Salvage radiation and hormone therapy.

Hi,

I had SRT without HT, but then I was T2C, albeit with a positive margin. I shared your anxiety about HT but my oncologist didn't recommend it anyway.

I'm not medical, but I think your T3b diagnosis may tip your treatment options sooner or later towards some sort of HT.

I think you will have a fair few questions for the surgeon. At the top of the list, I would ask can your nerves be spared. And I would weigh this up against sexual function returning after going down the RT/HT route.

Good luck, 

Kev.

Hi, I had 3 months on Bicalutamide prior to 20 sessions of Radiotherapy, the explanation I was given is that it starves the cancer cells prior to Radiotherapy I was happy with my treatment choice and my PSA is now steady at 0.5 and I have no regrets going down this treatment route, the hardest part is deciding which treatment path to go down but once decided you will feel better. 

John

Obviously there is the question of whether radiotherapy should be with or without ADT. That is to some extent a clinical question for which you rely on your consultants, based on how aggressive the return of cancer is. But your view counts too.

From my reading when I had salvage RT three years ago, ADT in advance of RT has a bigger benefit than ADT afterwards, and in cases caught early with a long doubling time ADT may actually be unnecessary. But predicting your individual risks is hard, even with a well designed study they can't report 10-year outcomes without waiting 10 years and in that time there are likely to have been improvements in radiotherapy practice.

So I am afraid the answer is to discuss all these points with your consultants. To be fair I imagine that is the point of your question, so you will be in a better position to discuss with them the balance of benefit and adverse side-effects in your specific case.

Chris's post above does spell out the risks of salvage RT without HT, though there was a clear reason why he couldn't have HT in his case.

A lot depends on what the surgeon has to say about your situation but with a T3b you're right in the middle ground where there might still be a choice between surgery and RT, or you could be told that RT is the only option. There's stats out there to compare the survival rates of RT with or without HT and RT alone is of course an option but a year of HT post RT certainly improves your prospects and for some men it's not a big deal.

As a G9er who went through RT/HT my thinking, with the benefit of hindsight is, think long term beyond the immediate challenges of treatment. The best option is the one that, in 5 or 10 years, will see you still cancer free and with the least concern about recurrence. Treatment, even 3 years of HT/RT, is only a small fraction of the rest of your life even if it is unpleasant for a time.

Jules

Hi again Grecophile.

This is link to recent research into the treatment of T3b PCa. You may find it useful, mate.

https://pmc.ncbi.nlm.nih.gov/articles/PMC10241841/

Hi again, mate.

I'd have thought it would have made more sense to see the surgeon after the scan result? Surely the results of the scan will significantly affect a decision as to whether your T3b disease is suitable for surgery?

I was T3a, extraprotastic extension, no seminal vesicles involvement, but Gleason 9(4+5).

Due to a heart problem there was much debate between surgeon, aneathetist and cardiologist as to my suitability for the op. During the two or three months deliberation, I was put on Bical as they initially thought RT was the most likely way forward. In the end, they agreed to give me what I wanted, and I had RARP.

It's not normal to have HT before surgery, but in my case it seems to have done no harm. In fact, I've read somewhere that HT prior to surgery, results in better outcomes and reduces the risk of BCR.

However, I was told that having HT prior to surgery can affect the post op histology report. It can alter the look of some cells and lead to an upgraded Gleason score.

I hope your consultation and scan goes well, mate.  👍 

I understand your concern over the possible implications of caring for your mum whilst dealing with our disease and it's treatment.

In 2017, aged 88 years, my dad "died with prostate cancer' but I'm sure it speeded up his demise. From the day he died, me and my brother both took turns in caring for my mum, who was then 93 years old. She lived with us at our respective homes, one month on one month off.

Unfortunately both of us were later diagnosed with PCa. He had RT and HT, I had surgery. Despite our cancer setbacks we managed to continue to care for her. Then other health issues cropped up and we were no longer able to provide for her and sadly had to put her into a care home. She was there just over a year before she passed away at just over 100 years old!

I can therefore fully empathise with your concerns over looking after your mum. It's not easy when you're fit, mate, and it's much harder when you're not.

Age is certainly catching up with me. My eyesight not as good as it was, but looking at your profile photo you look fit and healthy, which will help you cope with whatever they end up throwing at you. Is that a big blue fin tuna you caught?

Only kidding,  mate.😁

Edited by member 11 Jun 2025 at 17:46  | Reason: Additional text

Just read it now Adrian. Thanks for the added info.