Greetings. I am aware that Dr. Sartor, sometimes, does give high testosterone therapy for men with MCRPC. If a patient has bone mets, but no pain symptoms, is it possible to use Dexamethasone as pain flare prophylaxis?
I am aware that men with bone mets often get Dexamethasone to possibly avoid having pain flare after radiotherapy to treat bone mets pain.
So, is it possible that Dexamethasone can be used briefly right before getting the high testosterone injections? Can the Dexamethasone prevent the high testosterone injection from not working as it ought to?
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Masking the pain doesn't get rid of the objection to BAT in men with painful metastases.The issue is that once the metastases produce pain they are far gone enough such that BAT is dangerous.
" We included patients aged 18 years or older who had histologically confirmed and radiographically documented metastatic castration-resistant prostate cancer, with no more than two previous second-line hormonal therapies, and a castrate concentration of testosterone. Patients were asymptomatic, with Eastern Cooperative Oncology Group performance status of 0-2, and did not have high-risk lesions for tumour flare (eg, >5 sites of visceral disease or bone lesions with impending fracture)"
They did the study in asymptomatic patients and without bone lesions with could cause fractures if they grew. They did not report any complication with the bone metastases.
I think we can only speculate about the Dexamethasone in this context, since high-T is so rarely used. You could try asking Dr. Sartor or Dr. Denmeade directly, or one of the few other docs who use high-T (like Bob Liebowitz). I don't think anyone here is going to give you a better or more conclusive answer than Sartor or Denmeade himself!
I do see that your father has experienced pain in the past, so this therapy obviously carries not just the risk of pain recurrence but the risk of causing progression rather than regression. Since so little is understood about why some men might see cancer/pain progress and some see it regress, when on high-T, your father seems more likely to contribute to furthering that understanding rather than benefiting from it.
But is there much in the existing literature to show that high-T is all that likely to cause met pain in men not already experiencing it, or even in men ALREADY in pain? It seems more like a "risk" than a "likelihood." My recollection is that only SOME men who already HAVE pain may feel it worsen ( and of course some feel it lessen or not change at all, too) but I don't recall much about any tendency for high-T to cause pain where pain didn't formerly exist already because of very advanced disease in the bones.
High-T is going to be a crap shoot. There is no way to know if a man already in pain will see it relieved, or a man not in pain will suddenly experience some. But it should be reassuring to know that the cautions in selecting men for BAT trials do not seem to result from any observation of great numbers of men experiencing pain as a result of high-T therapy in recent decades. It appears to be relatively rare, and the cautions mostly seem to stem from very limited numbers of observations back in the 1970s.
One thing I found interesting is that early studies of Fowler and Whitmore showed "the proportion of men who had an unfavorable response was higher in those who had been on prolonged hormone suppression [or castrate resistant] compared to castration-naïve men or men in early stages of hormone suppression." (I don't know if other studies have shown similar findings. But it lends support to the apparent high rate of success of Bob Liebowitz of giving high-T after only a single 13-mo course of ADT/chemo.)
Those doing current BAT trials or otherwise experienced in giving high-T to PC patients are obviously going to be the most qualified in supposing whether your father is a good candidate, how likely he is to experience pain, and which meds might prevent that pain. I would continue to reach out to them, specifically.
Because of my PROSTATe Cancer operationj almost 3 three years ago; I nave been under ESTROGIN; to reduce my testosterone? Since my level of testerone is now ineligeable; how do I obtain my MANHOOD?????
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