Re: Another R. Wasserug article - Urology Today
Posted: Sat Dec 11, 2010 12:15 pm
I sent a copy of this thread to Richard Wassersug, and he replied with the essay below:
Thank you for sending me the EA thread that started with my UroToday essay. Feel free to post this. Thank them as well for having taken the time to read my essay.
Considering generic9436's data, the sample size is too small to know whether orchiectomy has any advantage over chemical castration for testosterone control. It has been presumed that surgery would be more traumatic and it is, of course, not reversible. But there are, in fact, no data to support that.
Regarding Caith721's comment on lymph nodes, the surgeons strip the lymph nodes when they do an orchiectomy for testicular cancer. However, they do not do that for prostate cancer other than to remove some local sentinel nodes.
butterflyjack wonders whether there are data comparing orchiectomy versus
speedvogel speaks on behalf of "watchful waiting" as an option for prostate cancer treatment. Although there is growing literature that we are over treating prostate cancer, too many men find it emotionally difficult to just wait around without taking some sort of treatment. He is right that economics have played a role in the r
mrt exemplifies the discomfort that some men feel when encouraged to consider "watchful waiting" as a treatment for prostate cancer. He also states that he is pissed off with the sentence from speedvogel that I quote above. Just in case someone isn't following the thread closely, I want to make it clear that the quote about most men "loosing their masculinity" is from speedvogel and not me. I leave it to mrt and speedvogel to hash out between them what are or what are not the determinants of masculinity.
The next person to comment on the thread, Woggler58, mentions both "anti-androgen" and "androgen-suppressing" drugs. One should be clear that they may sound the same but anti-androgens are, in fact, a sub group of drugs used for androgen suppression. When it comes to androgen-suppression as part of radiation therapy for prostate cancer anti-androgens are not the most common drugs used. LH-RH agonists are more commonly used (although patients are often started with an anti-androgen). Lastly, Woggler58 discusses at some length Dr. Mark Scholz's preference for the term "testosterone-inactivating-pharmaceuticals" (TIP) rather than ADT for androgen deprivation therapy. I follow closely what Dr. Scholtz writes in the Prostate Cancer Research Institute newletter PCRI Insights (and elsewhere). He's well respected, but very much a fan of non-surgical treatments. What he wrote most recently in PCR Insights, however, was not up to date on the use of transdermal estradiol to treat prostate cancer.
Overall, I was pleased to see the recent interest that prostate cancer inspired on the archives. When I first published an essay about being castrated to treat prostate cancer, the worlds of eunuchdom and prostate cancer were totally separate. Back then, it was rare to have anyone who was a prostate cancer patient on ADT, exploring his status as a eunuch. This has led me to be interested in how medical treatments influence one's gender identity. Although I've outed myself as a eunuch, I have occasionally run into prostate cancer patients, who are offended that a prostate cancer patient might ever identified as a eunuch even though I was just following a dictionary definition.
If people on the archives want specific papers of mine related to prostate cancer, they should feel free to email me directly.
Richards major research is on amphibian neuroanatomy, and he is one of the worlds experts on tadpole metamorphosis. He teaches in the school of medicine at Dalhousie University in Halifax, Nova Scotia.
.
Thank you for sending me the EA thread that started with my UroToday essay. Feel free to post this. Thank them as well for having taken the time to read my essay.
Considering generic9436's data, the sample size is too small to know whether orchiectomy has any advantage over chemical castration for testosterone control. It has been presumed that surgery would be more traumatic and it is, of course, not reversible. But there are, in fact, no data to support that.
Regarding Caith721's comment on lymph nodes, the surgeons strip the lymph nodes when they do an orchiectomy for testicular cancer. However, they do not do that for prostate cancer other than to remove some local sentinel nodes.
butterflyjack wonders whether there are data comparing orchiectomy versus
There are a lot of data on this going back decades and the two treatments are considered comparable for cancer control. The idea, though, of takingbutterflyjack (imported) wrote: Thu Dec 09, 2010 4:47 pm hormone therapy for the treatment of prostate cancer.
to reduce the size of the prostate is probably not a good one. Together they would increase the risk of a blood clot formation and would not necessarily provide better testosterone suppression (and subsequent prostate size reduction) than when either is used alone.
speedvogel speaks on behalf of "watchful waiting" as an option for prostate cancer treatment. Although there is growing literature that we are over treating prostate cancer, too many men find it emotionally difficult to just wait around without taking some sort of treatment. He is right that economics have played a role in the r
hat "most men who are faced with the prospect of loosing their masculinity will opt for a different approach to treatment." He has that as a freestanding paragraph so I'm not sure what the different approach is. It's my impression that there is a large spectrum of positions on how much of ones masculinity is lost with either chemical or surgical castration. In both the prostate cancer and the voluntary eunuch communities, I've seen men on androgen deprivation therapy (ADT) claim both extremes i.e., that they are still fully male or that they are something totally different. Lots of factors play into ones self-assessment of their own masculinity.speedvogel (imported) wrote: Thu Dec 09, 2010 5:20 pm ecent rise in the use of orchiectomy over chemical castration.
I'm not clear though on what he means when he says t
mrt exemplifies the discomfort that some men feel when encouraged to consider "watchful waiting" as a treatment for prostate cancer. He also states that he is pissed off with the sentence from speedvogel that I quote above. Just in case someone isn't following the thread closely, I want to make it clear that the quote about most men "loosing their masculinity" is from speedvogel and not me. I leave it to mrt and speedvogel to hash out between them what are or what are not the determinants of masculinity.
The next person to comment on the thread, Woggler58, mentions both "anti-androgen" and "androgen-suppressing" drugs. One should be clear that they may sound the same but anti-androgens are, in fact, a sub group of drugs used for androgen suppression. When it comes to androgen-suppression as part of radiation therapy for prostate cancer anti-androgens are not the most common drugs used. LH-RH agonists are more commonly used (although patients are often started with an anti-androgen). Lastly, Woggler58 discusses at some length Dr. Mark Scholz's preference for the term "testosterone-inactivating-pharmaceuticals" (TIP) rather than ADT for androgen deprivation therapy. I follow closely what Dr. Scholtz writes in the Prostate Cancer Research Institute newletter PCRI Insights (and elsewhere). He's well respected, but very much a fan of non-surgical treatments. What he wrote most recently in PCR Insights, however, was not up to date on the use of transdermal estradiol to treat prostate cancer.
Overall, I was pleased to see the recent interest that prostate cancer inspired on the archives. When I first published an essay about being castrated to treat prostate cancer, the worlds of eunuchdom and prostate cancer were totally separate. Back then, it was rare to have anyone who was a prostate cancer patient on ADT, exploring his status as a eunuch. This has led me to be interested in how medical treatments influence one's gender identity. Although I've outed myself as a eunuch, I have occasionally run into prostate cancer patients, who are offended that a prostate cancer patient might ever identified as a eunuch even though I was just following a dictionary definition.
If people on the archives want specific papers of mine related to prostate cancer, they should feel free to email me directly.
Richards major research is on amphibian neuroanatomy, and he is one of the worlds experts on tadpole metamorphosis. He teaches in the school of medicine at Dalhousie University in Halifax, Nova Scotia.
.