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The paradox of testosterone and ADT
Phil, It’s a curious thing, really — this blind devotion to testosterone as the prime mover in prostate cancer’s twisted little drama. One might imagine that a tumor emerging in an environment already barren of testosterone — my personal endocrine wasteland — might, out of sheer metabolic necessity, learn to dine elsewhere. Glucose, glutamine, maybe even sheer spite. In other words, it may never have been dependent on testosterone in the first place, rendering castration-based therapies about as effective as removing the steering wheel from a horse.
And yet, when I dared to suggest this — that perhaps my tumor was an evolutionary overachiever, already adapted to scarcity and thus indifferent to the standard hormonal starvation diet — I was met not with curiosity, but catechism. The gold standard, they said. Tried and true. As if medicine were a medieval guild and I, an unruly apprentice questioning the sacred text.
Now, don’t get me wrong — gold standards exist for a reason. They work. Mostly. But I’m not "mostly." I’m me. And my concern is not the statistical majority. It’s whether this doctrinal adherence overlooked a tumor that, by virtue of its very origin, had already found a detour around the testosterone toll booth.
So here we are: therapy proceeding with grim determination, and me quietly wondering if we’re starving a tumor that was never hungry in that way to begin with. And if that’s true, what then? Will the outcome reflect biology’s stubborn individuality, or medicine’s one-size-fits-all optimism?
Either way, it seems I’m not just fighting cancer — I’m also in a polite but pointed disagreement with protocol.
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I fully understand your frustration! Thank you for thinking outside the box.
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1 ReactionYes, it seems individual uniqueness might get overlooked in the statistical analysis that establishes “norms”. My mother had high blood pressure as did all her family. She and her siblings all lived into their nineties and none died from a stroke. Go figure!
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2 ReactionsTotally unrelated, but if I had to guess, I'm guessing that you are a writer or English teacher....something like that. You make this dreaded disease sound almost poetic! Steve
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2 ReactionsI am neither an English teacher nor a writer, though I do dabble in coherent sentences when necessary. My native tongue is Flemish, with German and French close behind. English came later—acquired after my arrival from Belgium in 1979, primarily as part of an ill-fated effort to introduce North Americans to the radical notion of basic etiquette. The outcome has been… instructive, if not exactly encouraging.
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4 Reactionsgoed geschreven
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1 Reaction@hanscasteels, like others, I enjoy your posts. They always make me smile! So thank you!
Remind me of where you are receiving treatment. Given your facility with languages, it could be on many continents!
GSD
I live in Waterloo, Ontario. And the facility that’s treating me is Grand River Cancer Centre.
I did nt like Hans posts; he uses big words that us morons find it hard to understand.
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3 ReactionsAh, I do apologize—it's never my intent to obfuscate with sesquipedalian loquaciousness. I merely assumed we were engaging in a dialogue above a third-grade lexicon.
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3 ReactionsHans, first of all, you're one of the many gifts I've been given since becoming a member of this club! A very close friend, who is also a member of our club, took a trip for pleasure with people he met on PCa forums. He said it was one of the best trips he had ever taken! You would be one my short list of people to invite!
Secondly, I too am frustrated by the existential question: 'But what about me?' Gold standards exist for a reason, but they can also be a barrier to more open discussions between doctors and patients about the specific information each individual needs to feel confident about moving forward. I long for a dialog that allows me to express my concerns and then results in a discussion about the pros and cons of alternatives I've read about. I would be glad to pay whatever hourly fee is appropriate to spend 15-30 minutes in such discussions. I feel I'm going to get that opportunity at Mayo and I'm look forward to that discussion.
I hope you have the same opportunity!
Best wishes!
GSD
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