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Difference treatment approaches in adjuvant salvage treatnents

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User
Posted 17 Sep 2019 at 11:41

hi all,


Just asking for thoughts/ knowledge on different hospitals/areas approach to salvage treatment following RP and recurrence


I had RP in Nov’ 2014, PSA undetectable until Summer 2017 (0.1 then 0.2)


MRi clear, bone scan clear


December 2017 started Bicalutamide 150mg daily


February 2017 commenced 30 or 32 sessions of radiotherapy (finished early April)


Currently due to end HT in December 2019 but I am really itching to stop asap but afraid of going against the medical advice


 


so my question is why there seems to be a wide variation in approach? Some oncology offer 18 months of HT rather than my 2 years and I think Lynne has mentioned before that some don’t offer HT at all. Seems nuts to me as I would like to imagine that there was good research to drive their treatments


(I’m in Glasgow btw)


Bill

User
Posted 17 Sep 2019 at 17:29
There was some research presented to the annual PCa conference about 5 years ago that suggested 3 years of HT provided a better chance of full remission than 18 months (which at that time was fairly standard). More recent research has found the opposite, that 3 years provides no additional benefit over 18 months. It is anyone's guess why your onco prefers a 2 year regime but there is nothing to stop you from asking that question!
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 17 Sep 2019 at 17:52

Bill - after 18 months, I finished taking bicalutimide in August.  Asked oncologist if there was a benefit to staying on for 3 years.  She said that was very old school and 18 months was considered to be the optimal length of time.  I would never want to say anything that would contribute to anyone making a decision against their own oncologist's advice, but I am feeling hundreds of times better since stopping.  My fatigue is gone.


Just hope I never have to go on to HT injections - bicalutimide was bad enough

User
Posted 18 Sep 2019 at 08:29

December is only a few weeks away. Obviously the decision is yours, but having been on HT for this long I'd personally put up with another few weeks if that were my oncologist's recommendation. Like you I'm on 150mg/day bicalutimide. My oncologist is also recommending a 2-year course. I've been on it for 13 months thus far.


Best wishes,


Chris

Edited by member 18 Sep 2019 at 08:31  | Reason: Not specified

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User
Posted 17 Sep 2019 at 13:15
I have previously read research that demonstrates no additional risk associated with 18 v 36 months HT.

User
Posted 17 Sep 2019 at 17:29
There was some research presented to the annual PCa conference about 5 years ago that suggested 3 years of HT provided a better chance of full remission than 18 months (which at that time was fairly standard). More recent research has found the opposite, that 3 years provides no additional benefit over 18 months. It is anyone's guess why your onco prefers a 2 year regime but there is nothing to stop you from asking that question!
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 17 Sep 2019 at 17:52

Bill - after 18 months, I finished taking bicalutimide in August.  Asked oncologist if there was a benefit to staying on for 3 years.  She said that was very old school and 18 months was considered to be the optimal length of time.  I would never want to say anything that would contribute to anyone making a decision against their own oncologist's advice, but I am feeling hundreds of times better since stopping.  My fatigue is gone.


Just hope I never have to go on to HT injections - bicalutimide was bad enough

User
Posted 17 Sep 2019 at 20:04

Ulsternan,


i hear you re: advising and any decisikn will be my own mate 👍


what you say about stopping and the effect is music to my ears tbh. Same with Lynn and Franco, I haven't actually put it straight to my Onco as it’s mostly the specialist nurse I see.


but thanks all of you, Its very helpful to hear others views and experience about this. To be honest I’ve been in the brink of stopping HT since April (12 months after stopping RT) and I’m now at 17 months post radiotherapy


its a difficult decision but all considered my plan is to stop in 2 weeks time when it will be 18 months HT after RT and 22 months HT overall


thanks guys, always good to hear your thoughts


Bill


  

User
Posted 18 Sep 2019 at 04:13

The RT continues having an effect for up to 18 months, and staying on HT at least 18 months from end of RT is probably a good thing.


I read a number of research papers on the duration of HT a year back when I was starting my journey. The difference in cancer outcomes between 18 months and 3 years is around 5% if I recall correctly. However, the side effects from long term HT are significant too, so staying on HT for an extra 18 months gives you something like 5% less chance of remission, but an increased chance of dying from cardio vascular issues (can't recall what the percentage was, but it will depend on things like how fit you are).

User
Posted 18 Sep 2019 at 07:50
I think I read the same research Andy, the 5% difference (something like 73% compared with 78% remmision) was considered statistically insignificant. The 18 month tranche had considerably better QOL.
User
Posted 18 Sep 2019 at 08:29

December is only a few weeks away. Obviously the decision is yours, but having been on HT for this long I'd personally put up with another few weeks if that were my oncologist's recommendation. Like you I'm on 150mg/day bicalutimide. My oncologist is also recommending a 2-year course. I've been on it for 13 months thus far.


Best wishes,


Chris

Edited by member 18 Sep 2019 at 08:31  | Reason: Not specified

User
Posted 18 Sep 2019 at 20:27

I don't know how good or reliable Practice Update is, but someone on here recommend it and I somehow finished up getting email notifications. The following popped up in my in box this morning.


http://www.practiceupdate.com/content/astro-2019-hormone-therapy-increase-mortality-in-select-patients-undergoing-prostate-cancer-salvage-radiotherapy/89648


I did not have HT with SRT as it was thought it may have an adverse effect on my urethral stricture. My PSA was 0.23 prior to RT and  after a fall it is back up to 0.22.


Thanks Chris

Edited by member 18 Sep 2019 at 20:36  | Reason: Corrected RT to SRT

User
Posted 18 Sep 2019 at 21:35
Oncologists can have different views on this subject and of course relate this to an individual case. I don't think there is a definite answer on this subject and if the same patient presented to another oncologist the recommendation could be different.

I had 8 months of HT (Zoladex) leading up to and during RT in 2008, which I had abroad. I have had no HT at any time since. After the RT I was taken back under the aegis of the Royal Marsden, who in due course referred me to UCLH due to a new tumour and I had HIFU in 2015 as part of a study. They offered me adjuvant HT but I declined. A year after this I was told at a check up that I did well to refuse HT. Now with slow but persistent increases in PSA and a tumour in my Prostate too close to the rectum for UK invasive treatment, it is again being suggested that HT should be considered. Should I have been offered adjuvant after the RT in 2008 when I might have accepted it? Should I have have taken it in 2015 when offered or now - I have no idea. I do know that I would explore every possibility before having it again. I would rather undergo another invasive treatment than go on HT. So just a different approach.
Barry
 
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