Dr Steven Tucker

Nobody likes to say castration.  Men make that gesture where they protect their privates whenever someone says the word.  It’s a symbiotic sensation we all have when see another man get kicked in the groin. However, in medicine, doctors like to use words like ‘andorgen deprivation therapy (ADT)’ or ‘testosterone inactivating products’, but we know what they mean, they mean castration.

Well today in the JCO there are 2 new articles about the impact of castration in men with non-metastatic prostate cancer.  The 1st study looked at cognitive function when castrated and the 2nd study looked at physical function.  I was a little surprised with the results, specifically they saw no cognitive decline in men receiving ADT.  But alas, the devil is in the details…the study only evaluated cognition at baseline, 6 months, and 12 months.  In my experience, patients do have noticeable declines but usually begining after 12 months.

The second study also surprised me.  All of us who see men with PC know that castration results in a debilitating array of biomedical problems such as muscle loss, glucose intolerance, insulin resistance, hyperlipidemia, etc but usually it takes at least 6-12 months to set in.  The increased risk of fractures is noticeable at 12 months.  So I was surprised that this report shows endurance and strength declining within 3 months of starting therapy.  All the more reason we must push men to start and maintain quality exercise programs during therapy.  This is for men on intermittent and continuous “castration”.  I completely agree with the conclusion – interventions must be started well in advance!