Alternatives to ADT / hormone blocking drugs. What happens if you refuse them?

You might have one or two mets which are amenable to SABR radiotherapy with a curative intent. A PSMA PET scan will be required to identify if that's the case (although they might start with a bone scan and/or abdominal CT scan as those are generally available much faster). Any more than a couple of mets and they're unlikely to offer a curative treatment.

HT is the primary treatment for advanced prostate cancer. If you refuse it, you are in effect refusing treatment. There are other treatments which are added on, but I doubt would be offered (or effective) without the HT.

You can always try it and see how you get on. You probably should do that before deciding to refuse treatment, because it might not impact you as badly as you're imagining.

What has been done by a small number of people is to defer HT until cancer symptoms show up, or there's imminent risk of something major or irrecoverable such as metastatic spinal cord compression.

Another option would be to use intermittent hormone therapy, where you start with HT and when your PSA has been very low for a while, you take a holiday (break from HT), and go back on to HT when your PSA reaches a level your oncologist decides (such as 10, perhaps). This works well for those whose PSA rises only slowly and they spend more time off HT than on it, but you do need an initial long burst to start with.

You might also look in to BAT (Bipolar Androgen Therapy), where you stay on HT medication all the time, but part of the time you are given Testosterone, so your body alternates between having and not having Testosterone. (The switching is done more frequently than is possible by coming on and off HT medications.) I haven't seen good outcomes for this, but I've only seen it tried when men have already become castrate resistant, and I suspect that if it works at all, it's probably more effective much earlier on.

Goserelin/Zoladex is also available as a 4 week dose (standard is 12-weekly). The first one is often 4-weekly just in case you're allergic to it (very rare). The recovery time depends how long you've been on it. For a year or longer, it's probably around 50% of the time you were on it. I don't know recovery time where people were on it for shorter periods.

Chris J took the path you are suggesting.

Hi Rumtac,

From my experience at Maggies, the side effects of HT vary greatly from on person to another, some have very little and others find they can be quite debilitating at times. They also greatly vary in severity and frequency, some have problems at night and some, like me, during the day. I’ve suffered from hot flushes, ED, brain fog, anxiety, insomnia, but the most recent and worst effect is joint ache/stiffness. My knees are the worst, at the moment at times I struggle to get off a chair at times. I haven’t however suffered from fatigue which seems to plague many men on HT.

My approach to it is to be proactive in tackling these issues, trying to find things that work for you…and above all give you some QOL. Yes, the side-effects can be a real pain in the arse but it hasn’t stopped me from having fun, which is so important when dealing with this disease.

I guess the only way you will find out is if your try HT and see how you react…it may well be that you get through it without too many issues.

Good luck whatever you decide.

Derek

Paul , if the question was to me, yes 150mg daily. Got a blood test tomorrow, be interesting to see what if anything it has done.

Added, just to part answer your original question,my oncologist did say under NHS rules, not having certain treatments can possibly rule out have certain further treatments.

Thanks Chris 

Edited by member 13 Aug 2023 at 23:53  | Reason: Not specified