A recent article from the Canadian national news. It's long, so it's posted in sections....

Why castration makes you no less of a man

Prostate patients seek to stamp out emasculating stigma

ANDRÉ PICARD

PUBLIC HEALTH REPORTER

September 29, 2007

HALIFAX -- When Richard Wassersug gives a lecture, he likes to begin with a provocative question: Who in our modern society is castrated?

The answer invariably comes back loud and clear: sex offenders. Someone may venture another guess: transsexuals? Or maybe men with testicular cancer?

Wrong, wrong and wrong.

In reality, castration is almost exclusively the lot of men with advanced prostate cancer.

An estimated 500,000 men in North America have been surgically or chemically castrated, the latter with a treatment known as androgen deprivation therapy, and their ranks are swelling by 40,000 a year. Yet the practice and the devastating side effects that can result are virtually never discussed publicly, and most patients suffer alone in silence.

"Right now, it's such a humiliation to be androgen-deprived that patients barely even talk to other patients," said Dr. Wassersug, a professor of anatomy at Dalhousie University in Halifax, and a prostate cancer survivor. "To admit that you've been castrated is shameful."

But Dr. Wassersug and a growing number of activists have no such shame. They are aiming not only to break the silence but to end the emasculation - sexual, social and medical - that castration can bring about.

Dr. Wassersug was diagnosed with prostate cancer in 1998, at age 52. He underwent surgical removal of his prostate - a walnut-sized gland located between the bladder and the rectum - as well as radiation.

The treatments failed to eliminate all the cancerous cells, so he was prescribed androgen-deprivation therapy.

Prostate cancer is a hormonally fuelled cancer. Cancerous cells feed on testosterone - the principal male sex hormone - and the way to snuff out their spread is cut off the fuel supply.

Most testosterone (also known as an androgen) is produced in the testicles. So men are left with an agonizing choice: Accept castration - surgical or chemical - or risk cancer running rampant in the body. "There are hundreds of thousands of men who are faced with this difficult decision," said Andrew Loblaw, a radiation oncologist at Sunnybrook Regional Cancer Centre in Toronto.

Worse yet, the decision is not nearly as clear cut as it seems, because of the potentially devastating side effects and the fact that while ADT may prolong lives, it doesn't save them.

While stopping the production of testosterone slows cancer growth, researchers don't know exactly who benefits most from ADT, when it is best to begin treatment and, more important, whether castration improves quality of life in the long run.

"We really don't have good answers for those questions," Dr. Loblaw said. He is currently recruiting prostate cancer patients for a study that should provide answers, but it will take at least a decade.

In the meantime, Dr. Loblaw said, it is important for patients to discuss the issue more openly and make decisions based on the best available evidence. "In my experience," he said, "people want to choose their poison."

Most treated successfully

This year in Canada, 223,000 men will be

JesusA (imported) wrote: Wed Oct 03, 2007 6:31 pm diagnosed with prostate cancer,

according to the Canadian Cancer Society. Most of them will be treated successfully and eventually die of another cause. But 4,300 men will die of prostate cancer. All of them, and many others, will have been offered castration as a means of prolonging their lives.

ADT aims to shut down production either through orchiectomy (surgical removal of the testicles) or using drugs called luteinizing hormone releasing hormone (LHRH) agonists.

In 1941, Charles Huggins, a Canadian-born researcher, showed that removing the testicles dramatically improved the fate of men with prostate cancer, a discovery that earned him a Nobel Prize. Then, in the early 1980s, French scientist Ferdinand Labrie showed the same effects could be achieved with drugs, and LHRH agonists have been the standard treatment since.

In most cases, the treatment can go on for years, even decades. But, increasingly, men are also prescribed ADT temporarily, for the months before they receive radiation.

"The side effects are astonishing," Dr. Wassersug said. "My symptoms were the same as a woman at menopause except they came on in days, not years."

Hot flashes were the worst. Night sweats soaked the bed. Impotence. Loss of libido. Cognitive problems meant that he could lose his car in a parking lot. A roller coaster of emotions: "I would cry during TV commercials," he said - especially those sponsored by Mothers Against Drunk Driving.

There were physical changes, too: loss of all body hair (except the groin and the face - that only occurs if someone is castrated before puberty); loss of muscle mass; shrinking gonads; gynecomastia (breast development) and accumulation of body fat. Research is showing increasingly that ADT increases the risk of cardiovascular disease (and sudden heart attack in particular), as well as diabetes and osteoporosis.

Dr. Wassersug believes ADT is prescribed in a cavalier fashion and patients are not adequately informed of the side effects.

He said ADT is often presented as a treatment of last resort - "a choice between impotence or life and that sounds like a fair trade-off. But is it really? The tradeoff is really dying of prostate cancer versus dying of a broken hip or a heart attack. And I'm not even mentioning the 16 other unpleasant side effects."

Dean Ruether, a medical oncologist at Tom Baker Cancer Centre in Calgary, said informed consent is a real issue in prescribing ADT. "It's not unusual for a man to not fully understand the implications of the treatment, but we try," he said.

The problem is not unique to prostate cancer, but talk of side effects often seems abstract to patients. This is doubly true of ADT, Dr. Ruether said, because there is so little public discussion of the treatment, and its pros and cons. "Men are starting to come in better educated, but they have a long way to go compared to women with breast cancer," he said.

Bob Shiell, president of the Canadian Prostate Cancer Network, said men would definitely benefit from being better informed. But oncologists and urologists - the physicians who generally diagnose prostate cancer - have to realize, too, that "newly diagnosed patients are in such a state of shock that they will go with just about any recommendation," he said. "They don't take the time to investigate their options or the impact on the quality of life with each option."

Mr. Shiell said that, unfortunately, men view their prostate in the same manner as their appendix: "I'll have it out and I'll be fine."

In fact, while prostate cancer is often portrayed as little more than an annoyance, it can be life altering. Common side effects of surgery and radiation treatment include impotence (the inability to maintain an erection), incontinence (loss of control over the release of urine) and infertility (the inability to produce viable sperm).

If primary treatment fails - as it does in one in five cases - the next step is androgen-deprivation therapy, and castration.

Man couldn't urinate

Fred McHenry, a civil engineer at the time, was on a plane from Singapore to Vancouver when he realized he was unable to urinate. His doctor immediately suspected a prostate problem. "Until then, I had no idea what the prostate was," he said.

Mr. McHenry soon found out more than he ever cared to know. A urologist "did a Roto-Rooter job on my prostate" - a biopsy - but there was no sign of cancer, he said.

Three years later, in 1997, Mr. McHenry returned to the doctor. He did have prostate cancer, an aggressive form. He underwent surgery and radiation, but his PSA (prostate specific antigen - a protein in the blood that can be an indication of cancer) continued to rise precipitously.

He was offered ADT but opted for surgical castration. "Some people cringe at the idea of removing the testicles, but I wanted the best and quickest solution so I bit the bullet," said Mr. McHenry, now 75.

Loss of sexual function was not an issue, he said, because the initial surgery had left him impotent.

But impotence and its ripple effects, from loss of intimacy to depression, are major issues for many men. According to one study, fully half of men on ADT end up divorced in short order. (Mr. McHenry remains happily married.)

John Robinson, a psychologist at the Tom Baker Cancer Centre, said the psychological and sexual implications of advanced prostate cancer treatment are huge and underappreciated. Cancer is not a disease of an individual, it's a family illness; prostate cancer, in particular, is a couple's illness because it casts such a dark shadow over the marital bed.

Dr. Robinson said a lot of couples simply give up on sex because the man can no longer get or sustain an erection. There are aides available like Viagra and penile implants, but what is really required is a change in attitude, he said.

"The message I try to deliver is that you can have satisfying, gratifying sex without an erect penis," he said.

The psychologist - who now treats prostate cancer patients almost full-time - said men are finally starting to speak openly about ADT, and that will make his job of education easier. But he cautioned that openness is a double-edged sword, particularly when dealing with emotionally loaded terms like castration.

"The words are powerful and can be hurtful," Dr. Robinson said. "If a man feels impotent, castrated, emasculated, he's not going to feel good about himself."

The decision on whether to undergo ADT can be a Catch-22. Yes, the side effects are horrible; they can even be fatal. But a death from prostate cancer is excruciating: Cancer migrates into the bone, causing pain that is intense and untreatable.

Despite all he has been through, Mr. McHenry said, that remains the more ignominious fate, and his greatest worry. "Men shouldn't fear ADT," he said. "They should fear the alternative."

But for Dr. Wassersug, the prostate cancer patient in Halifax, the debilitating side effects led him to opt for another form of ADT - estrogen, a female sex hormone that can also suppress testosterone production in men. When ADT was first developed back in the 1940s, estrogen was the drug of choice, but it was discontinued because it greatly increased the risk of stroke and heart attack.

However, Dr. Wassersug said that, based on his research, the manner in which the drug is taken matters. Rather than take estrogen in pill form, he uses a patch or gel - products that are popular with menopausal women.

He has fewer side effects than most men on ADT - fewer hot flashes, less damage to the bones and, most important, fewer cognitive problems that he found horrible when on standard LHRH agonists (drugs that cause chemical castration). The downside is pronounced gynecomastia, or breast enlargement.

"Given a choice between breasts and a brain," Dr. Wassersug said, "I go for the brain."

ANDROGEN DEPRIVATION THERAPY

Prostate cancer growth is dependent on androgens (male hormones), particularily testosterone. The use of drugs to reduce the amount of testosterone in the body can slow the growth of prostate cancer cells.

Pituitary gland: contributes to male hormone production by releasing LH (luteinizing hormone), which stimulates the testicles to produce testosterone. It also triggers the adrenal glands to make other androgens.

Adrenal glands: Produce 5 per cent of the body's testosterone.

Prostate: Its main function is to store seminal fluid and expel semen during ejaculation. The prostate needs testosterone to work properly.

Testicles: secrete between 90- 95 per cent of the body's testosterone.

LHRH: inhibit production of pituitary hormone, in turn reducing testicular hormone.

Anti-androgens: Block action of male hormone.

Surgery: Removal of testicles stops production

WWW.PROSTATEHEALTH.ORG

Side effects of ADT

Androgen deprivation therapy, which blocks production of the male hormone testosterone, has a number of side effects, including:

Loss of libido (sexual desire)

Impotence

Infertility

Hot flashes

Gynecomastia (growth of breast tissue)

Osteoporosis (bone thinning)

Anemia (low red-blood-cell counts)

Cognitive problems (decreased mental sharpness)

Loss of muscle mass

Weight gain, particularly belly fat

Fatigue

Increased risk of heart attack

Metabolic syndrome (a precursor to diabetes)

Depression

André Picard

The Globe and Mail (Canada)

Saturday, September 29, 2007

http://www.theglobeandmail.com/servlet/ ... uested=all

CORRECTION

A

JesusA (imported) wrote: Wed Oct 03, 2007 6:32 pm ccording to the Canadian Cancer Society,

22,300 men will be

JesusA (imported) wrote: Wed Oct 03, 2007 6:31 pm diagnosed with prostate cancer in

Canada this year. An incorrect number appeared in Saturday's paper.

An important and informative article. Thank you and thanks to Dr. Wassersug. --FLO--

I AM A PROSTATE CANCER SURVIVOR!

Seven years ago, at age 52, I was diagnosed as having prostate cancer. I was one of the lucky ones: I had been diagnosed early, and the cancer was fully contained within the prostate. I opted for prostate removeal instead of radiation treatment. As the article stated, there is no one right decision at this step. There are so many factors and far too many variables to know the "right" path to take. For me it was an easy decision: get it out before there is any chance to allow it to spread.

Was I aware of the potential side effects of the choices. Of course. I read numerous takes from various sorces on all of this. But the bottom line was that while informed, non of it had the ability to prepare me for the emotional repercussions of my surgery.

I came through the operation and recouperation cancer free. But I have many of the side-effects mentioned in the lecture. I began with nearly total loss of bladder control. That meant wearing depends at all times. I had always been a nude sleeper and found the nocturnal wearing annoying, causing me to sweat and wake up unrested. I also had to be cautious about diaper rash and continually treat for groin sores. That also meant the need to always sit when in the men's room -- not a great problem, of course, but a minor inconvenience all the same. It also meant keeping chances of depends and clothing at work and in the car for emergency use in case of accidents. Eventually some control returned with continued exercises and therapy. But I still suffered from "stress leakage" when straining to lift, sudden sneezing, hard laughter, coughing spells. Finally the doctor did an injection procedure to "bulk up" the contolling sphincter at the opening to the bladder. That immediately solved the condition, and I was able to again wear typical men's undergarments and stand at the urinal. But it is only a temporary fix and lasted about a year and a half. Now the urologist is talking about a differnt procedure requiring surgery, but with a more permanent outcome. Nothing definite on that yet.

But the major side effect is the impotence. It is nearly impossible to perform the prostate surgery and avoid damage to nerves in the groin even though the doctor tries his/her best. The nerves at the base of the penis are so fine as to be nearly invisible and are quite numerous. I have tried Viagra and all the newer related meds with little and quite eratic results. At most, I plump up but never become hard enough to penetrate. I've even used the injections. Thank goodness I've never been needle shy, cause it really takes nerve to hold a needle and stick it into your cock! But that solution needs to be refrigerated and is therefore most inconvenient. If it had produced better results than the pills, I would have indured that. But it really hasn't been any more sucksessfull. Thank goodness I am a submissive by nature. That has been my sexual salvation. Oral and anal sex have always been most satisfying to me, so I really continue to be sexually active and satisfied. And I can still climax whipping a limp cock. The thing I miss most, however, is my cum. Climaxes after prostate removal are dry. When you stop to think about it, it makes sense. The tube from your nuts to your prick go through the prostate. When they cut out the prostate, that section of the tube no longer exists. While dry climaxes deprive me of eating my cum:-\, it does mean no mess to clean up. So when I "cream my jeans" watching a hot porn flick, I don't end up with soggy drawers.

Do I regret my decision? Absolutely not. While these and other side effects are an inconvenience, I'm much happier being alive than dying a painful death.

Allen (imported) wrote: Thu Oct 04, 2007 3:40 am I AM A PROSTATE CANCER SURVIVOR!

Seven years ago, at age 52, I was diagnosed as having prostate cancer. I was one of the lucky ones: ...........

Thank you for sharing your story. I am glad to hear that the results are mostly favorable. Is the incontenance now under control? As far as sitting to pee - the biggest problem is that many men's rooms have a limited number of stalls, sometimes only one, and it is frequently difficult to find an empty stall. Also, some inconsiderate guys stand in the stalls but don't raise the seat, splashing all over it. Other than that, I find it much more convenient to sit and have done so for over 10 years.

Thank you, Jesus, for posting this article. My #1 interest was seeing whether any of the men on ADT encounter gender instability, but didn't see anything.

Two quotes of particular interest:

JesusA (imported) wrote: Wed Oct 03, 2007 6:33 pm But impotence and its ripple effects, from loss of intimacy to depression, are major issues for many men. According to one study, fully half of men on ADT end up divorced in short order.

It would be nice to know the direct causes of these divorces.

JesusA (imported) wrote: Wed Oct 03, 2007 6:33 pm "Given a choice between breasts and a brain," Dr. Wassersug said, "I go for the brain."

Fortunately, TS's like myself aren't faced with such a dilemma. We get to have both (or all three, depending on how you look at it).

Terri

I've spoken by email to Dr. Wassersug a number of times and he does report various changes in his sexual wiring. I won't put words in his mouth but maybe try contacting him and asking him. My theory about estrogen "Wiring" female sex drive into a non TS male could be true based on what I've heard reported.

bryan (imported) wrote: Thu Oct 25, 2007 7:19 pm Thank you, Jesus, for posting this article. My #1 interest was seeing whether any of the men on ADT encounter gender instability, but didn't see anything.

Two quotes of particular interest:

It would be nice to know the direct causes of these divorces.

Fortunately, TS's like myself aren't faced with such a dilemma. We get to have both (or all three, depending on how you look at it).

Terri

My uncle is 78 and a prostate cancer survivor. Chemotherapy and radiation, made him so sick he couldn't function. He opted for the orchiectomy and has been fine since. He says the only problem is that ever time he walks past the dog, he can hear him snickering.

Terry