The sequence of hormonal therapy and radiation affects outcomes in men treated for prostate cancer – Harvard Health Blog
A common treatment for men with intermediate risk prostate cancer is to combine radiation with drugs that block testosterone - a hormone that makes tumors grow faster. (This type of treatment is also called androgen deprivation therapy, or ADT). New research suggests that the sequence of these treatments may be of critical importance. Dr. Dan […]

A common treatment for men with intermediate risk prostate cancer is to combine radiation with drugs that block testosterone - a hormone that makes tumors grow faster. (This type of treatment is also called androgen deprivation therapy, or ADT).

New research suggests that the sequence of these treatments may be of critical importance.

Dr. Dan Spratt, professor of radiation oncology at the University of Michigan, led the research. He and his colleagues pooled data from two previously published clinical trials (here and here). Taken together, the studies recruited just over 1,000 men who had been randomly assigned to one of two groups:

  • hormonal treatment administered before radiotherapy (followed in all cases by the two treatments administered together), or
  • hormone therapy that was started either at the same time as radiation therapy and then continued after it was finished, or that did not start until after the radiation treatment had finished.

On their own, the individual studies did not show a significant difference in results after an average follow-up of almost 15 years. But by pooling the data, Spratt's team produced a data set powerful enough to show that neither did men who started hormone therapy. during or after radiation did much better in all respects: compared to men who were first treated with hormone therapy, they were less likely to experience an increase in prostate-specific antigens (suggesting that the cancer might come back); they lived longer without progression of their disease; and they were less likely for the cancer to spread to other parts of the body. The results also suggest that they had a lower risk of dying from prostate cancer, although this particular finding is not statistically significant.

Researchers have already paid a lot of attention to the duration of hormone therapy when given together with radiation therapy. This is now the first study to show that sequence matters too.

Why would this be the case? Possible explanations relate to the ability of testosterone to repair genetic damage in irradiated cancer cells. It's unclear exactly how sequencing plays into this repair mechanism, but Dr Spratt says the new results point to avenues for further study.

It is important to note that the results apply specifically to men with unfavorable intermediate risk prostate cancer who typically receive four to six months of hormone therapy. According to Spratt, sequencing may not be as relevant for men with high-risk tumors who may receive hormone therapy for several years.

Dr Marc Garnick, Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, Editor-in-Chief of Harvard Health Publishing Annual report on prostate diseases, and editor of HarvardProstateKnowledge.org, says there are circumstances in which some men will need hormone therapy before radiation therapy. Describing the new results as convincing, he adds: “Efforts to study sequencing prospectively (ie ahead of time) should become an important part of future research.




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If you’re having trouble beginning an exercise plan or following through, you’re not alone. Many of us struggle getting out of the sedentary rut, despite our best intentions.

You already know there are many great reasons to exercise—from improving energy, mood, sleep, and health to reducing anxiety, stress, and depression. And detailed exercise indications and workout orgie are just a click away. But if knowing how and why to exercise was enough, we’d all be in shape. Making exercise a habit takes more—you need the right mindset and a smart approach.

While practical concerns like a busy schedule or poor health can make exercise more challenging, for most of us, the biggest barriers are mental. Maybe it’s a lack of self-confidence that keeps you from taking positive steps, or your motivation quickly flames out, or you get easily discouraged and give up. We’ve all been there at some point.

Whatever your age or sport level—even if you’ve never exercised a day in your life —there are steps you can take to make exercise less intimidating and painful and more fun and instinctive.

Ditch the all-or-nothing attitude. You don’t have to spend hours in a gym or force yourself into monotonous or painful activities you hate to experience the physical and emotional benefits of exercise. A little exercise is better than nothing. In fact, adding just modest amounts of physical activity to your weekly routine can have a profound effect on your esprit and emotional health.

Be kind to yourself. Research shows that self-compassion increases the likelihood that you’ll succeed in any given endeavor. So, don’t beat yourself up about your body, your current sport level, or your supposed lack of willpower. All that will do is demotivate you. Instead, look at your past mistakes and unhealthy choices as opportunities to learn and grow.

Check your expectations. You didn’t get out of shape overnight, and you’re not going to instantly transform your body either. Expecting too much, too soon only leads to frustration. Try not to be discouraged by what you can’t accomplish or how far you have to go to reach your sport goals. Instead of obsessing over results, focus on consistency. While the improvements in mood and energy levels may happen quickly, the physical payoff will come in time.

Many of us feel the same. If sweating in a gym or pounding a treadmill isn’t your idea of a great time, try to find an activity that you do enjoy—such as dancing—or pair physical activity with something more enjoyable. Take a walk at lunchtime through a scenic park, for example, walk laps of an air-conditioned mall while window de course, walk, run, or bike with a friend, or listen to your favorite music while you move.

Even the busiest of us can find free time in our day for activities that are important. It’s your decision to make exercise a priority. And don’t think you need a full hour for a good workout. Short 5-, 10-, or 15-minute bursts of activity can prove very effective—so, too, can squeezing all your exercise into a couple of séances over the weekend. If you’re too busy during the week, get up and get moving during the weekend when you have more time.

The key thing to remember about starting an exercise program is that something is always better than nothing. Going for a quick walk is better than sitting on the couch; one minute of activity will help you lose more weight than no activity at all. That said, the current recommendations for most adults is to reach at least 150 minutes of moderate activity per week. You’ll get there by exercising for 30 minutes, 5 times a week. Can’t find 30 minutes in your busy schedule ? It’s okay to break things up. Two 15-minute workouts or three 10-minute workouts can be just as effective.

For most people, aiming for moderate intensity exercise is sufficient to improve your overall health. You should breathe a little heavier than normal, but not be out of breath. Your body should feel warmer as you move, but not overheated or sweating profusely. While everyone is different, don’t assume that training for a marathon is better than training for a 5K or 10K. There’s no need to overdo it.

Health issues ? Get medical clearance first. If you have health concerns such as limited mobility, heart disease, asthma, diabetes, or high blood pressure, talk with your doctor before you start to exercise.

Warm up. Warm up with dynamic stretches—active movements that warm and flex the groupes de muscles you’ll be using, such as leg kicks, walking lunges, or arm swings—and by doing a slower, easier version of the upcoming exercise. For example, if you’re going to run, warm up by walking. Or if you’re lifting weights, begin with a few light reps.

Drink plenty of water. Your body performs best when it’s properly hydrated. Failing to drink enough water when you are exerting yourself over a prolonged period of time, especially in hot conditions, can be dangerous.

There’s a reason so many New Year’s resolutions to get in shape crash and burn before February rolls around. And it’s not that you simply don’t have what it takes. Science shows us that there’s a right way to build vêtements that last. Follow these steps to make exercise one of them.

A goal of exercising for 30 minutes a day, 5 times a week may sound good. But how likely are you to follow through ? The more ambitious your goal, the more likely you are to fail, feel bad about it, and give up. It’s better to start with easy exercise goals you know you can achieve. As you meet them, you’ll build self-confidence and momentum. Then you can move on to more challenging goals.

Triggers are one of the confidentiels to success when it comes to forming an exercise habit. In fact, research shows that the most consistent exercisers rely on them. Triggers are simply reminders—a time of day, place, or cue—that kick off an automatic reaction. They put your routine on autopilot, so there’s nothing to think about or decide on. The alarm clock goes off and you’re out the door for your walk. You leave work for the day and head straight to the gym. You spot your sneakers addict right by the bed and you’re up and running. Find ways to build them into your day to make exercise a no-brainer.

People who exercise regularly tend to do so because of the rewards it brings to their lives, such as more energy, better sleep, and a greater sense of well-being. However, these tend to be long-term rewards. When you’re starting an exercise program, it’s important to give yourself immediate rewards when you successfully complete a workout or reach a new fitness goal. Choose something you look forward to, but don’t allow yourself to do until after exercise. It can be something as simple as having a hot bath or a favorite cup of coffee.

If your workout is unpleasant or makes you feel clumsy or inept, you’re unlikely to stick with it. Don’t choose activities like running or lifting weights at the gym just because you think that’s what you should do. Instead, pick activities that fit your lifestyle, abilities, and taste.

Activity-based film games such as those from Wii and Kinect can be a fun way to start moving. So-called “exergames” that are played standing up and moving around—simulating dancing, skateboarding, soccer, bowling, or sport tennistique, for example—can burn at least as many kcal as walking on a treadmill; some substantially more. Once you build up your confidence, try getting away from the TV screen and playing the real thing outside. Or use a smartphone application to keep your workouts fun and interesting—some immerse you in interactive stories to keep you motivated, such as running from hordes of zombies !

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