HT due only to Covid delay

User

Posted 02 May 2020 at 08:32

Since the Lockdown, I have been diagnosed T2N0M0, Gleason 3+4, wholly contained but right margin threatened.

MDT said active treatment but short term Hormone Therapy due to delay.

GP prescribed Casodex for 4 weeks and Zoladex. I wasn’t happy!

I proposed concurrent Sildenafil against ED, which was agreed.

Still not started it, because fortunately I had a Brachytherapy Consultation at which Consultant said “NO NO NOT Zoladex, not Zoladex, I hope you haven’t started Zoladex” explaining it was (in my terminology) a sledgehammer when a more nuanced approach was needed for HT short term. She instead prescribed higher level of ongoing Casodex, with side effect control by Tamoxifen and Sildenafil.

I am posting this in case others with delay due to Pandemic are put on HT as a short term ‘fix’, and may want to avoid Zoladex castration.

Strad

User

Posted 02 May 2020 at 15:10

That's good.

I would have chosen 5mg daily tadalafil over sildenafil because of its continuous dosing effect, unless you managed to get lots of sildenafil.

The important thing is that you keep having erections to protect the penis, even if you don't want sex, or find you have no libido because of the Cassodex (Bicalutamide) , and hence no desire for erections.

User

Posted 02 May 2020 at 16:10

Hi-

Similiar situation here- though i was prescribed bicatumalide without any commitment to when the surgery would take place. I have not started taking them though as after a private consultation I have decided to wait until a june blood psa test. Should they highlight an increase psa factor and if by then there will still be no surgery date time frame i will start.

It would be great if they published detailed nhs guidelines on prostate cancer treatment under covid-19. I think the european association of urology have- here thoigh am still trying to decode it:

Am really afraid of the backlog that is taking place, and that when things will ramp up they will do so very slowly...

https://uroweb.org/wp-content/uploads/EAU-Guidelines-Office-Rapid-Reaction-Group-An-organisation-wide-collaborative-effort-to-adapt-the-EAU-guidelines-recommendations-to-the-COVID-19-era.pdf

Perhaps they are all following the same.....just out of curiosity i did not understand what treatment are you going to be starting after covid ? Surgery or RT?

Edited by moderator 06 Jul 2023 at 13:27 | Reason: Not specified

User

Posted 02 May 2020 at 21:22

I am 69y. PSA only 2.31; initial suspicions were triggered by DRE, confirmed by self-DRE. Then mpMRI; I reviewed the scans and concurred with PIRADS 4, right apex threatened. Still waiting to see results of visually focal TRUS biopsy.

Brachytherapy is my plan. Treatment deferred due to lack of anaesthetists - most have been moved to Covid ITU duties.

I am currently deferring HT on a day by day basis, until I am convinced that the likely benefit appropriately exceeds the likely damage.

Strad

User

Posted 04 May 2020 at 01:59

What exactly is your problem with Zoladex? I've been on it since 24th January. Yes there are side effects, but then there would be with any HT. What damage are you afraid of? I assume you have some medical expertise? Otherwise your post would seem to be somewhat alarmist. I believe the urology/oncology team at Guy's hospital treating me know what they're doing. They treat numerous cancers after all.

User

Posted 04 May 2020 at 07:16

Of course, Zoladex will be the correct treatment for some.

My concern (and my consultant's concern) is that Zoladex actually stops testosterone production (95% at least) whereas Bicalutimide acts differently, stopping the testosterone reaching cancer cells.

Zoladex takes longer for the side effects to clear when you stop using it if used as a temporary therapy, and the effects can become permanent.

Strad

User

Posted 04 May 2020 at 09:05

The worst side effect of Zoladex that I have found, is Heartburn indigestion - 5mg Tadafil helps with Erection problems.
Thankfully, I had my last 3 month injection in Febuary - I hope the side effects are not too long wearing off.

Edited by member 04 May 2020 at 09:08 | Reason: Not specified

User

Posted 04 May 2020 at 10:10

Anyone going on to hormone therapy who finds it impacts sexual performance should ask their GP for PDE5 inhibitors. 5mg daily Tadalafil is good because it provides some extra protection to the flaccid penis by improving blood flow. If that's not enough for erections and sex, you might also need some event dose PDE5 inhibitors, such as 20mg Tadalafil or 50mg or 100mg Sildenafil. These drugs might not be advisable in the case of some other health conditions, so check that with your GP.

However, it is important you continue having regular erections, even though due to reduction in libido, you may have no desire to do so. Penis relies on regular erections to get enough blood flow - it is ischemic when flaccid. Normally, this happens around 6 times a night during your REM sleep, but that stops when on hormone therapy.

User

Posted 05 May 2020 at 09:25

Originally Posted by: Online Community Member

Hi Bob, I get terrible heart burn indigestion, but for me it is not the zoladex it is Tadafil, cialis, or any other pde5 inhibitor. Are you sure it's the zoladex?

I too had my last zoladex in early February, so it is out of my body now. I have had a few dreams of a nature which suggests testosterone may be returning.

Dave

User

Posted 05 May 2020 at 15:17

Originally Posted by: Online Community Member

Hi Bob, I get terrible heart burn indigestion, but for me it is not the zoladex it is Tadafil, cialis, or any other pde5 inhibitor. Are you sure it's the zoladex?

I too had my last zoladex in early February, so it is out of my body now. I have had a few dreams of a nature which suggests testosterone may be returning.

Dreams of nature?
Of course, I cannot be sure what causes the Heartburn, it does come & go.
It might just be my age!

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