ART ADT n Life Without Testosterone for Prostate Cancer Patients
ADT…we have all been told about it, some have selected it in their treatment regimes, most I fear have incomplete knowledge of what it does to general health, to men’s sexual function and specifically, to their penile organ. I had no idea of many of its impacts when I started my 21 months of treatment. Would I do the same thing over again, knowing the information contained in this podcast? No, I would not. I would be much slower to pull the trigger on ADT. If I went that route I would have been more aggressive in treatments to preserve my penile organ size and health. Ultimately, given my treatment decisions (RP w single nerve sparing, plus sRT IMRT and 21 months ADT Lupron), I would have moved much sooner to an IPP (inflatable penile implant) and not suffered permanent damage to my penile tissue.
In summary, I was not told of the sexual side effects of long-term ADT. Until this podcast I had no idea many of the side effects start 1 month after taking ADT! Its amazing to find that ADT alone has more impact on sexual function than radiation treatment without ADT! For me, even after having hired a ‘sexual health’ specialist, I was not counseled on what long term ADT and lack of TET (testosterone) would do to my sexual function. My induction to surgery did not mention many of the sexual function impacts noted here, nor was I given a sexual function evaluation pre surgery. There was simply no urgency to discuss this aspect of men’s health either before surgery or radiation treatment…preservation of life was the main focus; full stop.
This podcast has exposed much of what I learned about ADT treatment's impact on sexual function during my ‘hands on’ Phd PCa program…I hope when seen in advance that other men out there can make better informed decisions on use of hormone treatments. It can extend life, delay progression of PCa and be of benefit to a specific type of PCa patient. In fact we find out at MIN 1:30 that 92% of men are satisfied with their ADT treatment; no reference provided. But it should not be used blindly as I did as a general prophylactic without a keen understanding of what you are doing and the impacts of its long term use.
Podcast MIN: Key discussion points;
MIN 00:35 Forewarned is Forearmed – Men should know ADT’s side effects up front; it will help them deal with side effects when they materialize. They can also identify side effects faster and seek care for them sooner! [Profound statement]
MIN 2:48 TET Levels – The time with LOW TET more important than the length of ADT treatment. ADT duration has a ‘tail’ or lag; TET may take months or years to return to normal (300 ng/ml is the threshold for low TET). In some men TET never returns. [Baselines for TET are not generally taken in men before treatment; 82% of men don’t get levels checked before they start RP or RT!]
MIN 3:15 TET Recovery – MSK data shows only 2/3 of men at 2 years post ADT have recovered their TET; 10% are still at castrate levels (less than 50 ng/ml). Some men never recover their TET!
MIN 3:50 Fatigue – Fatigue will affect most men in some way when they take ADT. TET levels are linked to energy levels; return to normal levels bring 20% reduction in fatigue levels. 6% Men at baseline had fatigue issues but at 6 months that grows to 36% of men treated.
MIN 5:15 Hot Flashes – 93% of men will get hot flashes within first 12 months. There is variability in this symptom across men treated.
MIN – 6:05 Sexual Function Impacts – Small study showed 18 couples were all affected by ADT treatment; 100%. Libido is affected; Mental and Visceral Libido both impacted. Metal Libido is preserved in most cases but Visceral Libido is suppressed by ADT. Since most couple’s sex is Male initiated ADT use negatively impacts sexual relations between couples.
MIN 7:50 Libido Impact - Libido has the biggest impact on couple’s relationships. Small study of 9 men should after 12 weeks of ADT none of them were having sexual relations with their partners. Partners either did not step up to initiate sessions or felt rejected by lack of Libido in partners. Another study of 400 men found 50% had no Libido and only ¼ of the men had sexual relations.
MIN 8:36 ADT Impact Libido Study – Study of 400 young healthy men treated w Lubron; castration TET achieved. Separated into 5 groups, one group given no TET and the other 4 increasing levels of TET replacement. Libido was correlated to TET levels; the lower the less Libido reported.
MIN 9:15 Nocturnal Erections – Nocturnal erections are lost when using ADT. Healthy men get an average of 0.4 erections per Hour of sleep per night (measured by Rigid-scan device worn); 10 hrs sleep would provide 4 erections. After only 1 month on ADT nocturnal erections were lost; going down to 0.05 erections per hour w those being progressively less frequent, less rigid and shorter in duration. [This lack of oxygenation destroys penile tissue and atrophies the penile organ; it shrinks permanently]
MIN 10:46 ADT Impact w and w/o RT – Men evaluated were treated with ADT alone; only 30% were able to have erections sufficient for sex. Then MSK patients evaluated having had RT with and without ADT; 25% with ADT had normal sexual function vs 40% with RT alone. [ADT therefore greatly impacted sexual function, with or without RT.]
MIN 11:35 ADT Impact on PD5 Drugs – Men who had ADT w RT had only 50% success with PD5; more impacted than those with RT alone. [Percent success w RT alone not mentioned]
MIN 12:00 ADT Impacts Orgasm n Ejaculation – ADT suppresses orgasm; takes more time or is reduced. Study found 55% of men at baseline could achieve orgasm; 16% of them could after ADT treatment. Reduction in ejaculate volume is also impacted; men treated w ADT alone vs those with RT only.
MIN 14:07 CBC Blood Impacts – Baseline vs 1 year post ADT treatment evaluated; 10% increase in Cholesterol and LDL levels, 30% increase Triglycerides. Statins recommended with diet changes.
MIN 14:37 Body Composition – ADT impacts bone density (osteopenia n osteoporosis). Older study found 13 fold increase in fractures.
LINK: YouTube - youtu.be/MjOdnQU4jw4
