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Abuse of patients. Patients should be aware that sometimes QOL quality of life may be secondary or an absent goal in treatment. Sometimes overtreatment for profit or to prevent an unlikely death or metastization from low risk cancer may be the primary or the only goals of cancer treatment. Hormone therapy may have an extensive list of side effects that can be devastating for men. Biopsies and treatment are degrading, stressful and often unnecessary.
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Many men may not be prepared or have unrealistic expectations about the outcome, physical and psychological impact of testing and treatment. The risk of long term chronic and permanent fatigue that can result in depression is almost always understated if mentioned at all to many patients. Radiation with Hormone therapy has a high risk of fatigue. Long term fatigue also increases the risk of clinical depression and suicide.
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In my opinion: Castration, ADT hormone therapy chemical castration , LDR Brachytherapy radiation seed implant , radiotherapy, surgery and blind biopsies are often psychically and emotionally brutal, traumatic and disturbing. Newer treatments like, HIFU, hyperthermia, Boron Neutron capture therapy, focal Ablation only treating the cancer and not the entire prostate and orphan drugs should be approved and used when appropriate. Biopsies should be limited to selective MRI guided samples only; blind biopsies should seldom be performed.
Approved advances in prostate cancer treatment mostly consisting of newer more accurate radiation treatments, robotic surgery and new drugs. These advances sound like greater strides have been made. However most of these approved advances are of limited benefit to prostate cancer patients and still have about the same amount of long term side effects. Compared to other technologies, computers, communications, electronics, aviation, etc, cancer treatment approved advances have been dismal.
QOL quality of life issues have not been adequately addressed. Profit sometimes outweighs QOL. However as far as reducing long term side effects, only small gains have been made with the newer radiotherapy equipment. A patient should be skeptical if exaggerated claims are made about reduced long term side effects, especially fatigue and ED rates.
Patients should inquire as to the treatment plan: Gy dose and fractions, margins, testicular dose, constraints and age of radiotherapy equipment to insure excessive radiation exposure treatment is not given that can result in additional side effects.
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Patients should be aware that pelvic shaving, small permanent tattoo markers, fiducial marker small seeds are sometimes placed in the prostate, MRI, CT scan, photographs, catheters and other procedures may or may not a be required. Radiation has high probability of sexual dysfunction and fatigue. Sometimes radiation can also cause bowel and urinary problems. A 5 day SBRT radiation treatment is now commonly available with about the same results and side effects as a 9 week radiation treatment.
Excluding hormone therapy, this drop is determined by the testicular radiation dose treatment equipment and planning. A below normal drop in testosterone can result in increased fatigue, depression, sexual dysfunction and other symptoms. It seems all of the best treatments for prostate cancer have not been approved and most are only available outside the USA. Treatment options outside the country or under development are HIFU, Laser, Hyperthermia, Boron Neutron capture therapy and orphan drugs, just to name some.
Focal Laser Ablation is a good option with fewer side effects however it is not widely available in the USA and sometimes not practical. Any cancer patient man or woman who are being offered chemotherapy should be particularly cautious. Chemotherapy can be extremely toxic and sometimes deadly.
Without genomic testing or proof of the effectiveness of the specific drug being used on the exact cancer type being treated, chemotherapy can often be more toxic to the patient then to the cancer. Chemotherapy may be extremely expensive, profitable for some doctors if dispensed by the doctor and not by a third party and can be misused or overused, sometimes for profit. Do you think any regulatory agency will stop the exploitation of elderly men with a high PSA or prostate cancer or approve new treatments at the risk of financially bankrupting thousands of treatment facilities and jeopardizing thousands more jobs?
Do you think any regulatory agency will set guidelines for treatment and monitoring at the risk of upsetting the doctors who are over treating? Often few good choices exist for treatment. A prostate cancer patient treatment choice often ends up being the least worst choice or the choice with the side effects a patient thinks he can tolerate.
Patients can be sometimes misled about the expected side effects and results of the treatment being offered. The risk of chronic fatigue and depression is often never disclosed. Long term care consists of regular PSA testing for years. Long term care for side effects is often lacking or exploitive or ineffective. Often complaints of side effects are disregarded by nurses, doctors and sometimes referred out to other doctors. The patient is sometimes left to figure out what to do about his side effects with the resources available to him. Long term side effects often consist of fatigue, bowel or urinary problems, sexual dysfunction, depression and other symptoms.
Patients with complaints of chronic fatigue are often told to exercise, get plenty of sleep, pace yours self and eat a healthy diet; this advice is of limited help for chronic fatigue.
Often treatments for long term side effects are embarrassing, degrading, unavailable, nonexistent, costly, not effective, not offered or bothersome. Prostate cancer treatment often results in fatigue, depression, isolation and sometimes suicide. Billions of dollars are profited from ED drug and other ED products, catheters, pads and diapers, drugs for depression or pain or insomnia or incontinence, additional treatments and surgeries for side effects.
Also treatments for the multiple and bizarre side effects from hormone ADT therapy chemical castration is sometimes required. Men and ageing: If any man lives long enough it is very likely he will have a prostate problem, low testosterones or some form of sexual dysfunction. In my opinion modern medicine often has been exploitive, abusive and has provided substandard care for older men in general due to all of the explanation given in this text.
I believe much of the attitudes toward older Americans need improvement and they are sometimes viewed as being subhuman and exploitable by various individuals. If documented cases of unnecessary surgery and radiotherapy or blind biopsies on children by doctors for profit were released, the vast majority of Americans would be outraged and it would quickly end.
However for older men it dose not seems to be of great concern?
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Prostate cancer patients are at an increased risk of suicide. Almost all prostate cancer treatments usually result a high percentage of erectile dysfunction. Lower libido is almost never disclosed as a treatment side effect. Biopsies can sometimes also cause temporary or permanent ED. Often claims of prompt effective treatment for ED if it occurs after treatment are sometimes misleading. Statistics for ED percentages from treatment are usually quoted after treatment with Viagra, Muse or other ED treatments, therefore most statistics are very misleading.
For cryotherapy, ED rates are extremely high. Many insurance companies will not pay for ED drugs or treatment. The patent for Viagra should have already expired in the USA. Less expensive generic drugs are usually unavailable in the US. This is further exploitation by the drug companies of men in general. Men are further exploited by counterfeit mail order ED drug sales. ED drugs are not always effective and may have side effects. Some side effects may not be disclosed at all. If side effects low libido, chronic fatigue, depression, etc are not disclosed, no percentages will need to be quoted.
Results are often worse for a surgery option, the main difference in ED results between surgery and radiotherapy is; with surgery ED will start out bad and may or may not get better with time, however with radiotherapy ED will get worse over time.