Dear Dr. Roach: My romantic partner of one year (a 51-year-old man) is being treated for prostate cancer with Eligard. He received a second injection two months ago. I am satisfied with our level of sexual intimacy, even though it has not included penetration. He is frustrated that his sexual desire has decreased. This is not about an erection, per se. I am willing to be patient. He said his doctor told him he will feel closer to his normal self within a year. Is this typical for a cancer patient treated with Eligard? Could his recovery to normal hormone levels take longer than a year?
L.R.
The goal of androgen deprivation therapy with a drug like leuprolide (Lupron or Eligard) is to lower the blood testosterone and decrease stimulus for growth in prostate cancer and other testosterone-sensitive cancers. Sexual side effects are very common, and most men will have a decrease in libido, as well as erectile dysfunction. Psychologically, many men, like your partner, find the loss of libido very difficult to deal with.
Most men do have an increase in their testosterone levels after treatment, and this usually means an increase in libido, although it may never reach the level it was before treatment. Some men will continue to have improvements in their libido, and erectile function, even two years after treatment. I recommend both partners in a couple have counselling about sexual issues. There are many concerns beyond just loss of testosterone: Changes in body image and fear of recurrence both can cause men to have sexual troubles. A therapist experienced in treatment with cancer and cancer treatment can be very helpful.
Some men can be treated with testosterone if the prostate cancer is thought to be in remission, but this is only appropriate for some men and must be discussed with the treating physician, urologist or oncologist.
Dear Dr. Roach: I just tested positive for COVID and have been on 80 mg of atorvastatin for 20 years, after a heart attack. My doctor prescribed Paxlovid without mentioning that I should stop taking it, until I asked about stopping it. Should I abruptly end this statin? My symptoms are mild, and I am 85 and healthy.
E.O.
Ritonavir-boosted nirmatrelvir (Paxlovid) is a specific anti-viral therapy for COVID-19. It has been shown to reduce the risk of severe disease in people who do not need to be hospitalized, but who are at high risk for complications of COVID (a history of a heart attack is sufficient reason to justify the use of Paxlovid). However, there are multiple drug interactions that your physician should have carefully looked for before prescribing the medication. Statin drugs like atorvastatin are among the most commonly used drugs with significant interaction, and most doctors will stop the statin during the course of Paxlovid therapy. While it’s best not to stop statin therapy, the benefit of Paxlovid in a person with COVID outweighs the risk of holding therapy for the five days of Paxlovid treatment.
Two statins, lovastatin (Mevacor) and simvastatin (Zocor), have a greater risk of drug interactions than atorvastatin (Lipitor) or rosuvastatin (Crestor). Those two should be stopped 12 hours before starting Paxlovid, and should not be restarted for five days after completing Paxlovid.
The U.S. Food and Drug Adminstration made a fact sheet available for physicians prescribing this drug, with a list of the most important drug interactions, at www.fda.gov/media/155050/download.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
