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Radiotherapy without hormone therapy

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User
Posted 24 Dec 2022 at 02:39

Hi, am due to have Ultra Hypofractionated Radiotherapy. Hormone Therapy hasn't been put forward as an accompanying treatment yet.


I'll be happy if I don't have it, but wonder if I should. 


Am 70, PSA 9, T2a, G3 +4, in good health generally AFAIK.


I guess I am seen in the intermediate favourable risk category. 


As always any views, experiences etc, most welcome. Best wishes Tony 

User
Posted 05 Jan 2023 at 15:24

Gys or Grays is a measure of the absorbed dose of radiation to tissue.


For X-rays the number of grays is equivalent to the number of Sv or Sieverts which takes into account the biology of the tissue being irradiated.


in the UK the average yearly exposure is around 0.0027 Sieverts. For a standard chest X-ray the dose will be around 0.0002 Sieverts. 
When we look at doses of 60 Grays that is the equivalent of around 22000 years of background radiation which is enough to kill cancer cells! 
https://www.radiologyinfo.org/en/info/safety-xray


Hope that isn’t information overload. 

Ido4

User
Posted 05 Jan 2023 at 12:31

37 x 2Gy = 74Gy and 20 x 3Gy = 60Gy are equivalent treatment doses to the prostate which handles higher dose rate well and is more effective as a treatment, so less needed for the same treatment effect. The shorter your radiotherapy treatment, the lower the total dose needed. At one extreme is HDR brachy which is typically 2 x 15Gy = 30Gy over 2 days, and at the other extreme is LDR brachy which is 170Gy over 200 days. These are roughly equivalent treatment doses, but the total dose is widely different because of the different dose rate and treatment duration.


If other organs are also being treated such as lymph nodes, they can't handle the higher dose rates the prostate can, so that's why such a treatment will be delivered as 37 x 2Gy.

Edited by member 05 Jan 2023 at 12:36  | Reason: Not specified

User
Posted 28 Dec 2022 at 10:36

Tony 


I can only recount my experience and that is what I am committed to doing. I am not some armchair punter nor some sage talking about his mate, his dad or his brother.


It is going ok so far as I can tell. There is definitely fatigue but I am trying to change my diet and religiously sticking to 10000 steps a day. In my mind cutting out booze, meat,sweets and saturated fats, if nothing else will stave off diabetes and weight gain. Both are associated with hormone treatment.


For me it is interesting, but I was only prescribed Zoladex with no Bicalutamide or Flutamide. It's interesting because every medication brings positives and negatives. So I may have less positives but less negatives than others.


I think that I have a very aggressive strain so I have faced it as a death sentence. In reality we are all going to die, it's just a wake up call for me that my death will no doubt be sooner than that of my two brother's .


I also hope for a quality of life but practically I realise that will diminish.


I wish the forum was less dominated by the few and that there was a greater participation of individuals recounting their live journeys.


Stay in touch 


Gabriel 


 


 


 


 


 


 

User
Posted 06 Feb 2023 at 12:34

Final session completed, now the waiting and hoping begins. Was looked after so well, but also so grateful the tiring journeys are over. 


Wonderful staff, will miss them. 

User
Posted 24 Dec 2022 at 15:08

Tony, my oncologist thought HT along side salvage RT would be to toxic for my stricture. The salvage RT didn't get all the cancer because it wasn't all in the prostate bed.


Lots of research into RT with or without HT, but I don't know if there is a majority decision on which is best.


Thanks Chris 

User
Posted 24 Dec 2022 at 15:39

The thinking seems to be that hormone therapy benefits reduce as the power (dose rate) of the radiotherapy increases and the duration of the radiotherapy treatment reduces. There comes a point where the benefits of hormone therapy no longer outweigh the potential downsides. Exactly where this boundary is may be open for debate, and may also depend on the aggressiveness of the disease. Certainly, you could ask your oncologist what the difference in cure rate is in your case comparing with and without hormone therapy.

User
Posted 24 Dec 2022 at 17:00
I might be wrong Tony but generally, the HT is given for 3 - 6 months before RT so the fact that your UHRT is planned for next month suggests that you are having RT as a monotherapy?
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 24 Dec 2022 at 20:44
I recently had brachytherapy and when it was initially discussed the specialist nurse informed me that I would have HT for three months before the procedure. The doctor did not think the HT was necessary and I went straight to the radioactive treatment.
A merry Christmas to all πŸŽ„
Rgds
Dave
User
Posted 25 Dec 2022 at 01:37

Thanks very much for information Dave. I hope your RT went well.


Best wishes and a Merry Xmas to one and all, Tony

Edited by member 25 Dec 2022 at 01:39  | Reason: Not specified

User
Posted 28 Dec 2022 at 03:49

Tony. 


I can only speak from my experience. I wanted to avoid HT and was told that had my Gleason and stage been lower that would have been possible. I assume that was the judgement that was made with you. I was less fortunate and whilst the combination will no doubt offer hope for my Gleason8, I shall bear the side effects 


 


Good luck 


Gabriel 


 


 


 

User
Posted 02 Jan 2023 at 13:33
I have just had moderately fractionated radiotherapy so 20 sessions of 3Gy each and total of 60Gy over 4 weeks. I was on Bicalutimide for 10 weeks and now on Zoladex 2 months prior to RT and they are thinking of stopping it after 4 months.

Seems there is now some evidence that even though I have G9 T2cN0M0 (negative PSMA/PET) there is equivalence to longer RT and 18-24 months ADT.

Given my age and other health issues from childhood polio (low muscles mass) it seems a good option - of course that doesn’t help me overthinking and worrying about the future especially when so many post talk of the standard RT of 72Gy over 7-8 weeks and 2 years ADT.
User
Posted 02 Jan 2023 at 16:41
The thing is, Nomis, because of how radiotherapy accumulates, your 60gy over 20 fractions (days) is actually a bigger hit than the 74Gy over 37 days. Worry not - John had 20 fractions of 3.2Gy with 6 months of HT and that was 10 years ago when it was still only a trial!
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 27 Jan 2023 at 19:58
Enjoy a bit of a break over the weekend.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 13 Feb 2023 at 15:18

Hi Tony, 


Finishing treatment is such a great feeling. 


Good luck and fingers crossed for the future.


Kev.

User
Posted 13 Feb 2023 at 15:42

Thanks a lot Kev, best wishes to you tooπŸ€—

User
Posted 26 Feb 2023 at 19:06

I was given Solifenacin. I can't say it was a game changer but it did help once it had fully kicked in

Show Most Thanked Posts
User
Posted 24 Dec 2022 at 15:08

Tony, my oncologist thought HT along side salvage RT would be to toxic for my stricture. The salvage RT didn't get all the cancer because it wasn't all in the prostate bed.


Lots of research into RT with or without HT, but I don't know if there is a majority decision on which is best.


Thanks Chris 

User
Posted 24 Dec 2022 at 15:33

Thanks for reply Chris, it's very difficult to interpret the research. Partly because high dose radiation seems to be relatively new, so the long term effects with and without HT are maybe under researched ATM.


For me its currently a no brainer that I don't have HT as I definitely don't want it. But of course if the medics say I should have it, I will listen.


I just hope they tell me I dont need it, which seems to be the situation ATM, but until I get the treatment schedule cant be certain 

Edited by member 24 Dec 2022 at 15:36  | Reason: Not specified

User
Posted 24 Dec 2022 at 15:39

The thinking seems to be that hormone therapy benefits reduce as the power (dose rate) of the radiotherapy increases and the duration of the radiotherapy treatment reduces. There comes a point where the benefits of hormone therapy no longer outweigh the potential downsides. Exactly where this boundary is may be open for debate, and may also depend on the aggressiveness of the disease. Certainly, you could ask your oncologist what the difference in cure rate is in your case comparing with and without hormone therapy.

User
Posted 24 Dec 2022 at 15:57

Cheers Andy for that insight re high dose and short duration RT which I will be undertaking, also thanks for advice. 


I'm very much hoping my cancer isn't aggressive, I've had no indication it is.


Best wishes Tony 

Edited by member 24 Dec 2022 at 15:58  | Reason: Not specified

User
Posted 24 Dec 2022 at 17:00
I might be wrong Tony but generally, the HT is given for 3 - 6 months before RT so the fact that your UHRT is planned for next month suggests that you are having RT as a monotherapy?
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 24 Dec 2022 at 17:20

Good point Lynn, so unless I've misunderstood it will be just RT which is fine by me. 


Doubtless all will be revealed in New Year when oncology contacts me.


Best wishes Tony 

User
Posted 24 Dec 2022 at 20:44
I recently had brachytherapy and when it was initially discussed the specialist nurse informed me that I would have HT for three months before the procedure. The doctor did not think the HT was necessary and I went straight to the radioactive treatment.
A merry Christmas to all πŸŽ„
Rgds
Dave
User
Posted 25 Dec 2022 at 01:37

Thanks very much for information Dave. I hope your RT went well.


Best wishes and a Merry Xmas to one and all, Tony

Edited by member 25 Dec 2022 at 01:39  | Reason: Not specified

User
Posted 28 Dec 2022 at 03:49

Tony. 


I can only speak from my experience. I wanted to avoid HT and was told that had my Gleason and stage been lower that would have been possible. I assume that was the judgement that was made with you. I was less fortunate and whilst the combination will no doubt offer hope for my Gleason8, I shall bear the side effects 


 


Good luck 


Gabriel 


 


 


 

User
Posted 28 Dec 2022 at 09:39

Thanks very much for reply, Gabriel. I think you are right in your assessment. How is your HT going, I hope the side effects are not too distressing.


Best wishes Tony 

User
Posted 28 Dec 2022 at 10:36

Tony 


I can only recount my experience and that is what I am committed to doing. I am not some armchair punter nor some sage talking about his mate, his dad or his brother.


It is going ok so far as I can tell. There is definitely fatigue but I am trying to change my diet and religiously sticking to 10000 steps a day. In my mind cutting out booze, meat,sweets and saturated fats, if nothing else will stave off diabetes and weight gain. Both are associated with hormone treatment.


For me it is interesting, but I was only prescribed Zoladex with no Bicalutamide or Flutamide. It's interesting because every medication brings positives and negatives. So I may have less positives but less negatives than others.


I think that I have a very aggressive strain so I have faced it as a death sentence. In reality we are all going to die, it's just a wake up call for me that my death will no doubt be sooner than that of my two brother's .


I also hope for a quality of life but practically I realise that will diminish.


I wish the forum was less dominated by the few and that there was a greater participation of individuals recounting their live journeys.


Stay in touch 


Gabriel 


 


 


 


 


 


 

User
Posted 28 Dec 2022 at 13:51

Thanks for reply Gabriel. Great that you are exercising and eating well, and that the HT is not too bad re side effects.


Sorry to hear about your prognosis re aggressive cancer cells, and all the very best for the journey in front of you.


For sure we are all facing death, and let's hope we can all have some good quality life before the inevitable.


Very best wishes to you and all on here, and as Happy a New Year as possible. 

User
Posted 02 Jan 2023 at 13:33
I have just had moderately fractionated radiotherapy so 20 sessions of 3Gy each and total of 60Gy over 4 weeks. I was on Bicalutimide for 10 weeks and now on Zoladex 2 months prior to RT and they are thinking of stopping it after 4 months.

Seems there is now some evidence that even though I have G9 T2cN0M0 (negative PSMA/PET) there is equivalence to longer RT and 18-24 months ADT.

Given my age and other health issues from childhood polio (low muscles mass) it seems a good option - of course that doesn’t help me overthinking and worrying about the future especially when so many post talk of the standard RT of 72Gy over 7-8 weeks and 2 years ADT.
User
Posted 02 Jan 2023 at 14:52

Thanks for the reply Nomis, there are so many things to consider, it's hard to stop overthinking. 


Very best wishes to you and hope together with your medics you find the right way forward.


Tony 

User
Posted 02 Jan 2023 at 16:41
The thing is, Nomis, because of how radiotherapy accumulates, your 60gy over 20 fractions (days) is actually a bigger hit than the 74Gy over 37 days. Worry not - John had 20 fractions of 3.2Gy with 6 months of HT and that was 10 years ago when it was still only a trial!
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 05 Jan 2023 at 11:47

The journey picks up pace next week when I have two X rays. Then RT starts about 10 days after that. No HT which is great news.


Just hope the weather improves here in Sweden, as travelling in snow and ice is less than ideal. 

Edited by member 05 Jan 2023 at 11:51  | Reason: Not specified

User
Posted 05 Jan 2023 at 12:31

37 x 2Gy = 74Gy and 20 x 3Gy = 60Gy are equivalent treatment doses to the prostate which handles higher dose rate well and is more effective as a treatment, so less needed for the same treatment effect. The shorter your radiotherapy treatment, the lower the total dose needed. At one extreme is HDR brachy which is typically 2 x 15Gy = 30Gy over 2 days, and at the other extreme is LDR brachy which is 170Gy over 200 days. These are roughly equivalent treatment doses, but the total dose is widely different because of the different dose rate and treatment duration.


If other organs are also being treated such as lymph nodes, they can't handle the higher dose rates the prostate can, so that's why such a treatment will be delivered as 37 x 2Gy.

Edited by member 05 Jan 2023 at 12:36  | Reason: Not specified

User
Posted 05 Jan 2023 at 14:16

Interesting stuff Andy, I'm having 7 dose UHRT, but know nothing of Gys

Edited by member 05 Jan 2023 at 14:17  | Reason: Not specified

User
Posted 05 Jan 2023 at 15:24

Gys or Grays is a measure of the absorbed dose of radiation to tissue.


For X-rays the number of grays is equivalent to the number of Sv or Sieverts which takes into account the biology of the tissue being irradiated.


in the UK the average yearly exposure is around 0.0027 Sieverts. For a standard chest X-ray the dose will be around 0.0002 Sieverts. 
When we look at doses of 60 Grays that is the equivalent of around 22000 years of background radiation which is enough to kill cancer cells! 
https://www.radiologyinfo.org/en/info/safety-xray


Hope that isn’t information overload. 

Ido4

User
Posted 05 Jan 2023 at 22:23

Cheers Ido for information, I don't know how many Gys is involved in 7 dose UHRT, but a whole lot of radiation I guess. 

User
Posted 12 Jan 2023 at 17:40

The journey went another step today, with CT and MRI scans, very good staff and all went well. Then an appointment with very good doctor. 


So UHRT begins on 23rd January, gold seeds and tattoos in place. No need for any special preparation, just a visit to loo before RT


So far so very good, there will probably be bumps along the way with the side effects, but one step at a time πŸ€”πŸ™„πŸ˜

Edited by member 12 Jan 2023 at 17:48  | Reason: Not specified

User
Posted 23 Jan 2023 at 10:13

Day 1 of treatment, all went very well. Six sessions left on alternate days, so hopefully all over by Mon 6th.

User
Posted 27 Jan 2023 at 12:28

First week over and all going very well so far. No significant side effects and lovely staff looking after me.


Three more sessions next week, then if all goes smoothly, final one on Monday 6th

User
Posted 27 Jan 2023 at 19:58
Enjoy a bit of a break over the weekend.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 27 Jan 2023 at 22:02

Thanks Lyn, been a long week as hospital is an hour drive away. It will be nice to have a weekend off, definite signs of tiredness creeping in on this 70 year old body πŸ›ŒπŸ’€

User
Posted 30 Jan 2023 at 22:21

Week 2 and the same brilliant help and skills from medical staff. They kindly changed my early appointments to later, which is a great help as it avoids driving in commuter traffic 


Some expected side effects, difficulty peeing at times, not painful but on the way there. Lots of time I lie down then almost immediately get urge to go. Sleep becoming difficult, and with the travelling and RT, tiredness creeping in more and more


But overall still feel okay and no need for medication, I don't know if OTC ibuprofen or the like might help with inflammation which I guess I have. Not sure on guidelines with mild pain killers and RT. 


Next session Wednesday, then only 2 to go. 

Edited by member 30 Jan 2023 at 22:22  | Reason: Not specified

User
Posted 03 Feb 2023 at 13:01

Well week 2 finished, just one session left. No major side effects yet, so grateful to all the nurses, doctors and other staff for doing such a brilliant job.


Assuming Monday goes well, then its just to wait for  PSA test 🀞

User
Posted 06 Feb 2023 at 12:34

Final session completed, now the waiting and hoping begins. Was looked after so well, but also so grateful the tiring journeys are over. 


Wonderful staff, will miss them. 

User
Posted 13 Feb 2023 at 11:33

Back at the gym today a week after end of treatment, three weeks after start of treatment


Starting to feel good again, heres hoping cancer is defeated πŸ€žπŸ™

User
Posted 13 Feb 2023 at 15:18

Hi Tony, 


Finishing treatment is such a great feeling. 


Good luck and fingers crossed for the future.


Kev.

User
Posted 13 Feb 2023 at 15:42

Thanks a lot Kev, best wishes to you tooπŸ€—

User
Posted 26 Feb 2023 at 11:40

Well, have a cold which isn't fun, but grateful didnt get one during RT


Sun has reappeared in Sweden, so hopefully life will be on the up this week.


Peeing seems to be at pre treatment levels,  about 3 times a night. Maybe will ask if any medication can help on that at my next appointment


Approximately two months till my first PSA test

Edited by member 26 Feb 2023 at 11:42  | Reason: Not specified

User
Posted 26 Feb 2023 at 19:06

I was given Solifenacin. I can't say it was a game changer but it did help once it had fully kicked in

User
Posted 26 Feb 2023 at 20:17

Thanks for info Chris, will look into it πŸ€—

User
Posted 24 Apr 2023 at 10:59

Well, some good news, first PSA test shows levels down from 9.0 to 2.0.


My nurse is happy with that, so I am too. I don't know what the optimum score is some two and a half months after RT.


Next test is 6 months time, I think then I'm looking for around 1.5 or lower


Once again I give thanks for the great treatment I have recieved and the support of family, friends and those who run and contribute to this wonderful forum.


Best wishes Tony

 
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