I'm slightly confused as to what criteria are used for commencement of HT immediately upon diagnosis either on presentation of high PSA or on confirmation of cancer following biopsy.
The obvious advantage is that that cancer with a high risk of spreading is treated quicker than if waiting for results from all the scans and meetings with various consultants to discuss treatment options.
The disadvantage is that sensitivity of subsequent scans to pick up cancer may be reduced and an RP may no longer be option even if the cancer is found to be confined to the prostate.
At the extremes I can fully understand that if someone presents with PSA in triple figures this would make sense, but the criteria for more marginal cases PSA 40-100 seems to vary between hospitals and regions also when patients present with a lowish PSA but a Biopsy results in a high Gleason score i.e. 4+5 (assuming forumites to be representative) this doesn't seem to trigger commencement of HT, does this scenario represent a lower risk of spreading and existing micro mets than someone presenting with a high PSA alone?
Another issue I was pondering is that surgeons don't generally like patients to commence HT before an RP, my consultant told me this is because it makes the cancer “fuzzy” and less defined making the procedure more difficult, fair enough but does anyone know if this perceived difficulty has translated into worse results, either in increased side effects or need for salvage RT?
I was particularly thinking of the large number of patients who were put on HT before RP during the COVID pandemic due to delays and uncertainty of when surgery would be commenced.