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Zylodex after focal therapy

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User
Posted 07 Dec 2023 at 14:03

Hi I have intermediate 7 and have asked for focal therapy. My question is - does focal therapy have any influence on the length of time spent on Zoladex after treatment, or is it a case-by-case situation? RP would have been 2 years on Zylodex.

User
Posted 08 Dec 2023 at 01:08
It might just be me but having HT rather defeats the object of focal therapy
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 08 Dec 2023 at 01:30

I don't think you'd have any HT if you are having a focal therapy.

User
Posted 08 Dec 2023 at 12:13
For Focal therapy, of which there are several kinds, HT is not offered as part of it to the best of my understanding. However, after it was evident that my first HIFU treatment had failed , I was prescribed Zoladex but with some encouragement from the Royal Marsden I held back on HT as I knew from early experience of it prior to initial RT, that it caused side effects I did not wish to have again. Eventually, as my recurrence seemed confined to my Prostate, UCLH agreed to a repeat HIFU which a couple of years on is still giving a satisfactory result. I understand that should a new tumour grow in my Prostate a further HIFU or other form of Focal Treatment will not be given, so I would then be offered HT again. (I am 87 now and in the event of this happening, I would be more disinclined to start HT with each passing year. A younger man in a similar position might be more willing to have HT).

Whilst you can't look very far ahead, I think it is prudent to consider the implications of a failed form of treatment and options that would be open to you at that point.

Barry
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User
Posted 07 Dec 2023 at 14:41

Do you mean ‘RT would have been 2 years on Zoladex’?

User
Posted 07 Dec 2023 at 14:45

Oops yes - typo

User
Posted 08 Dec 2023 at 01:08
It might just be me but having HT rather defeats the object of focal therapy
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 08 Dec 2023 at 01:30

I don't think you'd have any HT if you are having a focal therapy.

User
Posted 08 Dec 2023 at 09:23

That's the answer I was looking for thank you so much. Because these hot flushes are driving me craaaaaazy lol

User
Posted 08 Dec 2023 at 11:04

Are you currently on HT? If so for how long have you been on it?

Dave

User
Posted 08 Dec 2023 at 12:13
For Focal therapy, of which there are several kinds, HT is not offered as part of it to the best of my understanding. However, after it was evident that my first HIFU treatment had failed , I was prescribed Zoladex but with some encouragement from the Royal Marsden I held back on HT as I knew from early experience of it prior to initial RT, that it caused side effects I did not wish to have again. Eventually, as my recurrence seemed confined to my Prostate, UCLH agreed to a repeat HIFU which a couple of years on is still giving a satisfactory result. I understand that should a new tumour grow in my Prostate a further HIFU or other form of Focal Treatment will not be given, so I would then be offered HT again. (I am 87 now and in the event of this happening, I would be more disinclined to start HT with each passing year. A younger man in a similar position might be more willing to have HT).

Whilst you can't look very far ahead, I think it is prudent to consider the implications of a failed form of treatment and options that would be open to you at that point.

Barry
User
Posted 11 Dec 2023 at 08:30

Thank you Barry I'm now told by my specialist that focal therapy is not the right treatment for my type of cancer - which begs the question why has a referral gone through? I'm feeling confused and anxious about the situation now.

 

Neil

User
Posted 11 Dec 2023 at 08:44

If you are interested in focal therapy, you do need to ask the consultant who does it, and not someone who doesn't. You haven't given your full diagnosis, so can't comment on how suitable you might be.

User
Posted 11 Dec 2023 at 08:49

Here goes:

(A) The cores from the left side show adenocarcinoma, Gleason 4 + 3 = Score 7, with pattern 4 comprising 80% of tumour and including cribriform pattern.  Tumour is present in seven out of eight cores, GPC 100%, TPC 70%. Perineural invasion is identified.

 

(B) The cores from the right side show adenocarcinoma, Gleason 3 + 4 = 7, with pattern 4 comprising 20% of tumour and including cribriform pattern.  Tumour is present in four out of six cores, GPC 100%, TPC 50%.  Perineural invasion is identified. Tumour lies close to adipose tissue in one core suspicious of possible EPE.

 

Comment

For management purposes the composite Gleason score is Gleason 4+3 = Score 7(Grade group 3).  There is no evidence of vascular invasion.
User
Posted 11 Dec 2023 at 10:37

None of us on here are medics, so my opinion counts for nothing compared to a medic. As far as I know any focal Therapy is dealing with a small tumour in the prostate. Your tumour does not look to be small, and it mentions EPE (extra prostatic extension) in to adipose(fat) tissue. I don't think a focal therapy can help you.

The EPE means surgery would likely leave some tissue behind, so is almost certainly not a good idea. I assume you are on HT and the plan is RT. Has anybody mentioned HDR brachytherapy? that can increase the radiation dose to the prostate without much effect on adjacent organs.

My diagnosis was worse than yours in every way, except I didn't have cribriform pattern, which adds more risk to you.

I was treated EBRT, HDR and HT. Five years later I'm considered cured (I have PSA test today, so we'll find out if that is still true soon).

I found HT unpleasant but not dreadful. You need to give RT the best chance of knocking that cancer out. Some people do stop HT early but in your case that would be quite high risk.

Andy62 may be able to guide you on living with HT as best you can.

Dave

User
Posted 11 Dec 2023 at 16:42
There is no harm speaking to the focal therapy specialist - perhaps the urologist thought it was wise to refer you to the specialist so that they can explain to you properly why you might or might not be suitable.

My guess though is that it is a) the elements of cribriform b) the perineural invasion and c) the suspected EPE that rules you out of anything except radical treatment. You don't want to mess about with focal treatments that potentially leave some cribriform in place to wreak havoc :-( and focal treatment is pointless where you already have PNI and / or EPE

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 11 Dec 2023 at 18:42

Just to further add, you don't seem to have focal disease (i.e. up to just a few isolated areas), so focal therapy probably can't be offered (but do still ask if you're interested).

Sometimes when disease is on both sides, focal therapy is still offered providing one side can be left untreated to effectively continue on Active Surveillance afterwards, but I don't think either side in your case would be eligible for Active Surveillance.

EPE (T3) which is known about before prostatectomy can often be handled by cutting a wider margin, providing it hasn't gone far enough to invade another organ (T4). A surgeon wouldn't agree to prostatectomy if they knew it was T4 before starting. You haven't given the staging, but it's presumably a T3a. The higher the risk, the more likely you are to need salvage radiotherapy afterwards.

 
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