Hormone Therapy or Quality of Life-

Yes I did mean more than.  Doubling in less than 6 months is often a point when hormones will start.  With such a fluctuating rate of change you should perhaps wait until you are sure.

Also my understanding is they wait until it reaches a higher psa because it extends the time to when HT or whatever drug might not work any more. 

I'm nearing the end of a three-year HT regime and have a similar "mathsy" job to your partner so perhaps I can talk a little bit about how HT has affected things there. But'i'll start off with a general pros/cons.

The good things about HT has been the apparent PCa benefits - the PSA count is very low. As a result life expectancy is increased (nothing guaranteed of course)

The bad things are are a bit of a daunting list: reactions, "episodes", erectile dysfunction and loss of libido, effect on thought / mental work. A few of these could do with a bit more detail:

- I started on Prostap but because of reactions (unnerving swellings) I switched to Zoladex.

- what I think of as "episodes" (but others term hot-flushes) are a whole set of things usually including a flush. If I am out walking there can be a loss of balance/steadiness some minutes before the flush (I start drifting across the pavement!), and an episode gets preceeded by a feelings of tiredness and coldness (a bit like one is about to "come down with something") and depression. There's a heart rate increase that if I'm running can mean I have to stop as the rate can go too high (and can stay high for some time). At night I often get woken by whatever some minutes before the flush happens.

- As regards the mental part of my job: that's noticeable too - I can't think in quite the same way as I used to and am fairly sure it's HT and not age (61). The things that seems to be lacking are a lack of mental stamina / courageousness, I doesn't affect solving silly things like sudoku or crosswords. The consequence is I am less able to investigate complex issues that require the evaluation and synthesis of concepts and ideas. My solution to this has been .. to cheat ! ... I delegate much more now and am probably a better manager as a result (so there can be silver linings).

That might seem a depressing long list of "cons" but there is no contest for me. The decision for HT feels right both for me, my partner, and my family. In terms of my relationship with my partner there's been lots to deal with - our 39th wedding anniversary is soon (we were "living in sin" for 2 and half years before getting married - gosh, that phrase sounds so quaint now - so in total a very long time). I get scared for my wife and feel guilty about the situation we are in. This situation has perforce deepened our relationship in many ways, I guess that's par for the course here. Sex has been less frequent and less satisfying for both parties, but it's still there in some form. The loss of libido is strange - I look forward (over-optimistically ??) to it's return at some point. So, the "cons" I try to compartmentalise (not always successfully) - occasionally it can be very frustrating (e.g. I'm giving up on the half-marathon because I get too runs cut short by an "episode") but I try to accept it and concentrate on finding good stuff (e.g. do runs in nice places instead)

But it's in terms of life expectancy and the possibility of experiencing whatever is round the corner that I get a buzz from ... when I'm gone, I'm gone. Whilst I'm here I'm going to live in the moment, walk on the sunny side of the street and do some nice things. It doesn't have to be special, special ... simple things are often the best.

Good wishes to you and your partner. I hope you find the answer that is right for you.

Hi Misty

Of course you are right that I am 20 years older but, honestly, I feel exactly as I did in my 50s!  I hike, I swim, I read widely, I travel and I get annoyed with politicians!  And do not look and act like my Dad did at 74+ and am no more ready to die than I was in my 50s!  I do understand what you mean though!!!!  But I was hoping to re-assure you that taking hormone therapy after an RP -and mine couldn't be nerve sparing because of seminal vesticle involvement - is not the end of the world!  People are different and react differently - so much is obvious from the various posts.  For myself, since a young age I had a (very) vibrant sex life before my RP but there was no decision to be made - in a nanosecond my wife and I decided on my treatment plan since life and living were more important.  In the event although the RP followed by HT and now a very low testosterone level all mean that penetrative sex is not possible, I do get still sexually excited with my wife (and when I see a pretty girl!) and, with effort, can have a pleasant (but dry, obviously!) orgasm. Some guys report that they get turned off seeing their wife naked.  All I can say is that that is not my experience! 

One thing I did do which I think was helpful was I keep a diary about events, test results and, importantly, my feelings as I rode the roller coaster of treatment - initially expecting the radical RP to solve my problems but the post-op biopsy showing major lymph node involvement to PSMA scan which finally demonstrated to us that my cancer was incurable.  Now, after 3 years of hormone therapy and currently having much to enjoy in life I look back at the despair I felt and that makes all these tiresome side effects of HT very bearable.

Being a mathematician by trade, I did take notice of the data, naturally.  But frankly that does not help the individual make decisions.  In fact I was in Dublin staying with friends when my doctor phoned to say my PSA was 8.2 and that I should have an MRI 'just to put my mind at rest'!!!! The previous DRE had shown no enlargement.  Statistically, a PSA of 8.2 plus a negative DRE gave me only a 13% chance of having serious prostate cancer.  But of course, I was in that tiny percentage!  So now I am banking on the 28% 5 year Metastatic survival rate not applying in my case!!!  I deserve a bit of luck.

Misty,

It's certainly not true to say that HT always has dire side-effects. I was on HT for 18 months in association with my RT and, although not a barrel of laughs, neither was it a particularly ghastly experience. I was 56 when I started HT, so pretty much the same age as your husband.

I did experience fuzzy thinking when I started HT, but that cleared up after a month or so. I was able to continue my job as an IT consultant while on HT, and that certainly required logical thought processes. Other side-effects I experienced were some degree of fatigue, itchy skin (which a steroid cream cleared up), breast growth (which chest RT stopped) and of course the expected loss of libido (no loss of function, just of desire).

Given the unquestionable benefits of HT, I think personally that the benefits vastly outweigh the downsides of it. For me at least it was absolutely NOT the case that HT meant a bad quality of life!

Best wishes,

Chris

Edited by member 30 Sep 2020 at 21:19  | Reason: Not specified

My oncologist prescribes bicalutimide rather than injectable HT for all his prostate cancer patients because, in his view, it's just as effective but most men tolerate it better than the injections.

Best wishes,

Chris