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HT (Zoladex / Apalutamide)

User
Posted 10 Jul 2024 at 16:40

Hi All


69 year diagnosed initially via Galleri trial back in April 2022. No symptoms, was tested a few years earlier as older brother had PC, but I was deemed to be OK. Then the bombshell 2 years ago followed by the usual tests/biopsies resulting in a full Prostatectomy in March 2023. Op went well - I was told - and then later PSA showed a rise and a further Petscan last Autumn showed a 'low-level' spread to various sites including some lymph nodes, pelvic bed etc. Gleason score has always been high 4+5 so not good. Oncologist put me on Hormone Therapy late last year so for 6 months I have been taking combination of Zoladex implants and daily Apalutamide tablets. I was told originally by my urologist that hormone therapy loses its effectiveness within 2 years so would be interested in anyone who is undergoing a similar path/ timeframe. Bizarrely I have very good bladder control and only medium side effects of fatigue and hot flushes but nothing which is adversely affecting day-to-day-life.


Any comments would be appreciated.


 


Thanks

User
Posted 18 Nov 2024 at 08:15

Hello, i dont know why no one responded to this query, but it spiked my interest as you mention that HT wears off after two years. I did not know this as I thought some people were on it for 3 years. I hope you are doing well.


 


Rory

User
Posted 18 Nov 2024 at 11:54

I'm not sure how that post slipped through the net.


The effectiveness of HT is about 2 years but that has a wide range, from not effective even from day one to effective for over 20 years.


HT can be used in two different situations, accompanying radiotherapy or as a lifetime treatment.


If it is used to accompany RT it is usually started six months before the RT and the duration is two or three years. The intention is to weaken the cells and make them less capable of dividing whilst the RT does it's work. There is an argument that the RT will have done it's job after 18 months and any more HT than 18 months is pointless. 


Once the cancer has spread beyond the prostate it is impossible* to target it all so systematic treatments such as HT and Chemo are what is left. As none of these kill all the cancer they will be used until they lose their effectiveness which for most people will be about two years, quite often five years and occasionally 20+ years.


*Treatment of a small number of distant mets is now proving effective.


 


 

Dave

User
Posted 18 Nov 2024 at 21:38

Hi, I am at two years on the same drugs. Similar side effects (ie not too bad,although would love my libido back!). I don’t know about the drugs stopping working at this point. I was hoping they would keep working for a bit yet, although realise they could stop working at any point. 

User
Posted 19 Nov 2024 at 01:22

I'm somewhat shocked that your cancer wasn't picked up during the galleri screening, given you should have been tested regularly over that period and really should not have slipped through the net. The psa rise after your prostatectomy should have probably caused your urologist to recommend follow up treatment [depending on the psa figures which you haven't given us here].  The G9 on its own isn't necessarily a disaster as it's the spread outside the prostate, to seminal vesicles and beyond that will probably cause more problems.


Depending on the details of what you describe as "low level spread to various sites ... " there should still be the possibility of RT to treat the prostate bed, seminal vesicles and a small number of nearby lymph glands, if that's what you're looking at. What's your psa record been like over time? Now, with HT it will presumably be low but the history can still be helpful as a guide.


You're now dealing with an oncologist, so what options have you been given by him/her?


Jules

 
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