da Beitraege anscheinend nicht mehr korrigiert, ergaenzt oder geloescht werden koennen, moechte ich in einem Nachtrag einige Zitate aus Dr. Patrick Walsh Guide to surviving Prostate Cancer einbringen:
"Note: As we will discuss below, no form of early hormonal therapy really prevents prostate cancer from progressing. The only thing it delays is your knwledge of this progression. (p.459)"
"There is one crucial concept here that you need to understand: ultimately - although it may take years - combined androgen blockade is going to stop working, just as every other kind of hormonal therapy does. Anyone who leads you to believe otherwise is not doing you a favour. It s because of the hormonally independent portion of the cancer - the cells that couldn t care less what hormones its host is taking, because hormones have no effect on this portion of the tumor.Using hormones to fight these cells is (going back to our bug spray analogy) like trying to kill a cockroach with weed killer instead of insecticide. (p.462)"
Zur Frage, wann mit Hormontherapie begonnen werden soll:
"The man who begins tratment early has a false peace of mind based on the idea that what he can t see won t hurt him. Whether a man is treated with hormonal therapy immediately, as soon as the diagnosis of advanced disease is made, or his doctor waits until the man has signs of progression and t h e n begins tratment, we believe - and study after study proves - that survival is exactly the same. There is no compelling evidence that any kind of hormonal therapy works better earlier than later, when a man begins experiencing symptoms such as urinary obstruction or has a positive bone scan. (p.478/479)"
Die Frage, wieso Hormonentzug uns von Aerzten als lebensverlaengernde Therapie verordnet wird, beantwortet Walsh so:
"You should be aware that the medical debate in this area is strongly influenced by factors that often don t get talked about oprenly. The pharmaceutical industry makes at least 1 billion $ a year on hormonal agents for the treatment of prostate cancer. There is no question that they look after their financial interests by stoking the furnace to keep sales (prescriptions) up. This happens in many ways - through direct advertising; cleverly disguised web sites;distribution of multicolored "scientific summeries", that endorse the widespread use of their products; or surreptitious support for medical meetings at fancy spas, at which "experts" (who receive generous honoraria, frequent- flier miles , and a free trip) promote the company cause. The massive financial and political clout - and largess - of the pharmaceutical companies is widepread and well known among physicians of every specialty, not just urology (p.471/472)"
Letzteres ist mir, der ich die Szene um den Prostatakrebs in Deutschland seit Jahren kritisch beobachte, aus der Seele gesprochen und so wuerde ich den "Paradigmenwechsel", wie von BurgerH hier zur Diskussion gestellt, bezeichnen als das Ergebnis einer erfolgreichen Werbekampagne fuer Casodex. Ein wirklicher Paradigmenwechsel waere das Eingestaendnis der Grenzen von Hormontherapie. Das allerdings wuerde dazu fuehren, dass nur noch selektiv verschrieben wird.
Reinardo
Kommentar