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Zoladex therapy post RT therapy

User
Posted 17 Nov 2023 at 00:45

I am very new to this forum, and a little lost with direction now. 

My dad (aged 72) had prostate cancer diagnosis in Dec 2021. PSMA showed only prostate involved.

Robot key hole surgery of removed prostate in feb 2022. 

Half year later PSA start to increase from 0.01 post surgery.  raised to 0.55 in April 2023. had 2nd PSMA, prostate bed and nearby lymph nodes light up.  start zoladex injection 31 May and RT treatment from 27th June to 15th August.  Just see Radiation oncologist 3 days ago for follow up.  PSA drop to 0.05. The original plan is to have zoladex for 1.5 years. During the appointment my dad was keeping complaining how tired he was now and decreased muscle strength. So oncologist let my dad to choose whether to continue HT or stop now. My dad choose "stop". 

My dad know minimal knowledge and I know it is his choice. but i just not sure he made the right one or not. 

He had lung cancer in 2016 with three lymph notes involved. I spend nearly a year time (my maternity leave) to choose the treatment and took him for treatment. chemo+surgery+RT. That was one of the most dark time in my life. But he fight off it. no recurrence so far at year 7.

This prostate Ca seems a long and endless road. I have to be honest that i didn't do as much research as last time. MY Question is " Is it too early to stop the HT now . (totally he only had two injection. half year time. )

looking forward for suggestions. 

Best regards, 

Jo

User
Posted 17 Nov 2023 at 08:23

The duration of HT recommended following salvage Radio therapy seems to be a lottery at the moment. It seems to range from 3 years to 0 years.

My Onco has said 6 months Zoladex type or 18 months for the casodex tablet kind, but a second opinion I had also said zero HT is ok.

So if the HT is making your dad miserable stopping it sounds like a no brainer, especially as his consultant is in agreement.

Edited by member 17 Nov 2023 at 08:24  | Reason: Not specified

User
Posted 17 Nov 2023 at 11:12

I'm not sure there's much strong evidence for hormone therapy with salvage radiotherapy. I have asked some oncologists, but get different incompatible responses. It's not always used at all.

I would guess in your dad's case, it was most likely done because the cancer was identified in lymph nodes, and there could be smaller micro-mets (mets too small to show on scans) in more distant lymph nodes which will not be receiving radiotherapy dose. The hope here is that wiping out the main tumour combined with Testosterone suppression will cause micro-mets to die, and we do know that there is signalling from a tumour to distant mets. I don't think there's direct evidence for this, but it's a scenario that fits with hormone therapy use for primary radiotherapy treatment. Alternatively, it may be that his oncologist always uses it for salvage radiotherapy.

I don't know your dad's age or life expectancy in the absence of prostate cancer. Ideally, this would be factored in to such a decision. I don't know how long the hormone therapy was originally going to be used either, but this can be up to 3 years in this scenario. If that 3 years is likely to be a significant proportion of his life expectancy, then it's reducing his QoL for a significant part of his remaining life, something he might well choose not to do. On the other hand, if he's expected to live 20+ years, then stopping early increases the chances of the cancer returning as incurable during that period, requiring him to spend the rest of life from that point on hormone therapy. Hopefully someone explained this to him, but ultimately it's his choice.

What side effects did he have which he regarded as troublesome? Some side effects can be avoided with other medications, such as hot flushes.

Another option might have been to switch to a lower impact hormone therapy, Bicalutamide, which is a daily tablet. That might not be quite as effective as the injections, but may have fewer side effects, enabling him to continue on it. It also doesn't cause osteoporosis - actually quite the opposite, it strengthens bones.

 

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User
Posted 17 Nov 2023 at 08:23

The duration of HT recommended following salvage Radio therapy seems to be a lottery at the moment. It seems to range from 3 years to 0 years.

My Onco has said 6 months Zoladex type or 18 months for the casodex tablet kind, but a second opinion I had also said zero HT is ok.

So if the HT is making your dad miserable stopping it sounds like a no brainer, especially as his consultant is in agreement.

Edited by member 17 Nov 2023 at 08:24  | Reason: Not specified

User
Posted 17 Nov 2023 at 11:12

I'm not sure there's much strong evidence for hormone therapy with salvage radiotherapy. I have asked some oncologists, but get different incompatible responses. It's not always used at all.

I would guess in your dad's case, it was most likely done because the cancer was identified in lymph nodes, and there could be smaller micro-mets (mets too small to show on scans) in more distant lymph nodes which will not be receiving radiotherapy dose. The hope here is that wiping out the main tumour combined with Testosterone suppression will cause micro-mets to die, and we do know that there is signalling from a tumour to distant mets. I don't think there's direct evidence for this, but it's a scenario that fits with hormone therapy use for primary radiotherapy treatment. Alternatively, it may be that his oncologist always uses it for salvage radiotherapy.

I don't know your dad's age or life expectancy in the absence of prostate cancer. Ideally, this would be factored in to such a decision. I don't know how long the hormone therapy was originally going to be used either, but this can be up to 3 years in this scenario. If that 3 years is likely to be a significant proportion of his life expectancy, then it's reducing his QoL for a significant part of his remaining life, something he might well choose not to do. On the other hand, if he's expected to live 20+ years, then stopping early increases the chances of the cancer returning as incurable during that period, requiring him to spend the rest of life from that point on hormone therapy. Hopefully someone explained this to him, but ultimately it's his choice.

What side effects did he have which he regarded as troublesome? Some side effects can be avoided with other medications, such as hot flushes.

Another option might have been to switch to a lower impact hormone therapy, Bicalutamide, which is a daily tablet. That might not be quite as effective as the injections, but may have fewer side effects, enabling him to continue on it. It also doesn't cause osteoporosis - actually quite the opposite, it strengthens bones.

 

 
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