.. Part. I: Androgen Suppression
(c) 2015, Davd
That first prostate cancer story i ever heard personally, from my father’s friend Bill, happened before 19751. He wrote that treatment included “the operation that makes a steer out of a bull.” That surgery made sense, though today they use drugs much more often than surgery. Castration stopped Bill’s testosterone production; and most prostate tumors need testosterone to grow.
If Bill died a year or two after diagnosis, the reason was probably that the cancer had spread before the diagnosis was made. He never told me specifically. As a guess, some two generations of time ago, he had had a prostate tumor for years before it was diagnosed.
Prostate cancer grows slowly, compared to most other kinds. If you have finger examinations of your prostate and PSA blood tests, regularly, there is a good chance—a far better chance than Bill had in his day—that you will be diagnosed with a prostate tumor whose biopsy results, or other “further tests” indicate that it is benign—not spreading, not about to spread.
The usual treatment for such prostate tumors is called “Watchful Waiting”: More tests, perhaps ultrasound or another biopsy—but no heavy drugs, no radiation, no surgery to remove the tumor. Prostate tumors grow slowly enough that you might well die of something else before your tumor becomes something that could kill you within a few years… and as you’ve already read about prostate biopsy, and will see again below and in the Radiation Therapy posting to follow, treatment is uncomfortable, makes life less to much less pleasant while it goes on, and requires hospital facilities. If the disease is a benign, slow growing tumor, it seems fair to predict the cure would be worse than the disease.
I wasn’t so lucky; my Gleason sum score was above the line between benign tumor and cancer. The diagnosis, and diagnoses are estimates, was that the tumor might “metastasize”, or spread around the body, if not treated quickly—indeed, the bone and CAT scans and the chest X-ray were to see if it had spread. They came back negative, so i fell into the category “no sign yet of spreading, but might be about to spread”. That got me the modern equivalent of what Bill got: Pharmacological castration. Instead of removing my “balls”, they drugged them out of action.
This is also called hormone therapy and androgen suppression therapy. As the American Cancer Society website puts it, “Androgens [male hormones] stimulate prostate cancer cells to grow. Lowering androgen levels or stopping them from getting into prostate cancer cells often makes prostate cancers shrink or grow more slowly for a time.” For localized cancer with a Gleason sum score high enough to be dangerous, androgen suppression disrupts cancer growth and “buys some safe time” to plan and schedule radiation treatment (or perhaps surgery).
Immediately the bone scan, CT scan, and chest x-ray came back negative (no sign the cancer had spread), i was given a large injection under the skin of my upper abdomen, and a prescription for pills to be taken daily. (I won’t name the medications, because they each seem to have alternatives, and i’m not medically trained. I don’t understand the subtleties of how specific medications are chosen, and i don’t want readers to think they ought to have something else than what they were prescribed, just because some blogger got it.)
Over the next few days, living in the same house with the same woodstove, i noticed i felt colder. My diary entry for two days later than the first injection reads in part, “Comfortable temperature … 2-3 C above what i found comfortable as a man.” Two comments: First, i was well aware that the medications were intended to suppress my male hormones, and had started calling myself “a pharmacological eunuch”. Second, if you are reading this from the US or UK, 2-3 degrees Celsius is about 4 degrees on the Fahrenheit scale you use. I needed that house, at least the part where i sat still, heated 4 Fahrenheit or 2-3 Celsius warmer than i had needed three days earlier… and for years before that.
It was 7-10 days after the injection (meaning i had also taken 7-10 of the pills) when i felt the first flush of heat. It lasted a few minutes and then i felt cooler than before the medications, again. I’d been warned about “hot flashes”, and told that women entering menopause have the same experience. Not having been a woman, i didn’t get much help from that comparison.
In my case, “hot flashes” were fairly rare, but i did notice that i could start perspiring with exertion that hadn’t got up a sweat before. I also noticed that my strength and stamina were going down. Over the months that i was “on androgen suppression” before radiation began, i lost noticeable strength, stamina, and “drive” compared to the years before. My stride was nearly as long, but walking fast, which hadn’t been tiring before, now got me breathing a little harder.
I also gained weight, though i was cooking the same foods and eating the same amounts as ever. The reason—some of you may have guessed already—was connected to the loss of strength and drive, and the need for a warmer house. My metabolism had slowed down, as could be expected: Eunuchs’ metabolism is normally slower than men’s. My body was burning less food, but my habits hadn’t adjusted—and there was some good reason for me not to “diet.”
The androgen suppression was preparation for a direct attack on the tumor. In my case, as in most cases from what i’ve heard and read, that attack would be with radiation. The radiation would cause heavy to total destruction of the tumor, and also some damage to the surrounding tissues. My body, i was warned, would need more nutrition, including more energy, to heal the damage to normal tissues and clean up the debris from the tumor.
The preparation seemed to work: My testosterone and PSA levels fell to far below ldquo;normal.” Next treatment was to be radiation, as seems to be usual for dangerous but localized tumors.
It took me months to organize for the debilitating effects that might have. I was warned i could not expect to do the chores that were normal and required for that wood-heated house in a region with heavy winter snow. So as happens to rather many men, but far from all, i had to relocate and i don’t expect to be able to go back. I don’t know how common that experience is, though; so the next “post” will be about the radiation experience, which from what i’ve heard, a majority of men with dangerous looking, localized prostate cancer have shared or will share.
1. This is from memory—i didn’t keep a diary in those days; and i didn’t plan on writing about prostate cancer at that time—so i cannot say just what years were involved. Indeed, the word “Movember” was first used at the very end of the last century, over 20 years after Bill died.