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hormone treatment, choice?

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User
Posted 14 Sep 2019 at 15:02

Diagnosed April 2015, PSA 11.38

RALF Aug 2015, SRT Sept 2016.

T3a N0 M0, Gleason 4+3+5 with intraduct component and circumferential margin involvement.

PSA Dec 2016 0.10, Dec 2017 0.30, Dec 2018 0.62, June 2019 1.22, Aug 2019 1.49. Doubling time now 6 months.

Recent CT scan has not shown any sign of active prostate cancer.

The consultant has recommended hormone treatment for 1 year.

Letter to family doctor says to put husband on " the LH-RH analogue of the doctor's choice, Zoladex, Decapeptyl or Prostap. There is no need for him to receive any antiandrogens since he has had a prostatectomy and has no evidence of radiological disease"

We are both surprised that the consultant has not stated exactly which hormone therapy to go on.

What are people's thoughts please? 

Many thanks

User
Posted 14 Sep 2019 at 22:07

I have no experience of this but is the consultant a Urologist or an Oncologist. I am puzzled and surprised also that an Oncologist would leave it up to a GP to choose which HT to prescribe. I thought that was the Oncologist's remit.

Best wishes

Ann

 

User
Posted 14 Sep 2019 at 22:26

They are all LHRH testosterone suppressants - medically it makes little difference, and it's best the surgery uses whichever they are more familiar with.

My surgery has lots of people on Zoladex, but I don;t know if they use any of the others too.

I am surprised it was recommended for a year as a standalone treatment. Was anything else suggested, such as radiotherapy?

Edited by member 14 Sep 2019 at 22:36  | Reason: Not specified

User
Posted 15 Sep 2019 at 01:20
I think I would want my husband to have whichever hormone the practice nurse is most experienced in dispensing. There are some differences, particularly in timing - Prostap and Decapeptyl are given every month or 3 months (or 6 months for Deca) and there can be a little bit of flexibility (2 or 3 days either side of the due date) whereas Zoladex must be given every 28 or 84 days and shouldn’t be early or late. There are are differences in where the injection is given as well, but they all do the same job.

The intraductal element in 2015 is interesting as it is usually aggressive but tends not to produce much PSA so the onco may be thinking that the recurrence doesn’t look like it is the intraductal carcinoma. After a year of HT they will be in a better position to judge whether it is responsive and therefore worth continuing.

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

User
Posted 15 Sep 2019 at 08:24

Thank you Lyn, that explains so much. Hopefully the intraductal carcinoma was totally removed or zapped by radiotherapy, fingers crossed.

Lyn - your knowledge & understanding has helped us yet again, thank you so much.  

Show Most Thanked Posts
User
Posted 14 Sep 2019 at 22:07

I have no experience of this but is the consultant a Urologist or an Oncologist. I am puzzled and surprised also that an Oncologist would leave it up to a GP to choose which HT to prescribe. I thought that was the Oncologist's remit.

Best wishes

Ann

 

User
Posted 14 Sep 2019 at 22:26

They are all LHRH testosterone suppressants - medically it makes little difference, and it's best the surgery uses whichever they are more familiar with.

My surgery has lots of people on Zoladex, but I don;t know if they use any of the others too.

I am surprised it was recommended for a year as a standalone treatment. Was anything else suggested, such as radiotherapy?

Edited by member 14 Sep 2019 at 22:36  | Reason: Not specified

User
Posted 15 Sep 2019 at 01:20
I think I would want my husband to have whichever hormone the practice nurse is most experienced in dispensing. There are some differences, particularly in timing - Prostap and Decapeptyl are given every month or 3 months (or 6 months for Deca) and there can be a little bit of flexibility (2 or 3 days either side of the due date) whereas Zoladex must be given every 28 or 84 days and shouldn’t be early or late. There are are differences in where the injection is given as well, but they all do the same job.

The intraductal element in 2015 is interesting as it is usually aggressive but tends not to produce much PSA so the onco may be thinking that the recurrence doesn’t look like it is the intraductal carcinoma. After a year of HT they will be in a better position to judge whether it is responsive and therefore worth continuing.

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

User
Posted 15 Sep 2019 at 08:15

Thanks Andy, that explains the hormone therapy choice. Salvage radiotherapy was a year after prostatectomy. 

User
Posted 15 Sep 2019 at 08:24

Thank you Lyn, that explains so much. Hopefully the intraductal carcinoma was totally removed or zapped by radiotherapy, fingers crossed.

Lyn - your knowledge & understanding has helped us yet again, thank you so much.  

 
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