I stumbled across this, and thought it was a pretty good article by a Uro who has PC...
ncbi.nlm.nih.gov/pmc/articl...
A few highlights:
Regarding recurrence after RP, supporting early systemic therapy, "studies using magnetic resonance imaging have shown a much higher incidence of bone metastatic disease than would be found by the traditional bone scan, and disseminated tumor cells are present in the bone marrow in men with PSA failure with unexpected frequency."
Regarding disease progression after failed ADT, "The term 'castration resistant', I believe, will need further refinement. Ample evidence now exists that the androgen receptor (AR) continues to drive prostate cellular proliferation and prevents pharmaceuticals from blocking AR activity which provides effective treatment and survival prolongation. The term 'castration recurrent' may better describe this disease state. In 2008 with a testosterone level within the castrate range, and with a PSA on the rise after trial of bicalutamide withdrawal, I was searching for other options. There was no Level 1 evidence to support any pharmaceutical therapy at that time and unfortunately that remains true to this day."
Regarding BAT, among many other potential options to pursue in addition to standard therapy, "The future is bright with a wealth of developing treatment possibilities on the horizon. Perhaps the most remarkable trials are those studying cyclical delivery of super physiological doses of testosterone. This concept is counterintuitive [but] steroid molecules are responsible for both cellular death and cellular proliferation. The challenge will be directing these pathways for appropriate response. However, if high dose testosterone does enter into the clinic, it perhaps will be the only treatment for an advanced cancer that both controls disease while simultaneously allowing the patient to feel stronger and better! An ultimate win/win!"
Regarding his own experience of ADT, "The four letter word that best describes the state of androgen deprivation therapy is LOSS – loss of energy, interest, vitality, mental and physical activity, muscle mass and strength, cardiovascular health, bone health and most overtly sexual health including erectile dysfunction and diminished libido. I believe the global effect of androgen deprivation is underappreciated..."
Regarding cure, "Cure promises to relegate the cancer experience to the past tense. However, cure is often evanescent. Dormancy may be recognized in the future as an accepted temporary pattern of cancer behavior. Against the background of persistent/recurrent disease, caring for the patient through a series of treatments is more realistic and supportive than the promise of final/complete obliteration of the disease."
Regarding wars on cancer, "The war metaphor has entered almost all aspects of our lives. War is energy depleting, resource consuming, and long wars all the more so. Prostate cancer is a disease of long natural history. Patients who enter into a daily battle with the disease forfeit the state of living well with their cancer. The emphasis [should be] on thrival as well as survival. This mindset has been described by others as when there are clouds on the horizon one learns to dance in the rain, or those patients do best who learn to dance with their disease. "
Testosterone & Castration-Resistant PCa.
Recent dropping of guideline \"Post from your own experience\".
Thoughts and experiences with Guardant 360 somatic testing
