Hormone treatment side effects

JerryB · Regular Joined: 13 Jul 2009 Posts: 43 Location: UK

I am a little over halfway through a three-month period of hormone treatment (Prostap3 injection) with the aim of shrinking my prostate prior to brachytherapy.

I am experiencing low energy levels, very poor sleep pattern + sweats, lost libido, weight gain, constipation, and general aches & pains.

Is anyone able to comment on how quickly these side-effects may disappear after the end of the three-month period?

Thanks. Jeremy

Age - 67. General health and fitness - good.
PSA (February 2009) – 7.8 ug/L. This had risen from 5.3 ug/L in August 2008.
Gleason – 7 (4+3). T stage – 2b. Prostate size - 52 cc

Jean222 · Senior User Joined: 14 Dec 2008 Posts: 249

Hi, I think most of your ailments come from the treatment.

My Hubby is adjusting to living with many of them, as he's on ADT.

Poor sleeping, sweats, no libido (had RP) and a bit achy, all to be expected.

As for the constipation, please add something like Metamucil and drink lots of water, fresh fruits and veggies, etc.
The constipation can make you feel very sluggish.

I know it's hard but for the low energy levels and aches and pains, try doing more activity, in spite of them, as the increased activity should give you more energy. Also some of the aches and pains may decrease.

Sorry to hear that you're feeling so crummy, it's part of your induced andropause. IMO

Best of luck with your treatment for PCa.

Jean

johnT · Senior User Joined: 27 Apr 2009 Posts: 176

Jerry,
This may be too late for you, but others may benefit. If your goal is to shrink the prostate prior to radiation or brachytherapy instead of taking Lupron take Casodex and Proscar. The side affects are about 20% that of Lupron and it works better at shrinking the prostate.
Many radiologists still recommend Lupron because they don't know any better. I spent a week convincing my radiologist that I would be taking Casodex instead.
Prostate went from 60mm to 32 mm in 8 weeks and PSA from 40 to 0.02.
The only side affect I had was loss of libido, no fatigue and very minor hot flashes about once a day for 1 or 2 min.

JohnT
_________________
psa at diagnosis 40 in nov-08
gleason 6 and 7
Treatment choice seeds and IMRT

johnT · Senior User Joined: 27 Apr 2009 Posts: 176

Also if you are taking Casodex also take Femera as it will stop any breast growth or tenderness. Keep taking Femera for a month after you stop Casodex as it will stop any affects of the hormones raging back.
JohnT
_________________
psa at diagnosis 40 in nov-08
gleason 6 and 7
Treatment choice seeds and IMRT

JerryB · Regular Joined: 13 Jul 2009 Posts: 43 Location: UK

Thanks to everyone for your helpful comments. Like all of us at my stage of prostate cancer I'm hoping that brachytherapy will put it into remission. My experience on just a short period of ADT makes me quite concerned at the idea of perhaps needing to go on ADT 'full time' sometime in the future if things don't work out well. I've noted the comments about Lupron versus Casodex and Proscar.

So far, breast growth or tenderness is about the only thing I haven't experienced!

Jeremy

John M · Experienced user Joined: 27 Jul 2009 Posts: 59

This is an article in today's New York Times:

http://www.nytimes.com/aponline/2009/08/25/health/AP-US-MED-Prostate-Cancer.html?scp=3&sq=prostate&st=cse
_________________
John

johnT · Senior User Joined: 27 Apr 2009 Posts: 176

Jeremy,
Compared to what you are going trough now Brachytherapy is a walk in the park. There is no pain, you may have some urinary frequency and urgency for about 4 to 12 weeks, but it is manageble with FlowMax and does not affect any of your daily activities. Take ibupropin for about a week to reduce the prostate swelling. Don't drink any alcohol or caffine. All in all a pretty minor procedure. I don't know how they do things in the UK, but be sure to have a CT scan 2 weeks after the procedure to insure that all the seeds are properly placed and there are no dead spots, and make sure they scope the bladder as soon as they are done to insure no seeds are in the bladder. These are standard quality control protocols in the US and I assume they would do these. I have heard of some doctors skipping these steps so make sure your doctor does them.
JohnT
_________________
psa at diagnosis 40 in nov-08
gleason 6 and 7
Treatment choice seeds and IMRT

JerryB · Regular Joined: 13 Jul 2009 Posts: 43 Location: UK

Thanks again to the 'Johns'. A useful link from John M, and encouraging information regarding brachytherapy from John T. I've been to an acupuncturist this morning to see if it can help with the sleep problems. Worth a try.

At the moment, there is some doubt as to whether I shall be a suitable candidate for brachytherapy as I have fairly severe BPH and my consultant is not sure if my prostate size / flow rate can be reduced / improved sufficiently for brachytherapy to be successful. Because of this I'm looking into other possible options.

Cheers, Jeremy

John M · Experienced user Joined: 27 Jul 2009 Posts: 59

Yeah, urinary obstruction is the pits. One reason I chose surgery is that I couldn't see how I could handle the possible increased obstruction from the seed therapy.
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John

johnT · Senior User Joined: 27 Apr 2009 Posts: 176

Just to set the record straight, the incidence of total urinary constriction is very rare in Brachytherapy. If you have had a TURP or problems with your urinary stystem there is an increased chance and you would not be a good candidate for seeds. The normal incidence is about the same as surgery, very low.
What you don't have is incontenance which is 100% in surgery for a period that may last for weeks up to a year with the chance of some sort of permanent incontenance. Some stress incontinence will last for months or years.

With seeds there is no catheter, at most one for 12 hours, In surgery you will have a catheter for weeks and many for months.
There is a huge difference between the temporary urinary constriction with Brachatherapy which can be handled easily with FlowMax and the incontenance from surgery that is managed by a catheter or pads.

There is a much higher rate of serious complications from surgery than any other treatment , because it is a major surgery and involves a serious invasion.

The recovery time for Brachytherapy is about an hour and there is no pain. For surgery, hospitalization is at least a few days, with moderate to severe pain, and return to work or normal activities is weeks.

ED in Brachytherapy does not occur until about 3 years. ED is 100% after surgery and slowly returns in about a year. At the 3 year mark both are identical and can be managed with meds.

With seeds you still have some ejaculate, none with surgery, A high % of surgical patients ejaculate urine during sex and have a penis length about 15% shorter than before surgery.

The cure rate for low grade, localized PC are very similar between the two procedures.

The above are NORMAL expected side affects for both procedures. A small number of patients will do either better or worse than the above.
JohnT
_________________
psa at diagnosis 40 in nov-08
gleason 6 and 7
Treatment choice seeds and IMRT

John M · Experienced user Joined: 27 Jul 2009 Posts: 59

Don't mean to get in another disagreement with John T, but I don't quite agree with the above post. There is a risk that brachytherapy may cause increased urinary obstructive symptoms. See abstract at the bottom of this post. And, while the incidence of at least transient urinary incontinence after surgery is very high, it's not 100%. This is also covered in this samw article. Also, resorting to internet anecdote, I had a radical open prostatectomy and did not have one second of urinary incontinence, in fact, my urinary function is better because it took away my urinary obstructive symptoms and the need to go to the bathroom every 3 hours. Not that this is the expected outcome, I was just lucky.

BTW, the article below was given to me by a radiation oncologist. Getting the full article from a medical library or on line purchase is worthwhile, if one is trying to compare the risks and benefits of surgery and radiation.

New England Journal of Medicine
Volume 358:1250-1261 March 20, 2008 Number 12

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 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.
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John

John M · Experienced user Joined: 27 Jul 2009 Posts: 59

Also, as this article discusses, the risk of serious complications with surgery is very low. Post operative catheter time is typically 7 to 14 days. Hospital time is 48 to 72 with open prostatectomy, about 24-48 with robotic.

The article gives graphs for sexual and urinary dysfunction over time so you can compare brachytherapy, radiotherapy, and surgery. The link to the article is

http://content.nejm.org/cgi/content/abstract/358/12/1250.
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John

John M · Experienced user Joined: 27 Jul 2009 Posts: 59

Oops, the link doesn't work. You can access this article by going to the New England Journal of Medicine home page at

http://content.nejm.org/

and doing a search on "prostate cancer quality of life"
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John

johnT · Senior User Joined: 27 Apr 2009 Posts: 176

Sorry John,
I can point to studies by Datoli and Blasco that show the opposite.
Urinary irration occurs after Brachytherapy, but you use FlowMax and it becomes very managable in fact unnoticable after a few weeks; total urinary obstruction is rare.
Incontinence is 100% after surgery; that's why you wear a cathether for at least two weeks. Normal incontenance, using pads and stress incontinence takes months to go away; being totally dry in a month is very unusual. (Go on the surgery forums).
Sardino at Slone Kettering clearly states in his book that all data from MSK, one of the best prostate surgical centers, 40% of all prostate surgeries are unsuccessful, defined as no cure, permanent side affects or major complications.
Bowel isssues with brachytherapy are about as common as death in surgery, which is virtually none. There is about a 5% issue with bowels using external radiation.You can point to an individual study to prove any point, but the above side affects are the norm for these procedures.
I'm not against surgery or pro radiation; just getting out information that is factual so people can make their own decisions and have reasonable expectations.
_________________
psa at diagnosis 40 in nov-08
gleason 6 and 7
Treatment choice seeds and IMRT

Hawk · Senior User Joined: 22 Nov 2006 Posts: 406

The doctor that performed my laproscopic surgery (not robotic) usually leaves the catheter in for 5 - 7 days to stabilize the urethra junction and to reduce chance of a leak in the junction, not to help with incontinence.

Additionally I would NOT say I was incontinent after surgery and I did not need a pad. I wore a one half of pad (actually cut in half) per day but would have managed with none. I never used my one box of pads. I did have stress incontinence (drops), but probably no worse than many women and men that never had surgery.
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History: PSA's 6.7 neg. biopsy - PSA 16.6 neg. biopsy - PSA's 8.2, 8.1, 8.7 - Biopsy. 4+4 Gleason 8. Lap RP Apr 2004, age 52 All neg margins, nodes, and structures. (T2a). Post RP PSA: every 6 mo. <.1 until Feb, 08 (46 mos) PSA .1 - I then got sensitive tests (all in 2008) showing:
Feb .06, May .09, Jun .10, Aug .10, Nov .15 -SRT

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