Ask Arthur … pretty much anything you like
Arthur’s done this all before. Hundreds of people around the world asked Arthur their questions about prostate cancer from 1994 to 1997 on the original Prostate Cancer InfoLink.
Please understand that Arthur is not a physician. He is only a reasonably well educated layman with some experience of prostate cancer and its problems. He cannot provide you with medical advice. You should always talk to your doctor about your clinical condition and how it should be managed.
You may post your question for Arthur using the comments/reply box below.
Is it true that eating lots of tomatoes can help to prevent prostate cancer? I’m confused. Thanks!
Arthur’s reply
Hi Cassie. Arthur says he’s not surprised that you’re confused. There has been lots of backwards and forwards information about this one over the years. Here’s the easiest way to think about it. There has never been any study that was big enough or rigorous enough to prove that a diet high in tomatoes (or in a chemical called lycopene, which is common in tomatoes) reduced a man’s risk for prostate cancer. So, strictly, no. We do not know that eating tomatoes prevents prostate cancer. However, eating a good, regular, mixed diet, including fruits and vegetables, and without excessive amounts of dairy and meat products, is good for nearly everyone and has significant potential health benefits. Including tomatoes in that diet isn’t going to hurt!
Hi Arthur,
I’m a post-RP 51-year-old with systemic GS9=5+4, no proven mets. It’s clear I probably have hormone therapy in my future. As a comparatively young man with a strong interest in sex, I dread the consequences.
I talked with one man on ADT who said, “When I look at a woman, all I see is clothes.” This strikes me as forlorn; but even worse was his lack of sadness or even interest in it; it was as if he was saying, “I wear brown shoes now.” Another man on ADT I talked with has gynecomastia. He told me, “It’s no big deal — I just don’t look at myself in a mirror with my shirt off.” Neither one of them even thought to mention that you lose all your chest and axillary hair. Both of them said that they didn’t really have any side effects from ADT, other than hot flashes.
Maybe I’m being vain, but sexlessness, hairlessness, and pendulous breasts on a man strike me as significant side effects. (I understand that I have a different point of view, inasmuch my upcoming ADT is prophylactic rather than remedial and presumably a last resort, as it was for these two men.)
But I can’t help wondering: What else about ADT am I not being told?
My situation with regard to ADT reminds of how I was before my RP — I thought I was well-informed because I knew about anesthesia, blood loss, incontinence, and impotency. I only learned later about “minor” and “self-evident” side effects like infertility climacturia, lack of ejaculate, altered orgasm, and penile shrinkage. If I had known about them in advance, I would still have had the surgery, but I probably wouldn’t have been hit so hard by depression over how much I had lost in feelings of masculine self-worth. I simply wasn’t well enough prepared or informed psychologically, despite a lot of clinical knowledge.
So my question is this: How much does a young(ish) man change when he is chemically castrated? Does he become a totally different person without even realizing it?
Arthur’s reply
Dear Paul:
Over the years Arthur has met a LOT of men who had had hormone therapy … with surgery, with radiation, for metastatic disease, you name it. These men had varied responses to hormone therapy (with few “pendulous breasts” to be fair). What Arthur can tell you is that no one became a different person “without even realizing it.” They knew what was going on.
Having said that, the effects of hormone therapy are significant. It is, after all, intended to minimize testosterone levels, and that can introduce profound biological changes that depend on individual endocrinology.
There are two things you need to do (in Arthur’s opinion). First, you need to find a “buddy” who has been on hormone therapy for a while but still has a positive attitude to life, regardless of how the hormones have affected him. Second, you need to start talking to your doctor about what can be done to minimize the adverse effects in your case when you have to start the hormones. One thing you can certainly consider is the possibility of intermittent hormone therapy. The evidence regarding the effectiveness of this (and the long-terrm impact) is still accumulating, but it certainly appears to work for some men.
The single most important thing is going to be what goes on in your head. “Sex” is as much a mental thing as a physical one. Just because you don’t get an instant response every time you see a well-developed 19-year-old young woman in a bikini does NOT mean that you aren’t still interested.
Here is a really good special report from Johns Hopkins that deals exactly with this issue:
Advice to Help You Cope With Side Effects of Prostate Cancer Treatments
* Hormonal therapy for prostate cancer can be rough with unpleasant side effects. Johns Hopkins provides advice to help soften the impact.
Arthur adds
Thanks for the input Joan. Arthur’s a bit rusty but he’s getting back up to speed as fast as he can manage!
Albert Pugh asked … So, do you define a double failure when 6 weeks after RP the psa is greater than presurgical (17.9 ->25 and then confirmed at 30 one week later. And then 8 weeks post IMRT a psa of 35.
Arthur responded as follows:
Dear Mr. Pugh: Those are certainly not the sorts of outcomes that you or your doctors can be too happy about. Obviously Arthur has very limited information to go on here, but it certainly sounds as though you may already have had micrometastatic disease by the time you received surgery. In other words, there may have been at least one tiny focus of cancer that had already escaped from the prostate and had traveled beyond the pelvic area that was radiated too. There MAY be other explanations for this continuing rise in your PSA, but this is the explanation that Arthur would think is most likely. You need to have a serious discussion with your doctors.
Is it wrong to assume that its possible to aggravate and increase the aggressiveness of any cancer found in the prostate with biopsies? I look forward to your response.
Arthur’s reply:
Arthur knows of no information that would suggest that this is the case. As just one example, we know that initial “saturation” biopsies don’t do any better at finding prostate cancer than the more standard initial 10- or 12-core biopsies. Now a “saturation” biopsy (which may involve the removal of up to 40 or 50 biopsy cores) would definitely fall into the category of “aggravation,” but there is no evidence that men who have undergone such saturation biopsies are any more likely to have aggressive prostate cancer later on.
Yours is a sensible question … but it seems like the answer is “yes,” it is wrong to make that assumption in general. (Having said that, Arthur is going to hedge his bets and add that there is always the possibility of exceptions to such a general rule. It would be unwise to suggest that such an event had never or would never occur.)
Arthur hopes that helps.
Hi Arthur
I’m a post op rp in 1966 with recurrence.. I have the slides from my procedure, Is there any point, at this time, to get the slides reevaluated? Ie: post op Gleason score, or any other info that would be of assistance in treating me at this time. I am currently on intermittent hormone therapy.
Thanks Arthur
Ed Roge
Arthur responded as follows:
Dear Ed: That’s a great question. And of course the answer is “Maybe!” Actually, to be strictly accurate, the answer is really “Maybe, but probably not.”
The critical issue here is going to be what your PSA, clinical stage, and Gleason score were at the time of your original surgery (which Arthur is assuming was actually in 1996 as opposed to 1966, yes?). If you had (say) PSA 5.4, Gleason 7, clinical stage T1c prior to surgery, which was then reassessed as Gleason 8, pathological stage T2c (for example) post-surgery, then a 12-year response to the surgery (while not as long as you were looking for) is still good.
Are you able to tell Arthur what your PSA, your Gleason score and your clinical stage were before surgery, and what the Gleason score and the pathological stage were post-surgery? Arthur is also assuming that you had negative lymph nodes at the time of surgery (if they were even sampled).
Also … how long have you been on IHT, and how are you responding? The critical question here is going to be whether the post-surgical information available from your slides gives any possible guidance to your doctors about the value of enrolling in some form of clinical trial to try to put yourself back into remission, such that you can stay off the hormones (at least for another really extended period of time). Oh, and one last question … How old are you now?
Hi Arthur:
Yep, you’re right, 1996 not 1966, that was a typo. My pre-op score was: Gleason 3-4, PSA 7.2. Post-op was Gleason 3-3, margins clear? A few lymph nodes were dissected prior to surgery and they were negative otherwise the operation would have been aborted. The pathology was done in the same hospital as the surgery, and I’m not too confident of the expertise of the pathologist. I started HT a few years later and was on and off, currently off about a year. PSA is slowly rising. Will probably go back on when it reaches 6 or so, this is a arbituary figure, also was on PC Spes for about a year. I will be 74 in May.
Thanks Ed Roge
Arthur’s reply:
Arthur says he feels a lot more informed now — although he isn’t entirely clear why you started on the hormone therapy “a few years later and was on and off.” So …
First, if your Gleason score went down from a biopsy-based value of 3 + 4 = 7 to a post-surgical value of 3 + 3 = 6, Arthur feels pretty comfortable that a re-evaluation of the prostate pathology material at this stage isn’t going to have any major impact on what you may or may not need to do now or in the future.
Second, you have effectively been practicing intermittent hormone therapy for some time, and (subject to your doctor’s opinion) Arthur can’t see any good reason for not continuing that strategy as a standard means of dealing with your situation. You just might want to “formalize” the strategy a bit more by having a clearer understanding from your doctor about why he thinks 6 ng/mL is a “good” PSA level at which to restart the hormones each cycle. (There’s nothing wrong with this number. It is indeed arbitrary. But your doctor might have had some reason for picking it as opposed to some other arbitrary number.)
Third, the one other thing you might want to consider is a consultation with a medical oncologist about the potential risks and benefits of an early course of docetaxel-based chemotherapy (before any signs of visible metastasis). This is not an “approved” form of treatment yet, but there are several clinical trials exploring this possibility, and medical oncologists with considerable experience in treating advanced prostate cancer are optimistic that, by using docetaxel earlier in the treatment pattern for men with progressive disease, they may be able to induce longer remissions which will also limit the need for hormone therapy. It’s not a question of “you should” or “you shouldn’t” have such treatment. But if you meet with an appropriate oncologist and talk with him or her about it, then you will be appropriately informed about whether this might be approriate for you and you can think about the potential risks and benefits.
Thanks for the replies. Can you give me any more info on the docetaxel therapy? Such as: how is it taken, for how long, what are the side effects, any other info that you can provide concerning this therapy.
Thanks Arthur
Ed Roge
To which Arthur responded as follows:
Dear Ed: Athur says that if you go to The “New” Prostate Cancer InfoLink Social Network you will find a whole discussion on this topic, complete with links, which will help you a lot.
Basically, Taxotere is usually taken once every 3 weeks for about 8 weeks as an intravenous infusion at the oncologist’s office, together with a steroid known as prednisone (which is taken orally every day). Taxotere CAN have a lot of side effects, but most of them are manageable. However, if you are particularly proud of a fine head of hair, that’s going to go! If you read the long list of side effects on the Taxotere prescribing information, you’ll probably be put off, but the vast majority of patients don’t get most of these adverse reactions. Men do tend to be tired for a couple of days after each infusion.
Arthur, I have a question about an herbal supplement called Prostasol.
I am stage D2, 5 years out. PSA nadir on intermiitent hormone ablation. Have been on Zometa holiday subsequent to tooth extraction.
My question is this: A recent study (Anderson J. Management of advanced prostate cancer: can we improve on androgen deprivation therapy? 2008 BJU International 2008;101:1497-1501) states that level of testosterone should be below 20 ng/dl — and that this is a good predictor of longer survival.
I am able to lower my testosterone to this level by taking Prostasol — but I get breast tenderness and I suspect there may be estrogen in this herbal supplement. I have stopped taking the Prostatsol and am waiting for blood work to determine if what my other hormone levels look like and what the risk is for stroke. Are you familiar with this product? I wonder if this is PC-Spes with a new name? Thanks.
Arthur responded as follows:
Hi Charles. Arthur is aware of Prostasol but does not have any specific or detailed information about the clinical risks or benefits of using this product. However, he is always very suspicious about these supposed “alternative medicines” that are not actually natural products. His suspicion was only made worse by the whole PC-SPES issue. The very fact that there are no good clinical data to support the use of this product is enough to make Arthur twitch!
It is clear that Prostasol will lower men’s testosterone and PSA levels (at least in some men), and when one has metastatic disease, one may reach the point where products like Prostasol start to look like a good idea, regardless. So. Here is Arthur’s basic rule: Thou shalt use all alternative medicines only after a complete discussion with thy physician so that everyone knows the deal! (and is therefore ready to handle the potential consequences). In the meantime, it sounds to me like you are doing the right things. The two people whom it might be worth really getting an opinion on Prostasol from would be Mark Moyad, MD (University of Michigan) and Charles “Snuffy” Myers, MD (Early, Virginia). They have both made a considerable effort to study the pros and cons of a wide range of “alternative” medications. Arthur did a quick search on the Web, but he couldn’t find any specific comments on Prostasol by either of these individuals.
Dear Arthur:
As you may recall I have recurrent PC after failed rp in 1996. My primary care md just put me on iron supplements, Slo Fe, due to a low iron count in my blood work 31, range 45-170 mcg/dl. Would the iron supplements effect by recurrent pc. I am currently off cycle on hormone therapy, psa 1.24.
Thanks Arthur
Ed Roge
Arthur responded as follows:
Hello again Ed. Arthur has no reason to believe that that type of iron supplementation would have any impact on your cancer. However, this is the sort of thing that you would be wise to make sure your urologist is aware of when you next see him (or before). Arthur isn’t a doctor, and there may be subtleties here that he doesn’t know about. So … If you doctor is the sort who is OK getting messages from his patients by e-mail, just drop him an e-mail and tell him that your primary care physician has put you on Slo Fe because you have a low blood count. Or if he has a nurse, call the nurse and ask her to make a note in your file and to let the urologist know. It’s always best to make sure that your doctors know everything that you know. That way you minimize any risk for confusion and miscommunication.
Mark Waltermire wrote that “Testosterone is always kept low in PC patients. A side effect is weight gain, particularly belly fat. How is a PC patient to keep his body weight low considering low testosterone is maintained in PC patients???”
To which Arthur replied:
Dear Mr. Waltermire, the ability to maintain a health body weight when being treated with hormone therapy for prostate cancer can be extremely challenging. What works for some men simply does not seem to work for others.
The one thing that Arthur is relatively sure of is that “determination, a well-controlled diet, and regular exercise are all critical.” You might find it helpful to join the Social Network (see link in the left-hand column). Some men on hormone therapy who belong to that network have found ways to keep healthy and very fit (by most people’s standards). Learning from their experiences may be helpful for you.
Within 6 months I went from 1.0 to PSA Total-4.9, free PSA 0.6. My physician asked me to wait 4 months which then showed a rise to 6.74. Biopsy revealed 5 cancer sites out of 12. He suggested that I go on hormonal therapy, which I did. At that time “Uropredict”: organ confined 22%, extraprostatic ext. 78%, Seminal vesicle 9%. Age 83, PSA 6.74, Gleason score 8, Clinical stage T2, Unifocal: no. I’ve rec’d 2 shots of Lupron, 3 mos. apart. Any suggestions? I’ve had no radiation.
Arthur responded as follows:
This situation is very much one for individual discussion between you and your physician. You have signs of potentially aggressive disease; your PSA is still low; but you have a short PSA doubling time. It seems to Arthur that the key issues here are (a) whether the hormone therapy has dropped your PSA to zero and, if it has, then (b) how long can the hormone therapy keep your PSA down at zero. There are two things to ask your physician that might be helpful. The first is whether, if your PSA is maintained at zero, he thinks intermittent homrone therapy might be a possibility. The second is whether he would even consider referring you for radiation therapy. Arthur thinks it is only proper to inform you that radiation therapy may not be appropriate in someone of your age, but that also depends on all sorts of other health information that you have not provided. Radiotherapy might be appropriate in a “young” 83-year-old with a 10-year life expectancy, for example. Having said all that, the first thing you need to know from your physician is what your PSA is now — after the initial few months of hormone therapy.
i can’t seem to find out if denosumab is a bisphosphonate. I can’t take bisphosphonates because of previous head and neck cancer radiation treatments which probably have caused osteoradionecrosis of my jaw, so denosumab is very interesting to me.
Thanks, Clark
Arthur replied:
Dear Clark: Denosumab is not a bisphosphonate. Denosumab is a fully human monoclonal antibody that specifically targets the receptor activator of nuclear factor kappa B ligand (“RANK-L”), a key mediator of the cells responsible for bone breakdown. However, since Arthur has seen only a small amount of adverse effects data related to the use of denosumab yet (and none in a cancer condition), he cannot tell you whether it has any of the same risks for ONJ as the bisphosphonates. Until full publication of the safety data from clinical trials, it may be difficult to know precisely what some of the less common side effects of denosumab might be.