Can we talk about, you know, you mentioned the possible case of stopping the intermittent hormone
therapy and maybe doing it for a short time period versus a long time period, and I think
that anytime somebody's on a treatment what they really want is the cure but since prostate cancer
is a chronic disease and you kind of really have to monitor it and there's different treatments
that work for certain periods of times a lot of times not saying there aren't treatments that
totally do kill it, there are, but how does a man who's on intermittent hormone therapy
really know where he's at? Like, do you just monitor PSA and if the PSA is rising up
you know it's not a cure; he went into a short remission? Can you define what those terms are?
Yeah, I mean the issue is primarily driven by PSA. The PSA is a unique marker for prostate cancer;
we don't have, really, anywhere near as effective hormone treatments
for other cancers like we have for prostate, and we don't have anywhere
near as accurate markers as we have with PSA. So, the whole idea in taking a holiday
is that the amount of cancer in these gentlemen has been reduced to very tiny amounts and that
when the treatment is stopped and the testosterone comes back and the cancer starts growing again,
if you allow the PSA to say rise up to five or six or something in that range,
you really haven't given the cancer much of a head start and then the typical policy, then,
is to restart the treatment and, of course, not allow the cancer to get out of control.
But that time period from the PSA going down, you know, starting at zero and going up to five or six
may be several years and quality of life can certainly be improved during that time period.
Another thing that's come up with intermittent treatment is with the advent of these new PSMA
PET scans is we can now start looking for where the cancer is and possibly when that is discovered
treat it with a spot radiation, and this is called the whole field of oligometastatic disease
which is a big topic we're not going to go into right now, but the idea of trying to cure some of
these men that previously were incurable because we couldn't really locate where the cancer was.
I have a patient recently who asked PCRI if they can take
testosterone replacement therapy when they're doing intermittent hormone therapy.
Yeah, well that would be the exact situation where it could be discussed. So, if someone has
stopped his Lupron with the idea that they want to get their testosterone back but that after a
period of say six months there's no evidence of normal testosterone production, we'll have
a conversation about giving some testosterone. The testosterone that comes from the testicles or from
a cream or a shot is all identical so there's no real reason to be prejudiced against the
guys who's got weak testicles. He can take some testosterone if it's appropriately supervised.
Can you talk a little bit about bone density and hormone therapy and do they take a pause
in the bone density drug when they're off hormone therapy? How does that work?
Well, people lose calcium quickly from their bones when their testosterone is low,
just as postmenopausal women who lose their estrogen also lose calcium quickly, and then if
that becomes extreme, we call that osteoporosis which is the bones have become so weakened that
they're at risk for fractures. That can be easily prevented with oral medications like Fosomax,
Boniva, Actonel, or injectable medicines such as Prolia, and typically those things should be done
routinely. You can check people's bone density with a simple scan to determine if people are
predisposed to fractures but almost everyone loses calcium from their bones when they're
going through this treatment so our typical policy is put people on medications automatically
regardless of how good the bone density is to start with because we don't want it to get worse.
Can you actually speak to diet when it comes to hormone therapy? I know that's a long huge
subject but in regards to when it comes to, you know, their testosterone going low obviously
they're going to gain weight and you want to do muscle resistance, how much does diet affect that?
Diet is everything. It's just a matter of caloric intake. The problem is that if people lose muscle
their metabolism slows down, so if they just stay on the same diet that they've always eaten,
they're going to start to accumulate weight. So people have to take special precautions
and cut back maybe drop one meal a day or something like that and they won't gain weight,
but if people stay in their normal mode of what they've always done and their
metabolism is slowing down they're going to put on some weight usually around the middle.
Thank you so much for watching if you would
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