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HT really necessary with EBRT? - Radiotherapy IMRT,Hormone therapy (HT / ADT / IMHT)

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User
Posted 06 Feb 2017 at 14:00

Hi

I posted a few weeks back while OH was agonising over whether to opt for Active Surveillance (he's Gleason 7, 3+4). 

After much angst, he's now decided to opt for radiotherapy (they offer IMRT at our hospital). Decided against prostatectomy as he's terrified of surgery, and added that fact to the decision-making pot. Brachytherapy discussed but probably not an option as size of his prostate is right at the upper limit for treatment (69cc). 

He's got an appointment with the oncologist tomorrow. We saw her briefly a couple of weeks ago; she seemed to indicate that hormone therapy being used before, during and after EBRT is likely to be on its way out over the next few years (although it's currently standard practice). Apparently as far as they can tell from the MRI and biopsy there's only a 'very small' amount of cancer. So, does anyone have a perspective on whether HT is really necessary in this case? And if so, for a whole 3 months beforehand? Will it also shrink the whole prostate and therefore help with the targeting of treatment? I know it's hard to comment on individual cases, but I would appreciate hearing from anyone with similar experience (or relevant knowledge). 

Many thanks, Janet 

User
Posted 06 Feb 2017 at 17:48

As you say hardly ever are two cases identical but I can repeat my simple view of HT.

It is now 14 years since I set out on this path. Top of my head can't remember my gleason score but I have only ever dealt with a Urologist who told me he and a Radiologist had looked at my blood tests, PSA was 25ish, and biopsy results and were recommending HT (zolodex three monthly injections). I was almost 68 at the time, my wife and I had carefully gone through all the info about the various options that might be on the table and went along with them.

There I remain. Unlike some you can read about, I don't feel I have ever been involved or consulted since in any decisions about coming off for a trial period or whatever. On the plus side my PSA showed a good response from the off down into single figures and has never increased significantly. When the Uro left last year his replacement told me at our initial meeting he was discharging me. I could arrange my six momthly PSA tests  which he would see - - next patient! I couldn't tell you his name but I'm convinced I'm as well off without him and he can't take any of those 14 years back in any case.

One thing I would point out is HT is chemical castration and it kicks in quite soon after the first injection. We have coped with the consequences and look forward to our Diamond wedding 2018. I'm not called the 'Lucky Lad' for nothing!

 

 

 

User
Posted 13 Feb 2017 at 11:05

Hi Jansong.
I have just finished HT with IGRT. I had 2 injections of Zoladex, 3 months apart, my last implant was in September. I had 3 months before the RT and 1 at the start of it. My oncologist says I dont have to have another. So even if you do have HT it may not be for long. It is chemical castration though, no urges at all, and no function. It should all come back though.
If in doubt at having HT, try crossing the road with your eyes closed. Same thing.

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User
Posted 06 Feb 2017 at 17:48

As you say hardly ever are two cases identical but I can repeat my simple view of HT.

It is now 14 years since I set out on this path. Top of my head can't remember my gleason score but I have only ever dealt with a Urologist who told me he and a Radiologist had looked at my blood tests, PSA was 25ish, and biopsy results and were recommending HT (zolodex three monthly injections). I was almost 68 at the time, my wife and I had carefully gone through all the info about the various options that might be on the table and went along with them.

There I remain. Unlike some you can read about, I don't feel I have ever been involved or consulted since in any decisions about coming off for a trial period or whatever. On the plus side my PSA showed a good response from the off down into single figures and has never increased significantly. When the Uro left last year his replacement told me at our initial meeting he was discharging me. I could arrange my six momthly PSA tests  which he would see - - next patient! I couldn't tell you his name but I'm convinced I'm as well off without him and he can't take any of those 14 years back in any case.

One thing I would point out is HT is chemical castration and it kicks in quite soon after the first injection. We have coped with the consequences and look forward to our Diamond wedding 2018. I'm not called the 'Lucky Lad' for nothing!

 

 

 

User
Posted 06 Feb 2017 at 17:53

Hi Janet,

I have a grandson, who is likely, because all his ancestors had it, to be at high risk of developing prostate cancer in 50 years time.

I imagine if and when he does there will be wonderful new treatments available and he will look back at our current treatments and wonder did they really do that to granddad?

The thing is medical science is always advancing and whatever treatment is available to day will be superseded, but your OH needs treatment now, so all you can do is go along with what your consultant recommends.

I have had two bouts of RT with HT, so over the last 10 years I have spent half my life on HT.

But look on the bright side, in 2007 I was diagnosed with Gleason 9 on the cusp of being 'Advanced'.  If you had told me then that in ten years time I would be off HT and have a PSA of 0.4 I would have been overjoyed.

Doesn't bare thinking about what might have happened if I had rejected my consultant's advice.

:)

Dave  

User
Posted 07 Feb 2017 at 02:36

Can't comment on individual cases but overall it has been found that HT works with RT to give a better result and now it is often started 6 months before RT although in some cases the previous norm of 3 months is given. By shrinking the cancer it enables the RT to concentrate more heavily on the affected area(s).

Barry
User
Posted 07 Feb 2017 at 11:53
Hi Janet

Trust issues are a little clearer after today. My brother dx. He lives in Australia and is opting for rt and had a Lupron injection last month prior to his 9 X 5 sessions. I'm updating my profile once I have more detail. I had da vinci at similar age to your partner. I visualise decision like driving. Ie

Once the chosen route is taken from the 'dx-pc-as roundabout ' things actually get a long easier to deal with.

You can play with the analogy in many ways. Who is driving the car or navigating ? In both my case and my brothers we both agreed .. Time to take a route off the roundabout as Gleason 4 + 3 so AS to keep going around and around was not an option for us.

PS. I don't use the term 'exit' from the roundabout. Lol. Nor are any a holiday scenic route .... just a mystery tour.... umm...

Regards Gordon

Edited by member 07 Feb 2017 at 12:02  | Reason: Not specified

User
Posted 13 Feb 2017 at 11:05

Hi Jansong.
I have just finished HT with IGRT. I had 2 injections of Zoladex, 3 months apart, my last implant was in September. I had 3 months before the RT and 1 at the start of it. My oncologist says I dont have to have another. So even if you do have HT it may not be for long. It is chemical castration though, no urges at all, and no function. It should all come back though.
If in doubt at having HT, try crossing the road with your eyes closed. Same thing.

User
Posted 19 Feb 2017 at 21:21

I had HT before my EBRT. I started on bicalutamide in January 2016 and the EBRT (20 sessions) took place late April to late May. I continued with the HT until early July - 6 months in total.

I was told that the purpose of the HT was indeed to shrink the tumour. At Clatterbridge, where I was treated, they also inserted gold markers into the prostate to enable more accurate targeting so a sort of belt and braces approach.

I suffered some slight enlargement of the breast tissue and they were a bit tender. The tenderness has gone although I'm still a bit bigger up top than I was.

The good news is that my libido and erectile function has returned and speaking to other fellow sufferers it often does return once the HT has left the system.

 
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