Scott Adams made it know that he was having severe (undertreated) pain from his prostate cancer and decided to kill himself legally, got his medicine, and even had the date set to do it.
But then a doctor suggested to him to use hormone blockers, which he had refused earlier because he was under the impression he would be a different person if he took them.
But according to a discussion here he tells of how one physician persuaded him to take hormone blockers, and since then he has gone into remission and is improving.
WTF?
now, these hormone blockers have a bad reputation because they are being misused to transition transexual children and stop puberty.
Wikipedia on GNRH Antagonists.
but they are used for other problems: hormone sensitive cancers, benign tumors, and (in my case) endometriosis.
I took a course of hormone blockers for benign tumors and endometriosis as an alternative to a hysterectomy so I could get pregnant (no I didn't get pregnant, but the point is that I was young and unmarried, and was grateful for them doing this since I did marry a few years later). They work by putting you into artificial menopause, so the benign tumors and the endometriosis, both of which are hormone dependent, shring.
The hormone blockers did work: after several months of treatment and surgery to remove extensive scar tissue from the endometriosis, I remained pain free for ten years before the condition reoccured.
But I cried every day on that treatment i.e. went into depression so I warned my male patients taking hormone blockers for prostate cancer that if they got depressed, well it was the medicine, not reality.
So anyway, one is happy for Mr Adams that he was persuaded to take a fairly benign (next to chemotherapy) medicine for his cancer and presumably got a doctor to manage his pain relief and other cancer symptoms.
But you know: this shows that getting legal persmission to get drus to kill oneself is flawed.
and if a rich, intelligent guy like Mr Adams got poor treatment for his cancer, what about people like my patients, who tended to be poor, not sophisticated or educated, minorities, and lived far from expert care?
what makes me especially angry? This is not an experimental drug.
GNRH Antagonists are a variation of an old and well known and widely used treatment for bone metastatses from Porstate cancer (and breast cancer too): estrogens or surgical castration.
Hormone dependent cancers with metastates have long been treated by blocking the hormone.
Before the GNRH Antagonists, they castrated men with prostate cancer, or gave them estrogen to turn off the male hormone that fed the growth of the cancer and relieve bone pain from metastases. (and for women, Ovarian removal was used for women with metastatic breast cancer.)
Back when I started medical school both castration and estrogen were used for prostate cancer, until a study showed that giving estrogen didn't prolong life in large studies because the patients had more heart disease. (never mind that part about pain relief).
So presumably blocking the hormone replaced estrogen.
So I asked Grok abbout using estrogen in prostate cancer:
Estrogen was first used for prostate cancer treatment in the early 1940s. Charles B. Huggins, a urologist, pioneered its use after discovering that hormonal manipulation could slow the growth of prostate tumors.
His research, published in 1941, showed that diethylstilbestrol (DES), a synthetic estrogen, reduced tumor activity in patients with metastatic prostate cancer, marking a significant milestone in hormone therapy. This work earned Huggins the Nobel Prize in 1966.
so Grok when did these hormone blockers replace estrogen for prostate cancer?
Estrogens, such as diethylstilbestrol (DES), were a primary hormone therapy for advanced prostate cancer from the 1940s until the late 1970s and early 1980s, when they were largely supplanted due to significant cardiovascular side effects like blood clots and an increased risk of heart disease.
This shift was driven by the introduction of gonadotropin-releasing hormone (GnRH) agonists (e.g., leuprolide and goserelin), which achieved medical castration more safely and effectively without the estrogen-related risks; the first patient was treated with a GnRH agonist in 1979, leading to rapid worldwide adoption by the mid-1980s.
GnRH antagonists (e.g., degarelix and relugolix), which suppress testosterone without the initial "flare" seen with agonists, did not directly replace estrogens. Instead, they emerged later as an alternative to GnRH agonists for specific clinical needs, such as avoiding flare in high-risk patients (e.g., those with spinal metastases).
The first GnRH antagonist, abarelix, was approved by the FDA in 2003 but withdrawn in 2005 due to allergic reactions.
Degarelix gained FDA approval in 2008, establishing GnRH antagonists as a viable option in clinical practice. Relugolix, an oral formulation, followed in 2020.
Today, both agonists and antagonists are standard androgen deprivation therapies, with antagonists preferred in certain cardiovascular-risk scenarios.
so one is happy that Mr Adams now is on the correct treatment for his painful cancer.
But if an intelligent and sophisticated man can't get decent treatment, what about ordinary folk, especially minorities?
