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Hormone Treatment: Tablets or Injections?

User
Posted 28 Jan 2022 at 08:07

Hi,


I've posted elsewhere under the title "PSA Detectable 3 1/3 years after RP", and received kind and helpful replies from Bollinge, LynEyre, Old Barry and music_man on what treatment may await me.


It appears that I'm looking at 6 months of hormone therapy with 6 1/2 weeks of radiotherapy somewhere in the middle, after my PSA rose to 0.13 in November (and will be measured again soon). Based on a PSMA PET scan, the hope is that the rogue cells are confined to he prostate bed.


The decision on whether my hormone treatment should be with tablets or injections is most likely down to the oncologist. However, if I'm given a choice, I would like to ask this Community what your preference would be, based on side effects, reversibility of side effects, effectiveness, ability to continue with daily life etc..


Would you choose tablets ot injections?


Many thanks,


Peter


 


 


 

User
Posted 29 Jan 2022 at 20:11

I had the same treatment as Chris and also had tamoxifen.   No breasts and a PSA of <0.006.

User
Posted 28 Jan 2022 at 09:53
You may get both. I started hormone therapy with a course of tablets for 2 weeks, then was switched to Prostap injections for 6 months, before radio therapy. I can't recall the exact reason for the tablets, but it was something to do with preparing your system to react properly to the injections. No doubt someone will be along to explain it more clearly! After the radio therapy I had no further drug treatment.
Hermit.
User
Posted 28 Jan 2022 at 18:55
My HT was bicalutimide (tablets) as a primary HT, which seems slightly unusual around here! My oncologist reckoned that the side-effects were less problematic than with injected HT.

Cheers,

Chris
User
Posted 28 Jan 2022 at 19:43

I was on 150mg/day bicalutimide for 18 months. Side effects weren't too bad, but they're very much a personal thing - everyone gets different ones. One very common side-effect of long-term use of bicalutimide is breast growth; it's common to be prescribed Tamsulosin alongside the bicalutimide to counteract this.


I had pretty standard side-effects: a couple of months of "brain fog" (which cleared up), mood swings, fatigue, muscular aches and pains, loss of body odour and body hair, complete loss of libido, and some weight gain.


Note that it's very common to also be prescribed a short course of lower-dose (50mg/day) bicalutimide prior to starting injectable HT. This is done to prevent something called "tumour flare" when injections start  


Best wishes,


Chris

Edited by member 28 Jan 2022 at 19:46  | Reason: Not specified

User
Posted 28 Jan 2022 at 20:28

I was on Zoladex injections for two years, one injection every three months. For 7days before and 7 days after the first injection I was on bicalutamide, which prevents a boost of testosterone whilst you adjust to the zoladex.


You can expect loss of libido, possibly hot flushes and weight gain with all hormone treatment. Some people have problems around the injection site, but that is more with deregalex and may be prostrap, I have not heard anyone on this site mention side effects at the injection site with zoladex.


Bicalutamide is a tablet every day, injections are either monthly or quarterly. I prefer quarterly injections, then I can just forget about it.


Bicalutamide may cause breast growth. Chris said tamsulosin prevents this but I think he ment tamoxifen (similar names and both things he may have been prescribed).


There may be other considerations for you, but I was happy with three monthly zoladex.

Dave

User
Posted 29 Jan 2022 at 08:40

Originally Posted by: Online Community Member
I was on 150mg/day bicalutimide for 18 months. Side effects weren't too bad, but they're very much a personal thing - everyone gets different ones. One very common side-effect of long-term use of bicalutimide is breast growth; it's common to be prescribed Tamsulosin alongside the bicalutimide to counteract this.


That should be Tamoxifen rather than Tamsulosin.


If you are prescribed Bicalutamide for 3 months or longer by itself (i.e. not with injections), ask to be prescribed Tamoxifen too, which will help avoid breast issues. Usual Tamoxifen dose is 2x20mg per week. If you have cardio issues or risk of DVT, then Tamoxifen will usually not be given.

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User
Posted 28 Jan 2022 at 09:53
You may get both. I started hormone therapy with a course of tablets for 2 weeks, then was switched to Prostap injections for 6 months, before radio therapy. I can't recall the exact reason for the tablets, but it was something to do with preparing your system to react properly to the injections. No doubt someone will be along to explain it more clearly! After the radio therapy I had no further drug treatment.
Hermit.
User
Posted 28 Jan 2022 at 18:55
My HT was bicalutimide (tablets) as a primary HT, which seems slightly unusual around here! My oncologist reckoned that the side-effects were less problematic than with injected HT.

Cheers,

Chris
User
Posted 28 Jan 2022 at 19:33

Thanks for your reply, Chris. 


Bicalutimide is in fact what's been mentioned by my Oncologist.


I'm wondering how long you were on the tablets, and how severe the side effects were.


Best wishes,


Peter 

User
Posted 28 Jan 2022 at 19:43

I was on 150mg/day bicalutimide for 18 months. Side effects weren't too bad, but they're very much a personal thing - everyone gets different ones. One very common side-effect of long-term use of bicalutimide is breast growth; it's common to be prescribed Tamsulosin alongside the bicalutimide to counteract this.


I had pretty standard side-effects: a couple of months of "brain fog" (which cleared up), mood swings, fatigue, muscular aches and pains, loss of body odour and body hair, complete loss of libido, and some weight gain.


Note that it's very common to also be prescribed a short course of lower-dose (50mg/day) bicalutimide prior to starting injectable HT. This is done to prevent something called "tumour flare" when injections start  


Best wishes,


Chris

Edited by member 28 Jan 2022 at 19:46  | Reason: Not specified

User
Posted 28 Jan 2022 at 20:28

I was on Zoladex injections for two years, one injection every three months. For 7days before and 7 days after the first injection I was on bicalutamide, which prevents a boost of testosterone whilst you adjust to the zoladex.


You can expect loss of libido, possibly hot flushes and weight gain with all hormone treatment. Some people have problems around the injection site, but that is more with deregalex and may be prostrap, I have not heard anyone on this site mention side effects at the injection site with zoladex.


Bicalutamide is a tablet every day, injections are either monthly or quarterly. I prefer quarterly injections, then I can just forget about it.


Bicalutamide may cause breast growth. Chris said tamsulosin prevents this but I think he ment tamoxifen (similar names and both things he may have been prescribed).


There may be other considerations for you, but I was happy with three monthly zoladex.

Dave

User
Posted 29 Jan 2022 at 08:30

Many thanks, Hermit of Eyam, Cheshire Chris & Dave64diag2018!


I'm probably too vain, but I am really concerned about breast growth. I'm hoping that, if it's really just Bicalutimide I'll be on, and if it really is just for 6 months, with 33 days of radiotherpay somewhere in the middle, the side effects won't be too bad and hopefully mainly reversible.


I guess it's a bit like the RP I had in mid-2018: once you're in the process, you just go with it. It's the run-up that's scary. I hope you're all doing well!

User
Posted 29 Jan 2022 at 08:40

Originally Posted by: Online Community Member
I was on 150mg/day bicalutimide for 18 months. Side effects weren't too bad, but they're very much a personal thing - everyone gets different ones. One very common side-effect of long-term use of bicalutimide is breast growth; it's common to be prescribed Tamsulosin alongside the bicalutimide to counteract this.


That should be Tamoxifen rather than Tamsulosin.


If you are prescribed Bicalutamide for 3 months or longer by itself (i.e. not with injections), ask to be prescribed Tamoxifen too, which will help avoid breast issues. Usual Tamoxifen dose is 2x20mg per week. If you have cardio issues or risk of DVT, then Tamoxifen will usually not be given.

User
Posted 29 Jan 2022 at 14:16
Apologies, yes of course, Tamoxifen, not Tamsulosin!

Cheers,

Chris
User
Posted 29 Jan 2022 at 20:11

I had the same treatment as Chris and also had tamoxifen.   No breasts and a PSA of <0.006.

User
Posted 29 Jan 2022 at 20:29
Thanks Ulsterman,and great to read up on your trajectory and progress!
User
Posted 29 Jan 2022 at 20:40

And thanks for the Tamoxifen advice, Andy62!

User
Posted 07 Feb 2022 at 20:07

Do you usually get Hormone Therapy before Radiotherapy starts. Just recently been diagnosed.

User
Posted 07 Feb 2022 at 21:25

Yes nearly always. Usually about six months, it takes about a month for the testosterone to get near zero. It then takes about three months for the prostate cancer to realise it hasn't got any testosterone to work with, so three months is about the minimum before RT starts. It then usually continues for one to two years.

Dave

User
Posted 08 Feb 2022 at 00:44

Thanks Dave !

User
Posted 08 Feb 2022 at 08:08
Are there any studies on the relative benefits of the 2 types of HT for salvage radiotherapy? They have quite different actions so the mode of action could impact the effect of the RT?

I have my next PSA on Thursday and I don't have high hopes for its direction, I guess I will be asking the question above of the onco if I don't get an answer here..
User
Posted 23 May 2023 at 13:19

Similar to you except over a shorter timeframe - in the midst of of it so I can only tell you my experience, so far. The salvage plan is hormones plus 33 fractions of nuking. I was give a 28 day course of Bicalutamide (one a day) two weeks ahead of the first 3 month version of Prostap (I've got another three days to go on the Bicalutamide). They tell me to expect the nuking programme to start end June early July...unless it's sooner (so who knows what that means!).


Side effect wise the best way I can describe it is a permanent slight hangover - one where the night before I did some ill advised boogieing - so assorted joint pains that come and go. Overall it could be worse! I have found that those little mixer cans of Schweppes ginger ale a god send. Also if you are like me get a good supply of Rennies or Tums or some such - I've got through a lot of those.

Edited by member 23 May 2023 at 13:20  | Reason: correction of typo

 
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