Another R. Wasserug article - Urology Today

[Hash (imported)]

Excerpt: BERKELEY, CA (UroToday.com) - As part of their treatment for prostate cancer, approximately a half million men at any time in North America are on LHRH agonist drugs to lower their testosterone to castrate levels. These men suffer various side effects from this medical "emasculation" that reduce not only their quality of life, but also that of their partners (reviewed in Elliott et al., 2010). Our investigation focused on the language related to androgen deprivation. Language, used both literally and metaphorically, structures our understanding of reality (Wardhaugh, 2006). The way language is understood by physicians and their patients thus influences patient-doctor communication and may affect health care outcomes.

see the complete article at: http://www.urotoday.com/45/browse_categ ... sculation_ implications_for_cancer_patients_by_richard_wasser sug_phd_et_al11012010.html

A half million men!

[generic9436 (imported)]

i have known 5 men with prostate cancer

2 opted for orchiectomy

10 years later they are still doing quite well

the other 3 opted for chemical...they didnt want to be mutilated ...their words

1 died in 3 years

1 died in 4

and the last died 5 years later

i think something else besides hormones happens with surgical castration

[Caith721 (imported)]

Physical/surgical removal of the testicles prevents metastatis via the lymph nodes. If I had either testicular or prostate cancer, I'd certainly opt to have them cut out, as fast as possible.

[butterflyjack (imported)]

Generic...I would assume that there has been studies on the outcomes of orchiectomy VS hormone therapy for the treatment of prostate cancer...

If those studies revealed anything like your observations, I would have to guess orchiectomy would be strongly recommended.

I've asked this before, but will anti-androgens plus female hormones reduce the size of my prostrate...without the use of these expensive drugs I am taking?

I've had one person say yes to this question..Any others? dragonfly

[speedvogel (imported)]

Androgen deprivation therapy has been shown to have only a minor role in extending the life of prostate cancer patients. Given quality of life issues, most patients will achieve the best possible result with watchful waiting.

If one has access to a doctor who has done hundreds of robotic radical prostatectomies and has a stage one or two cancer, then that is the way to go.

The current trend back to surgical castration is simply cost. Most insurance companies want to avoid paying out thousands of dollars for drugs that will do little to help the patient. They can pay a small sum for a relatively simple procedure instead.

Most men who are faced with the prospect of losing their masculinity will opt for a different approach to treatment.

I for one, have faced this prospect and fortunately found that I did not have prostate cancer. If androgen deprivation therapy had been offered me, I would have rejected it out of hand. I've experienced very low testosterone levels account my diabetes. The results are not good and not desirable.

Speed

[butterflyjack (imported)]

Hi Speevogel...I too, recently underwent testing for prostate cancer and, luckily it turned out to be benign swollen prostate...Strangely, I was almost looking forward to getting castrated..I know...what a buffoon...But that's what I was thinking...Just another warped bastard...dragonfly

[mrt (imported)]

I really get uptight when I read about "watchful waiting" Prostate cancer maybe slow acting in some men but it killed several of my relatives in just a few years. Watchful waiting is all fine if your an insurance company that doesn't want to pay out for treatment.

Grrr - MrT

Androgen deprivation therapy has been shown to have only a minor role in extending the life of prostate cancer patients. Given quality of life issues, most patients will achieve the best possible result with watchful waiting.

If one has access to a doctor who has done hundreds of robotic radical prostatectomies and has a stage one or two cancer, then that is the way to go.

The current trend back to surgical castration is simply cost. Most insurance companies want to avoid paying out thousands of dollars for drugs that will do little to help the patient. They can pay a small sum for a relatively simple procedure instead.

Most men who are faced with the prospect of losing their masculinity will opt for a different approach to treatment.

I for one, have faced this prospect and fortunately found that I did not have prostate cancer. If androgen deprivation therapy had been offered me, I would have rejected it out of hand. I've experienced very low testosterone levels account my diabetes. The results are not good and not desirable.

Speed

[mrt (imported)]

"

Most men who are faced with the prospect of losing their masculinity will opt for a different approach to treatment.

"

P.S. THIS also pisses me off. Testosterone is what gives a man masculine traits not having a "pair" So if he has Testosterone regardless of if it comes from a pair of testes or a gel, injection, patch he can still retain his masculinity.

Mr Anger....

[Woggler58 (imported)]

Generic...I would assume that there has been studies on the outcomes of orchiectomy VS hormone therapy for the treatment of prostate cancer...

If those studies revealed anything like your observations, I would have to guess orchiectomy would be strongly recommended.

I've asked this before, but will anti-androgens plus female hormones reduce the size of my prostrate...without the use of these expensive drugs I am taking?

I've had one person say yes to this question..Any others? dragonfly

Add me to the "yes" replies, as to the anti-androgen part of your question. As a prospective recipient in 2007 of radiation treatment for prostate cancer, I learned that androgen-suppressing drugs are often administered for several months pre-treatment to shrink the size of large prostates to make them a smaller target for externally beamed-in radiation and thus reduce collateral damage on the rest of the patient from less tightly focused radiation. (My own prostate was small and I did not have any anti-androgen drugs as part of my successful radiation treatments late in 2007.)

[Woggler58 (imported)]

Androgen deprivation therapy has been shown to have only a minor role in extending the life of prostate cancer patients. Given quality of life issues, most patients will achieve the best possible result with watchful waiting.

ADT, namely prescribed reduction of testosterone's presence and/or effects to virtually nothing, is indeed understood to usually work only until the malignancy further mutates to the point it no longer is suppressed by lack of testosterone. But ADT is often not used until primary treatment (prostatectomy, radiation, cryogenic freezing, or heat by ultrasound) has failed and the tumors have returned and migrated, becoming less vulnerable to ADT in the process.

A plain-language article in the Aug 2010 issue of PCRI Insights, the magazine of the Prostate Cancer Research Institute, reveals innovative use of ADT as the first recourse following biopsy confirmed diagnosis and staging of prostate cancer. The patient goes on ADT for a year or so while the tumor is still young, without invasive, destructive treatment of the prostate itself. Often the cancer dies out without returning, or another round of ADT after perhaps five years obtains that result. The article explaining this is by Dr Mark Scholz, a leader of PCRI, and is online in pages 16 through 20 of that Insights issue, here: http://www.prostate-cancer.org/pcricms/ ... _p1-40.pdf

Note: Dr Scholz and PCRI use the term "Testosterone-Inactivating Pharmaceuticals" (TIP) for the temporary chemical castration version of ADT while dismissing the alternative of surgical castration (presumably followed later by testosterone replacement therapy as the way back to or above normal) as "repugnant." Many of us would not concur with surgical castration being repugnant per se, but that's beside the point.

The point here is that up-front acceptance of one or more year-long spells of ADT may be acceptable to avoid substantial risk of enduring collateral damage from the mainstream primary treatments now in use. There appears to be a good chance that treatment-caused long-term side effects of having developed prostate cancer can be avoided, if ADT is undertaken early, followed by watchful monitoring before and after discontinuation of ADT.

PCRI was the source of info on side effects of testosterone deprivation posted by Kristoff on 01-04-2008 in EA's Cancer - Testicular, Prostate forum. It's a very thorough discussion that pulls no punches, and I agree those effects are unpleasant and largely unwanted.

Dr Wassersug, co-author of the subject of this thread, was featured in a well-written media article posted by Jesus on 10-03-2007, concerning surgical and chemical castration for advanced prostate cancer. Advancement of temporary castration to early-stage cancer as its sole treatment is this new method.

[JesusA]

I sent a copy of this thread to Richard Wassersug, and he replied with the essay below:

Thank you for sending me the EA thread that started with my UroToday essay. Feel free to post this. Thank them as well for having taken the time to read my essay.

Considering generic9436's data, the sample size is too small to know whether orchiectomy has any advantage over chemical castration for testosterone control. It has been presumed that surgery would be more traumatic and it is, of course, not reversible. But there are, in fact, no data to support that.

Regarding Caith721's comment on lymph nodes, the surgeons strip the lymph nodes when they do an orchiectomy for testicular cancer. However, they do not do that for prostate cancer other than to remove some local sentinel nodes.

butterflyjack wonders whether there are data comparing orchiectomy versus

hormone therapy for the treatment of prostate cancer.

There are a lot of data on this going back decades and the two treatments are considered comparable for cancer control. The idea, though, of taking

anti-androgens plus female hormones

to reduce the size of the prostate is probably not a good one. Together they would increase the risk of a blood clot formation and would not necessarily provide better testosterone suppression (and subsequent prostate size reduction) than when either is used alone.

speedvogel speaks on behalf of "watchful waiting" as an option for prostate cancer treatment. Although there is growing literature that we are over treating prostate cancer, too many men find it emotionally difficult to just wait around without taking some sort of treatment. He is right that economics have played a role in the r

ecent rise in the use of orchiectomy over chemical castration.

I'm not clear though on what he means when he says t

hat "most men who are faced with the prospect of loosing their masculinity will opt for a different approach to treatment." He has that as a freestanding paragraph so I'm not sure what the different approach is. It's my impression that there is a large spectrum of positions on how much of one's masculinity is lost with either chemical or surgical castration. In both the prostate cancer and the voluntary eunuch communities, I've seen men on androgen deprivation therapy (ADT) claim both extremes i.e., that they are still fully male or that they are something totally different. Lots of factors play into ones self-assessment of their own masculinity.

mrt exemplifies the discomfort that some men feel when encouraged to consider "watchful waiting" as a treatment for prostate cancer. He also states that he is pissed off with the sentence from speedvogel that I quote above. Just in case someone isn't following the thread closely, I want to make it clear that the quote about most men "loosing their masculinity" is from speedvogel and not me. I leave it to mrt and speedvogel to hash out between them what are or what are not the determinants of masculinity.

The next person to comment on the thread, Woggler58, mentions both "anti-androgen" and "androgen-suppressing" drugs. One should be clear that they may sound the same but anti-androgens are, in fact, a sub group of drugs used for androgen suppression. When it comes to androgen-suppression as part of radiation therapy for prostate cancer anti-androgens are not the most common drugs used. LH-RH agonists are more commonly used (although patients are often started with an anti-androgen). Lastly, Woggler58 discusses at some length Dr. Mark Scholz's preference for the term "testosterone-inactivating-pharmaceuticals" (TIP) rather than ADT for androgen deprivation therapy. I follow closely what Dr. Scholtz writes in the Prostate Cancer Research Institute newletter PCRI Insights (and elsewhere). He's well respected, but very much a fan of non-surgical treatments. What he wrote most recently in PCR Insights, however, was not up to date on the use of transdermal estradiol to treat prostate cancer.

Overall, I was pleased to see the recent interest that prostate cancer inspired on the archives. When I first published an essay about being castrated to treat prostate cancer, the worlds of eunuchdom and prostate cancer were totally separate. Back then, it was rare to have anyone who was a prostate cancer patient on ADT, exploring his status as a eunuch. This has led me to be interested in how medical treatments influence one's gender identity. Although I've outed myself as a eunuch, I have occasionally run into prostate cancer patients, who are offended that a prostate cancer patient might ever identified as a eunuch even though I was just following a dictionary definition.

If people on the archives want specific papers of mine related to prostate cancer, they should feel free to email me directly.

Richard's major research is on amphibian neuroanatomy, and he is one of the world's experts on tadpole metamorphosis. He teaches in the school of medicine at Dalhousie University in Halifax, Nova Scotia.

.

[butterflyjack (imported)]

Thanks for this Jesus..I stand edified, clarified...smooches dragonfly