A look at hormone treatment

My last blog covered some of the key reasons why I am postponing the NHS recommended treatment for my prostate cancer (do read that as context for this blog). I wanted to explore in this blog hormones, some of the challenges they present and the hopes and the next blog will look at radiation. I note again that I have not ruled out this route, but am just postponing my decision.

1. Hormone treatment. 

I am still trying to get my head around these hormones - particularly as prostate cancer is a hormone driven cancer. In truth I haven’t yet been able to fully understand how they work so maybe another blog in the future…….but for now it seems some argue that testosterone doesn’t usually cause problems but, if you have prostate cancer, it can make the cancer cells grow faster. If testosterone is taken away or blocked, the cancer will usually shrink, wherever it is in the body. The hormone therapy works in two ways – either by stopping your body from making the hormone testosterone, or by stopping testosterone from reaching the prostate cancer cells. PSA levels can drop to near zero and prostate cancer cells die through the process of programmed cell death, a.k.a. apoptosis.

It is interesting (and confusing to me) that a large study shows that supplemental testosterone does not fuel prostate cancer (i). See also a very useful article here looking at how for decades, the medical establishment erroneously conjectured that testosterone replacement therapy increases one’s risk of prostate cancer (ii). Indeed it would seem that according to a number of observa­tions and some published studies, low levels of testosterone seem to predispose men to prostate can­cer, including more high-grade Gleason score tumors. So my understanding is that as we age testosterone con­verts to estrogen and DHT, and these two testosterone metabolites have been shown to be involved in benign and malignant prostate disease. Indeed estrogen is a cell growth promoter that has been implicated in the development of prostate cancer (iii). So it seems testosterone and estrogen play a complex role in cancer. 

Update 27/05/19: Testosterone slows prostate cancer recurrence in low-risk patients:
https://medicalxpress.com/news/2019-03-testosterone-prostate-cancer-recurrence-low-risk.html

My experience? 

After the transurethral hyperthermia treatment in Germany, I had six months of hormones; Finasterid 5mg, Bicalutamid 50mg and two Trenatone injections that each last three months. The doctors there considered that the biopsy I had, could have encouraged the cancer to spread (see my blog re the biopsy here). 

In terms of estrogen my levels were normal in November 2017 before starting the hormones but by December 2018 were way above normal. As part of my supplement protocol I have been taking Indole 3 Carbinol since January this year which has been shown to be helpful to lower estrogen levels (see my supplement protocol here). 

The hormones clearly cut my PSA to virtually nothing but it climbed again four months after I had stopped taking them. There is lots of evidence to show they are an effective treatment for prostate cancer, but they seem to be more about holding the cancer at bay rather than stopping it altogether.

I was interested to read that a recent study found that men taking finaste­ride for prostate cancer preven­tion were far more likely to benefit if they had lower estrogen levels prior to initiation of treatment with finasteride (iv). This links to my comment above regarding estrogen and that at least my levels were lower when I started the treatment. This study showed higher concentra­tions of estrogen to be associat­ed with increased cancer risk; hence the priority to try and reduce my own levels of oestrogen.

Side-effects; an 'extreme menopause’?

My own experience of hormone treatment wasn’t great in terms of side-effects. Of course not everyone experiences such negative side effects of hormones, indeed a friend and others I’ve met, have managed well with few side-effects. 

• Hot flushes and changes to mood; very hot and sweaty and sometimes needed to change clothes or bedding and was woken by flushes four or five times a night at it’s worst. They also, at times, made me feel irritable and uncomfortable, but I still don’t try those jokes about it being worse than a woman’s menopause! We all experience these things differently.
• Extreme tiredness; yes but this also was caused by the stress of diagnosis, treatment etc.
• Strength and muscle loss; ten months on since finishing the hormones and I still have significant muscle loss and finding it hard to restore muscle.
• Breast swelling; fortunately not for me but a couple of guys at the cancer exercise class joked about the heart monitor strap around their chests being 'great support’! I think this is symptom is more often when hormones are taken for longer.
• Weight gain; didn’t have this one, in fact lost weight due in part to changes in diet.
• Sexual function; libido, orgasm and erections - basically sex virtually ended several weeks into taking the hormones and only returned some months after stopping them (v).
• Other stuff: There are also greater risks for other diseases like for example severe kidney problems (vi), osteoporosis (bone thinning), loss of body hair, heart disease, stroke, diabetes

You can also see more about side-effects here and a three minute video here by Dr Susan Sloven. Update July 2019: I've just seen this video and wish I'd had some of this info when I started the treatment - I wouldn't have taken all those measures but would have worked harder to reduce the muscle wastage that is still not been fully restored a year after stopping hormones: https://www.youtube.com/watch?v=efza9vq-cg8

Can treatment cause cancer? 

There have also been some conflicting results that indicated some hormones like finasteride increase prostate cancer death. Fortunately that seems to have been disproved by a study this year (vii).

However there is a new study that details how prostate cancer can be transformed into a much more aggressive disease: lowering androgen levels can make prostate cancer cells shrink or grow more slowly but those of us who receive these new treatments, are also more likely to develop a deadly, treatment-resistant cancer called neuroendocrine prostate cancer (NEPC) (viii). While this seems to only be a small number of people there are no effective treatments for this type of cancer.

There is evidence that some other hormone treatments (eg glucocorticoid) can increase chances of cancer returning and can have significant impact on longterm quality of life (ix).

There are also controversial doctors like Dr Lee who wrote a booklet entitled, “Hormone Balance for Men” (2003). He seems to suggest that the hormone treatments make men more estrogen-dominant and therefore speed up the spread of cancer (x).

These random links here don’t really allow for a fair picture regarding the risks of hormone treatment. It is remarkably hard to find articles that give a more balanced view. If anyone reading this can help out please do share.

NHS proposals?

The offer from NHS is for three months of hormones then radiation with possibly more hormones. Some folks end up on hormones for years and while the plan for me is to only be on them for a short time this doesn’t always work out. As yet I have been unable to establish what hormones or strength I’m being offered. The evidence seems clear that the addition of androgen deprivation therapy (ADT) to external beam radiation therapy (EBRT) can improve overall survival in prostate cancer (xi). 

Patricia Peat in her book, “The Cancer Revolution, Integrative Medicine, The future of cancer care” writes “The problems with orthodox hormone therapy in a holistic sense are:

• It does not address the treatment side-effects, which many people find debilitating
• If it isn’t working properly, doctors have no way of analysing this
• It does nothing to address the underlying issues. Once treatment stops or cancer evolves to the point where it is ineffective, the original problem re-emerges unchanged.”

Patricia goes onto say this is an opportunity to reassess lifestyle choices; something I have been doing over the last 18 months and will share more in a blog about my protocol coming very soon. She writes: “Diet, liver function, endocrine function, gut symbiosis and stress are the main causes of poor hormone methylation and are all within your influence."

So I'm left with more questions than answers. Any insights from readers welcomed!

Update 16/5/22 On hormones: https://www.canceractive.com/article/the-reality-of-lowered-testosterone-and-higher-oestrogen-in-men-counters-orthodox-theories-of-prostate-cancer

Notes

(i) https://newsroom.uw.edu/news/study-testosterone-therapy-does-not-raise-prostate-cancer-risk?fbclid=IwAR0iMSLZ0cIZwQeLezAMJ75KfYEhsKHXuDwFyPTuqizF4ob4HR5yHcIzSW4
(ii) https://www.lifeextension.com/magazine/2008/12/Destroying-the-Myth-about-Testosterone-Replacement-Prostate-Cancer/Page-01?fbclid=IwAR0M8UL2oUUAwJ73anIJMbIklJnHbyDiQhONwphBLpCMc7g4ic5E9Uo6-7s 
And see more at: https://www.lifeextension.com/Protocols/Cancer/Prostate-Cancer-Prevention/Page-01

(iii) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3134227/
(iv) https://www.lifeextension.com/Protocols/Cancer/Prostate-Cancer-Prevention/Page-01
(v) https://www.futurity.org/prostate-erectile-dysfunction-941462/?fbclid=IwAR2R1xqzkdeqhF3nwOuLVav52H93PuwjxshOz1Pe9vNDIR5qBFRgvtemke 
(vi) https://www.canceractive.com/article/prostate-cancer-hormone-therapy-linked-to-severe-kidney-problems 
(vii) https://www.medscape.com/viewarticle/908167?nlid=127450_1521&src=WNL_mdplsfeat_190129_mscpedit_wir&uac=154060AV&spon=17&impID=1871609&faf=1#vp_2 
(viii) https://www.foxnews.com/health/how-prostate-cancer-becomes-resistant-to-treatment?fbclid=IwAR26HfKWPKJF_H1Vp2D5LQtJFVI4ZcD3eMKDlbCaYhgHF7GFQWEB8sdY09g 
(ix) https://www.sciencedaily.com/releases/2016/10/161018094123.htm 
(x) https://www.johnleemd.com/
(xi) See the huge Hamdy study: https://www.nejm.org/doi/full/10.1056/NEJMoa1606220 plus various other papers. Of interest was this one showing that Gleason 9–10 disease may derive a smaller survival benefit from ADT than Gleason 8 disease: https://www.europeanurology.com/article/S0302-2838(18)30628-6/pdf?ct=t(EMAIL_CAMPAIGN_1_30_2019_11_23)&goal=0_bc8795358a-66557320cb-199204941&mc_cid=66557320cb&mc_eid=e7e7fa69da