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Decapeptyl treatment period and cancer cells

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User
Posted 05 Jul 2023 at 14:35

In 2021 I found out I had prostate cancer. I had a PSA of 22 and my gleason score was 9.


I chose EBRT and hormone treatment and had the bicalutimide for 1 month and then decapeptyl for 2-3 mths and then the 20 doses of radiation. The radiation ended Nov 21, but I have been having 6 mthly decapeptyl injections since then.


My PSA since Nov 21 has been almost zero and except for hot flushes I have been lucky with side effects, I guess - although I do notice vision issues occasionally, bit of 'brain fog' and the odd ache and pain here and there but they go away. I do a bit of weight training 3-4 times and week and lotsa walking etc to try and keep fit. I have noticed a bit of excess fat on the body, but I guess if the body is working with limited testosterone - it must have an effect.


The oncologist has told me that I might be on hormone treatment for up to 3 years. Apparently because of some statistical work that was done that you might get more longevity the longer you stay on the hormones??


Does anyone know anything about this? Because as I understand, if there are any cancer cells still in the prostate the decapeptyl might keep them in check, but would not 'kill' them. Do PET scans detect microscopic cancer cells??


Staying on hormone treatment for long periods can have its own dehabilitating consequences.It keeps the cancer down and this can be tracked with PSA tests, but seems there is no way of knowing if all the cancer cells are gone or not?? 


Does anyone have any information in this area?

User
Posted 05 Jul 2023 at 17:44

The radiotherapy doesn't instantly kill all the cancer cells. What it's aiming to do is to damage their DNA sufficiently that the cells can no longer divide and multiply, which stops them from growing and spreading. They will then die of old age over the next few years. The hormone therapy keeps them dormant over this period.


It also has another effect. Being a high risk patient (because your PSA ≥ 20), you do have a higher risk of having micro metastasis outside the area treated by radiotherapy. A combination of the main tumour having been disabled and the hormone therapy seems to cause tiny metastasis to die, as they appear to be supported by some signalling from the main tumour which is now lost.


This would also apply to any cancer cells in the prostate, although it's relatively rare for the cancer to survive in the main radiotherapy target area. (Maybe slightly more common for brachytherapy in case a bit was missed.)


You won't know the effectiveness of the radiotherapy until the hormone therapy has worn off, Testosterone returned, and PSA risen back to its new (lower) stable level.

User
Posted 05 Jul 2023 at 17:56

Fascinating and informative reply as always Andy and I’ve learned something new. I never knew about the HT possibly killing any tiny mets.


Thanks
Derek

User
Posted 05 Jul 2023 at 18:45

That's interesting, as a T3b G9 I worried about micromets in lymph nodes. It makes putting g up with the rotten side effects of zoladex more bearable.


Many thanks


Peternigel

User
Posted 08 Aug 2023 at 15:56

Andy - thanks for that informative post. That's really interesting about the RT damaging the DNA and the 'support' signalling from the 'main' tumour to other cells.


I understand that PET and other scans cannot detect if micro cancer cells are still 'active' inside or outside the Prostate? 


Therefore, I'm assuming its a bit of calculated intuition (and the statistical results of various studies) as to when a high risk patient might be taken off the hormone treatment?

 
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