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Prostate Cancer Network
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Should you have hormone therapy along with radiation?

A useful video about this was cited in a Urology Practice Update email. The video is here: practiceupdate.com/expertop...

The radiation oncologist being interviewed advocates 4 months of hormone therapy to accompany radiation for intermediate risk PCa (Gleason 7 or PSA between 10 and 20) and 18 months for high risk (Gleason 8-9 or PSA above 20). He didn't mention low risk cancer.

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I had 43 fractions of EBRT. Gleason score 4+3=7 .No Hormone therapy. 6 months check up PSA .08.

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My Radiologist stated that he felt the combination of hormonal therapy with radiation is like a one-two punch to cancer. He wanted me to be on Lupron at least two months before starting (38 rounds) of radiation. I am still on Lupron along with Zytiga at the advice of my medical oncologist.

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My doctor was not planning to use hormone therapy at all with my radiation (2 sessions of HDR brachytherapy + 25 sessions of 3DCRT external beam) but I had a second opinion from another radiation oncologist who said I absolutely should have HT. I did some research in Pubmed and found a trial showing a 25% better chance of a cure (or at least long term remission - who ever knows he's cured) in Gleason 7 patients with 6 months of HT. So I asked for it and got it.

Rodger: If you're at .08 six months after treatment, that's an excellent result. You may have done fine without it.

Alan

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MY Gleason was 4+4 =8. After prostatectomy my PSA was .1. Began 37 rounds of radiation along with Firmagon (I'd still like to get my hands on the person who named that drug). Anyway, PSA dropped to 0.0 and I discontinued the ADT after two injections. I found the side effects a bit much plus wondered how I'd know if the radiation had worked or not if I stayed on it. PSA stayed at 0.0 for five months but then reappeared and started rising. Obviously the radiation did not work. So while this question was about should we get the ADT along with the radiation, I'm wondering if the question shouldn't be flipped to be should we get radiation along with the ADT. Always much to be considered with our malady. We must do our homework and pray for wise decisions.

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I'm sorry to hear about the outcome of your treatment. Unfortunately, your story is a common one. You had the most aggressive possible primary therapy - surgery followed by radiation and ADT, but still the cancer isn't conquered. "High risk" prostate cancer truly is high risk.

At this point, if you haven't already found a medical oncologist, it's time to search for one. Ideally, I think you want an oncologist with a specialty in prostate cancer, and you want one who keeps up with the latest research. I always recommend looking at the National Cancer Institute's "Designated Cancer Centers", places that NCI thinks are national leaders in cancer treatment and research. Here's a link to the NCI web page: cancer.gov/research/nci-rol...

You can also often find good people by asking others if they know someone. If you haven't done it yet, you might want to join the "Advanced Prostate Cancer" group on HealthUnlocked. It has 2400 people dealing with cancer that failed initial treatment.

There is some good news for you. New treatments (especially Zytiga and Xtandi, and the use of combination therapies) are extending life a lot longer than the previous ones and the science is advancing a lot faster than it did in the past with more new therapies in the works. I don't know how old you are but, in spite of the Gleason 8, there is a decent chance that you'll live to old age.

I wish you the best of luck.

Alan

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Thank you for your reply, Alan. Much appreciated. Yes, as soon as I get the results from my upcoming imaging I plan to submit all my records to the Dana Farber Cancer Institute in Boston for their evaluation. I could have chosen any of several great facilities to send records to but I'm descended from the Dana clan and I figure in this battle we need every edge we can garner. Not that I'm superstitious :)

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If you look at my profile or other posts on salvage radiation you will see my complete history. I am 18 months out after SRT and with NO ADT. I went against my radiologists recommendation for ADT and SRT. I have my own reasons why I chose the route I did. There are numerous studies out there that will show many different results. I looked at my history read countless studies and research consulted professionals and chose the path of radiation alone. Was I one of the lucky ones so far, who knows when and if it will return, but my PSA is .026 - 18 months after SRT. I firmly believe a plant based diet, lots of exercise, supplements and staying positive all played a role with the current remission I am experiencing. I am reporting my results so others can take the information for what it’s worth and choose their own path for treatment.

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Wishing a continuous good luck.

As a chemistry teacher I am skeptical about plant based diet only, since the use of pesticides,germicides ,fungicides etc

in my point of view, balance the bad chemicals in meats.

Very few people are able to grow their "organic" plants,

thus depriving themselves of important elements, iron just to name one and important proteins.

Discussion on the subject is open.

I am prostate cancer "survivor" for 11 years, exercise a lot,having balanced "Mediterranean style" diet.

Gleason 7,PSA 6, EBRT without hormones, failed after 3 years and on Lupron and Casodex since.

Now my oncologist is recommending to be on continuous hormonal therapy (instead on interrupted), because of recent jumps in last year PSA, namely 0.68, 0.87, 1.10 ...

Any comments Alan , or others ?

Victor

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I got a 6 month eligard (ADT) shot in preparation for radiation. I jumped ship and went for HIFU instead. The ADT is recommended for that for good reason -- my prostate shrank from 34 to 27 and eased the task of HIFU surgery. My local urologist (not the out of state HIFU urologist) recommended another 1 1/2 years of ADT for my gleason 8 cancer. I refused. I would not have been able to gauge the effectiveness of the surgery doing that. Going for labwork soon.

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I had read that ADT adjuvant to radiation had a declining marginal benefit. In other words, the first 6 months convey a certain benefit. Adding 6 more conveys a smaller additional benefit. Adding 6 more yields an even smaller addition, and so on out to 3 years. The video I cited, if it's accurate (always a big if) gives much more precise advice. The rad onc in the video would have suggested something between what you got and what your urologist recommended.

My impression is that, since very few doctors have undergone ADT themselves (or any other cancer treatment for that matter), they aren't always aware of how onerous the treatments can be.

I think that, in this case at least, there is no single right answer. Different doctors and different patients have different ideas.

Best of luck with your treatment outcome. Let us know how it goes.

Alan

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Provision Proton (Knoxville) said absolutely 18 month ADT for my G 4+5.

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My radiation oncologist said he was involved with the trials regarding ADT and radiation. He says the trials showed benefit from ADT for 2 years and started it a week before external beam Rad Tx. Second Lupron shot soon, still continuing Casodex. Also a former director of radiation oncology at Cleveland clinic has reviewed my "case" and recommends no change. FYI

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