Daniel Petrylak, MD: Patients do have a bias against chemotherapy. There’s a lot of press and literature saying that chemotherapy is difficult to tolerate, and I think that chemotherapy’s adverse effects are dependent upon patient selection. Their age,comorbidities, and also some of the cancer comorbidities, as well. Weight loss, fatigue, bone pain. We know that we can see improvements in bone pain with both chemotherapy as well as next generation antiandrogens. We saw in the CARD trial, patterns of toxicity are different. You need to counsel the patient that they may expect adverse effects; we can alleviate some of them, such as neutropenia, with growth factors. Also, if they develop edema from chemotherapy, they can also receive diuretics. Same thing with next generation agents, you’ve got to watch their blood pressure, you watch their liver function tests, all of these need to be monitored. Good monitoring is very important for these particular patients.
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