospective" section at the end.

wjnc 10y ago

Good read. Been through exactly this with my father. Obviously no causality, he could have started dementia without the treatment, but gives some backstory to what my family went through. One important point is that the hormones probably add more life than they take. You don't start on hormones AFAIK before they figure they can't cure you anymore. It's then about prolonging life. First to admit that dementia is horrible as well, but for most patients a risk worth taking. Further reading: -99% survival in 10 yrs regardless of initial treatment in the dataset (in article)? -It seems there is a subset where ADT is first treatment. That is at odds with what our oncologist told us iirc. ADT prolonges, but does not cure. Makes some sense to prescribe ADT if alternatives are too heavy, but that is at odds with the 99% 10 yr survival. As an actuary: only children have 99% 10 yr survival (guesstimate). Went to the article. Not paywalled (nice). They include common logic comparisons and stuff. Love the approach to text processing. But no basic data tables? Death should be really common when studying 60-70-80 yr olds. Gleason score mostly 6 or higher. That gives you a 30%+ baseline of dying (ballpark, Google). Next thought: data gathering conditional on survival. Only if there is a follow-up, you can be included. That still makes sense re the study (relative chance of dementia), but makes interpretation harder. It's an analysis in one branche of the probability tree. ADT might make your dementia chance 100% if nothing else kills you first. Still a nice study. Just don't think of this if you've just been diagnosed. Draw the entire tree. You need to survive first.

pfarnsworth 10y ago
My mother is suffering from dementia right now and my family is trying to deal with it. One of my closest friends is also dealing with this with his mother, who was just put into an institution where she can't leave the floor because she wanders. It's the cruelest disease, cancer is more merciful at this age.
- anigbrowl 10y ago
  I could not agree more. Not only is dementia horribly corrosive for the family, it's frightening and confusing for the patient in most circumstances. By far the most depressing cases I dealt with as a nurse's aide were those patients who were still physically healthy and strong but suffering from dementia, because they were the most likely to need to be manhandled if they wandered away or got into an altercation with the nurses. I still remember the fear and confusion in some patients' eyes 30 years later and have no desire to experience that.

jmcgough 10y ago

Wonder if this translates over to hormone replacement therapy in transgender people :\

said 10y ago
It's plausible that this would negatively impact transgender women, considering dementia is associated with lower testosterone levels in men. Please see: https://news.ycombinator.com/item?id=12708367 https://news.ycombinator.com/item?id=12708367
- stormbrew 10y ago
  Disclaimer: IANAD. That's not necessarily a relevant comparison since the goal of HRT in trans women is not simply to lower testosterone, but also to raise estrogen (and sometimes progesterone) to female levels. Trans women on HRT are not hormonally like cis men (including men on ADT), so extrapolating any effect of sex hormone from cis men to trans women is going to lead you astray.
auganov 10y ago
Well women are generally much likelier to get dementias. Close to 2x the risk (as compared to males) too I think. A quick google search shows there's studies suggesting giving women testosterone could help with dementia.
- pervycreeper 10y ago
  That's a consequence of their increased empirical longevity.

alejohausner 10y ago

I find this depressing. As far as I know chemical castration (another name for this treatment) tends to increase deaths from cancer and other causes! That's what table 2 tells me in this[1] retrospective study. It all seems backwards and wrongheaded. 1.10.1200/JCO.2013.54.2043, or Google "Effectiveness of primary androgen deprivation therapy"

said 10y ago

Dementia is associated with low levels of testosterone in men. [1] Unfortunately, (over-the-counter) DHEA seems to have no effect on Alzheimer's, [2] though I'm not sure about other forms of dementia. [1]: https://www.ncbi.nlm.nih.gov/pubmed/24035146 https://www.ncbi.nlm.nih.gov/pubmed/24035146 [2]: https://www.aan.com/PressRoom/Home/PressRelease/39 https://www.aan.com/PressRoom/Home/PressRelease/39 and https://www.ncbi.nlm.nih.gov/pubmed/16977674 https://www.ncbi.nlm.nih.gov/pubmed/16977674

orthoganol 10y ago
If [1] is established, it's disturbing it's never mentioned regarding Propecia, a hair loss treatment a significant percentage of men I know take.
- ClassyJacket 10y ago
  I take it. Does this mean I should stop?
  - orthoganol 10y ago
    I should have searched for Finasteride before commenting, there is some discussion further down.

zizzles 10y ago

Not surprising. Trying to overcome faulty genetics with medication is a double edged sword. You are almost always trading one issue for another, tit for tat. Prostate cancer medication? Enjoy dementia. Chemotherapy treatment for cancer? Enjoy having healthy cells destroyed. SSRI for depression? Linked with autism in pregnancy, heart disease, numerous other issues. Steroids for improved performance? Gynecomastia. Ball shrinkage. Acne because of raised hormones. Accutane to fix acne? Liver problems. Crohns. Finasteride to retain your hair? Lowered DHT levels, diminished sexual drive. That's just the tip of the iceberg. Mother nature seems to be an unstoppable force.

themodelplumber 10y ago
Lift weights and cut calories? Accusations of steroid use for the rest of your days. Life is hard, man.
mjb 10y ago
No, that's not true. A huge number of medical treatments and interventions have been developed - mostly over the last 100 years - that are way more beneficial than they are risky. Some treatments have side-effects. Some have unexpected, or long-term side effects. Some have awful life-altering side-effects. That's all true. But to say "mother nature is an unstoppable force" to support the idea that all medical treatment does equal harm and good is crazy. Health interventions - from clean food and water to drugs and surgery - have improved and lengthened the lives of billions over the last century.
- Alex3917 10y ago
  > Health interventions - from clean food and water to drugs and surgery - have improved and lengthened the lives of billions over the last century. Public health interventions, such as clean water and vaccines, have lengthened life expectancy. Drugs haven't made much of an impact though.
  - NoPiece 10y ago
    Antibiotics?

randcraw 10y ago

No doubt there are confounding factors to the influence of ADT, such as surgery, radiation, or other support meds. But the impact of long term exposure to cancer cells can't be discounted either. Because slow growing cancer is a fairly recent phenomenon, I suspect living with active cancer for 5-10 years is probably not well documented or fully quantified yet. The effects of such stress on the immune system alone must lead to uncharted waters. There's other evidence that persistent inflammation (or protein glycosylation?) may accelerate dementia, as suggested by the ~45% protective effect of Actos (pioglitazone) against dementia, for both those with and without diabetes. http://www.nytimes.com/2006/07/17/health/17alzheimer.html?_r=0 http://www.nytimes.com/2006/07/17/health/17alzheimer.html?_r...

nylonstrung 10y ago

It is becoming increasingly obvious that androgen deprivation has massive neurological effects. I seriously think there should be some inquiry into whether it is a driver for the epidemic of post-transition MTF trans suicides

teslabox 10y ago
> It is becoming increasingly obvious that androgen deprivation has massive neurological effects. Progesterone USP is both a pro-hormone and a neurosteroid [1]. The science literature commonly confuses Progesterone USP with various "progestins" (xeno-hormones), so there is much confusion on the effects of this substance vs the fakes. > I seriously think there should be some inquiry into whether it is a driver for the epidemic of post-transition MTF trans suicides At one point I made a progesterone supplement, which I sold on Amazon - topical progesterone formulas are grandfathered as non-prescription because they are safe, and because the substance was available before the food & drug act was passed. My best customer was "Billie", whom I never met, but who I'm certain was MTF. SHe emailed me recently when she ran out of her last purchase - I told her what to buy instead. MTF probably usually do poorly post-transition because they only supplement with "the heart attack hormone"/"The Cancer Hormone" - Estrogen. Progesterone USP is essential for balancing the toxic effects of any kind of estrogen/xeno-estrogen. Fertile women are protected from their estrogen load because their bodies produce large amounts of Progesterone during the second half of the cycle. [1] https://www.ncbi.nlm.nih.gov/pubmed/11108866 https://www.ncbi.nlm.nih.gov/pubmed/11108866 edit: gender pronouns
- jauer 10y ago
  I've noticed a patient-driven push to add Progesterone to transwomen HRT based on anecdotes about mood, sex drive, and breast development. Alas there isn't much research into trans health.

v0x 10y ago

Part of the Stanford article is highly misleading. They say: "That study, published in September in The New England Journal of Medicine, revealed that prostate cancer patients randomized to either active monitoring, surgery or radiation therapy all had the same risk of death from the cancer after 10 years. Ninety-nine percent of men in the study survived regardless of initial treatment. These startling results suggest that active monitoring of prostate cancer patients may be as good as early radical treatment and may cause fewer side effects." In the actual NEJM study they reference, though, the conclusions are the exact opposite: "...death from prostate cancer occurred in 8 of the 545 men assigned to active monitoring, 5 of the 553 men assigned to surgery, and 4 of the 545 men assigned to radiotherapy" "For today, we can conclude on the basis of level 1 evidence that PSA monitoring, as compared with treatment of early prostate cancer, leads to increased metastasis. Therefore, if a man wishes to avoid metastatic prostate cancer and the side effects of its treatment, monitoring should be considered only if he has life-shortening coexisting disease such that his life expectancy is less than the 10-year median follow-up of the current study..." http://www.nejm.org/doi/full/10.1056/NEJMe1610395#t=article http://www.nejm.org/doi/full/10.1056/NEJMe1610395#t=article

pcrh 10y ago
From the article: "causality between an increase in metastatic disease and the use of active monitoring versus treatment was established." The notion that monitoring PSA levels can per se increase the risk of metastasis is ridiculous. It's far more likely that some other factor caused the increased incidence of metastases.
- v0x 10y ago
  They are just saying that metastasis occurs more frequently with monitoring as compared to active treatment, not that PSA testing itself causes metastasis.
  - pcrh 10y ago
    Ah yes, you're correct...
- 10y ago

alabamamike 10y ago

Ugh, leaving us guys with a tough choice: Do we want to pee or think?

bawana 10y ago

Steroid deprivation in general leads to depression- post partum depression, etc. Steroid administration leads to a type of 'euphoria' or well being - 'steroid high'. The link between steroid levels and mental status is an old story. The question becomes what was the patient's testosterone before ablation was initiated and how far did it fall. This value may be the more relevant predictor. So, patients who already have a low T(<150) might not be at risk for altered cognitive function though no one has really looked at this.

petronic 10y ago

My father's currently 9 months into an 18 month course of Lupron (paired with an earlier course of radiation) for advanced, inoperable prostate cancer. He won't get his next 3-month shot until December. I've already shared this study with him and asked him to talk about it with his oncologist. At this point, is there anything else that he can do with this information?