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Prostate cancer and blocking testosterone

Prostate cancer is often slowed by the removal of the testes (the principal source of testosterone) or by the use of a drug that blocks testosterone.  However, this is overdone for most prostate cancers are indolent.  There is however an uncertain as to whether a particular prostate cancer is indolent, and for who long it will remain that way.  However, given the effects upon the quality of life, this intervention occurs too often.  Below is an article which questions the common practice.

 

 

Prostate-Cancer Treatment Questioned

By KEITH J. WINSTEIN
March 20, 2008; Page D5

 

Prostate-Cancer Treatment Questioned

By KEITH J. WINSTEIN
March 20, 2008; Page D5

Hormone therapy, an aggressive treatment for prostate cancer, may be overused, a new study suggests.  Treatment used to reduce the size of the prostate has been shown to improve survival in advanced cancers, but doctors have increasingly been giving hormone therapy in less-severe cases.

The study, published in this week's New England Journal of Medicine, charted the quality of life for 1,201 men and their partners after the men received three kinds of prostate-cancer treatment: removal of the prostate; implantation of radioactive seeds; and radiation therapy in a laboratory. The prostate is a gland that helps make semen.  About a third of the patients who received radiation therapy or radioactive seeds also took hormones, and those patients had more problems with energy and sexual function. Doctors and patients made their own decisions about what treatments to take and weren't assigned to different groups by the study, so the study's conclusions are more suggestive than definitive.

Martin Sanda, a urologist at Beth Israel Deaconess Medical Center in Boston, who led the study, said the findings would "throw a splashful of cold water" on the practice of providing hormone therapy for less-severe cancers.  "Doctors or their patients should think twice if they're considering hormone therapy," Dr. Sanda said. "Most of the cancers that are treated nowadays are not really that aggressive."

Treating prostate cancer is a balancing act. Aggressive treatments and surgery can usually cure it -- more than 99% of patients now survive at least five years, up from 69% thirty years ago. But too much treatment can make a patient needlessly miserable.

In the U.S., about one in six men will be diagnosed with prostate cancer over their lifetimes, according to the American Cancer Society. Among men, it is the most common cancer and the No. 2 killer, behind lung cancer. This year, that will be about 186,000 diagnoses and 28,700 deaths in the U.S., the society estimates.

 

 

NEGM (New England Journal of Medicine, volume 358:1250-1261, March 20, 2008, Number 12. http://content.nejm.org/cgi/content/abstract/358/12/1250

 

Quality of Life and Satisfaction with Outcome among Prostate-Cancer Survivors

Martin G. Sanda, M.D., Rodney L. Dunn, M.S., Jeff Michalski, M.D., Howard M. Sandler, M.D., Laurel Northouse, R.N., Ph.D., Larry Hembroff, Ph.D., Xihong Lin, Ph.D., Thomas K. Greenfield, Ph.D., Mark S. Litwin, M.D., M.P.H., Christopher S. Saigal, M.D., M.P.H., Arul Mahadevan, M.D., Eric Klein, M.D., Adam Kibel, M.D., Louis L. Pisters, M.D., Deborah Kuban, M.D., Irving Kaplan, M.D., David Wood, M.D., Jay Ciezki, M.D., Nikhil Shah, D.O., and John T. Wei, M.D

ABSTRACT

Background We sought to identify determinants of health-related quality of life after primary treatment of prostate cancer and to measure the effects of such determinants on satisfaction with the outcome of treatment in patients and their spouses or partners.

Methods We prospectively measured outcomes reported by 1201 patients and 625 spouses or partners at multiple centers before and after radical prostatectomy, brachytherapy, or external-beam radiotherapy. We evaluated factors that were associated with changes in quality of life within study groups and determined the effects on satisfaction with the treatment outcome.

Results Adjuvant hormone blocking therapy was associated with worse outcomes across multiple quality-of-life domains among patients receiving brachytherapy or radiotherapy. Patients in the brachytherapy group reported having long-lasting urinary irritation, bowel and sexual symptoms, and transient problems with vitality or hormonal function. Adverse effects of prostatectomy on sexual function were mitigated by nerve-sparing procedures. After prostatectomy, urinary incontinence was observed, but urinary irritation and obstruction improved, particularly in patients with large prostates. No treatment-related deaths occurred; serious adverse events were rare. Treatment-related symptoms were exacerbated by obesity, a large prostate size, a high prostate-specific antigen score, and older age. Black patients reported lower satisfaction with the degree of overall treatment outcomes. Changes in quality of life were significantly associated with the degree of outcome satisfaction among patients and their spouses or partners.

Conclusions Each prostate-cancer treatment was associated with a distinct pattern of change in quality-of-life domains related to urinary, sexual, bowel, and hormonal function. These changes influenced satisfaction with treatment outcomes among patients and their spouses or partners.

 

There are patterns to care.  One is to over prescribe:  it is the safe things.  Doctors are not sued for giving standard treatment.  If a conditions progresses, most people will think it is because of the medication withheld.  Thus even when the treatment has a profound effect upon the quality of life, most physicians will nevertheless prescribe that drug.  One particular one is for the prevention of epileptic seizures.  Others are chemo therapy for cancers

 

Other reasons for medicating include financial gain through the need to monitor the physician, and assorted social pressures exerted by other physicians and drug salesmen.  Moreover it is quicker to write a script then explain why not.