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Hormone therapy combined with radiotherapy?

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User
Posted 16 Dec 2017 at 15:16

My husband was recently diagnosed with prostate cancer with a Gleason Score of 9 and a PSA of 115.  He has begun hormone therapy, tablets at the moment, then his first injection next week.  However, I have read that initial treatment seems to be, more commonly, hormone therapy combined with radiotherapy.  The consultant said the cancer was too far advanced for either chemo or radiotherapy, even though his bone scan was clear.

Is it usual to just have hormone therapy without any other form of treatment?   

User
Posted 17 Dec 2017 at 16:53

Usually such cases are reviewed by a multi disciplinary team (MDT) encompassing the surgeons concerned, oncologists, nursing and radiological people. Ensuring that the oncologist now takes the lead should be routine. Stress the point to the nurse and she will make it happen, I'm sure.

AC

User
Posted 19 Dec 2017 at 06:51

Genevieve,

I can't speak for others and I think it depends upon where you live and are being treated but my experience was that after referral to the hospital I was seen by a specialist urology nurse, once PCa had been confirmed the transfer to oncology was automatic.

User
Posted 20 Dec 2017 at 10:48

Just an update. I spoke to one of the specialist nurses on here and she was incredibly helpful. So, my husband and I were able to go to the appointment armed with a list of questions and expectations. The specialist nurse at the hospital told us that there had been a multidisciplinary meeting and my husband will be having an MRI and will also be seeing the oncologist within the next 2/3 weeks, so we left feeling much happier.

Thank you all so much for your help, it's very much appreciated.

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User
Posted 16 Dec 2017 at 19:36

No. I would have thought other treatments would be offered as soon as the PSA comes down to single figures, suggesting that the tumour is small enough then to irradiate.

Good Luck and Patience!

AC

User
Posted 16 Dec 2017 at 19:46

I think that you have a bit of the story missing. If the onco says it is too far advanced for RT, but has confirmed that there are no bone mets, then you need to ask where s/he believes the mets actually are. If it has gone to the lymphatic system or soft tissue radiotherapy is a bit pointless. If the scans have been clear then he may have micromets but the PSA suggests that there must be an awful lot of them!

Hard to understand why he is not being offered early chemo. You could ask the onco whether they are aware of the recent research and NICE guidance that chemo can be offered in this circumstance. Or you could ask for a referral to another oncologist for a second opinion.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 16 Dec 2017 at 20:04

Thank you Lynn and AC for your replies. He is under a urologist at the moment and it was this consultant who gave us the diagnosis and said it was too far gone for radiotherapy or chemo. There has been no mention of him seeing an oncologist. It's a little awkward to ask questions when I go with my husband as he is accepting of whatever treatment they give him and I don't want him to feel that I'm taking over the consultation. However, I do want to be sure that he is getting the best treatment available.

User
Posted 16 Dec 2017 at 22:04

You really need a referral to an oncologist then - the urologist doesn't seem to be aware of newer treatment regimes

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 17 Dec 2017 at 09:08
I understand that you don’t want to be seen as taking over from your husband, I have the same thing with my husband but you should definitely ask for a referral to an oncologist. The contrast between both consultants and departments that I have experienced is tangible, the oncologist has a lot of resources at her side and the department is so much more supportive and positive and efficient. Both my husband and I feel so much better for transferring over from urology to oncology, he is being offered a lot of different medications and therapy. I can only suggest that you speak to your husband about requesting this change.

Good luck

Judith

User
Posted 17 Dec 2017 at 11:31

Hi Genevieve,

I would definitely ask to see and Oncologist as the others have said already. I was diagnosed in May, Gleeson 9, PSA 57, locally advanced PCa. I started with Prostap, Hormone injections and will be on those for some time. I have just completed 5 cycles of Chemo (should have done 6 but had problems with peripheral neuropathy so didn't have the last cycle). I am scheduled now for 30 sessions of radiotherapy. As Lyn pointed out it is now practice to offer Chemo in order to help make the Hormone treatment more effective, hopefully for longer. However difficult it may be you need to ask lots of questions to find out exactly what your husband's situation is and keep pushing for referral to the Oncology team! All the best.

Ian

User
Posted 17 Dec 2017 at 16:10

Thank you, Lynn, Blueytrew and Bigferg. I've discussed things with my husband today and he's happy for me to ask about seeing an oncologist when he goes for his first injection on Tuesday. It sounds as though this will be a good decision and, hopefully, there won't be any problem with referring him.

Did you have any difficulties in switching from a urologist to an oncologist? Just like to be prepared! We're not actually seeing the urologist on Tuesday, just the specialist nurse, so will that be a problem, do you think? Forgive me if these seem simple questions, but we're both very new to this.

User
Posted 17 Dec 2017 at 16:53

Usually such cases are reviewed by a multi disciplinary team (MDT) encompassing the surgeons concerned, oncologists, nursing and radiological people. Ensuring that the oncologist now takes the lead should be routine. Stress the point to the nurse and she will make it happen, I'm sure.

AC

User
Posted 19 Dec 2017 at 06:51

Genevieve,

I can't speak for others and I think it depends upon where you live and are being treated but my experience was that after referral to the hospital I was seen by a specialist urology nurse, once PCa had been confirmed the transfer to oncology was automatic.

User
Posted 20 Dec 2017 at 10:48

Just an update. I spoke to one of the specialist nurses on here and she was incredibly helpful. So, my husband and I were able to go to the appointment armed with a list of questions and expectations. The specialist nurse at the hospital told us that there had been a multidisciplinary meeting and my husband will be having an MRI and will also be seeing the oncologist within the next 2/3 weeks, so we left feeling much happier.

Thank you all so much for your help, it's very much appreciated.

 
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