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SRT very likely - HT as well?

User
Posted 02 Apr 2026 at 10:44

I had RP in February 2024 that was straightforward enough - negative margins, T2c confirmed in post op histology and partial nerve sparing. General recovery and health over the last two years has been good. I'm still working and generally very active. 

Initial PSA tests were undetectable but became measurable in December 2024 (0.01) then 0.03 in August 25 and 0.06 in January. Next test is in a couple of weeks time.

Discussion with the oncologist indicated that salvage radiotherapy was very likely based on the rate of PSA increase but there was an open discussion on the need for accompanying hormone therapy - i.e. quality of life over potential improvement in long term outcomes. 

Has anyone else been through this question of whether or not to take the HT as part of the SRT? I'd appreciate any experiences people may have had or any advice.

Thanks  

 

User
Posted 02 Apr 2026 at 13:48
Lots of guys on here have done both (with and without) the evidence on the optimal duration is still evolving.

Ultimately you will need to decide on the risks of either approach.

User
Posted 02 Apr 2026 at 16:56

Of course, there is a middle option of shorter term HT. I had 33 sessions SRT in 2024 with a recommendation of 24 months Decapeptyl. PSA on starting had risen to 0.2. I did suffer significant side effects and after reading the report and conclusion of the Radicals HD trial as it stood at the time, decided to stop after 12 months. My reasons were that there appeared to be little benefit in continuing for longer; QOL; risk of bone thinning and a greater risk of testosterone production being delayed or not happening at all. Only time will tell if I made the right decision. 

 

 

User
Posted 02 Apr 2026 at 17:54

If RT is the primary treatment, then HT usually precedes it to shrink the tumour and continues afterwards to keep the cancer cells weak. It is considered in this situation that the early HT is very beneficial, and the later HT is diminishing in its usefulness.

For SRT, I do not know if the same logic applies. There is probably not a tumour as such, just left over cancer cells in the prostate bed. However if they are weakened by HT prior to RT it is probably beneficial.

Most men find HT bearable. If I were in your position I would start the HT and have the SRT, because if it is giving benefit, then this is when it is giving the most benefit. If you don't have problems with the side effects then continue with the HT. If you do have problems just stop the HT, by this time the extra benefit HT is giving will be marginal.

 

Dave

User
Posted 03 Apr 2026 at 07:54

C 365, I had SRT in 2017 three years after surgery. I had developed a stricture after surgery and they thought the additional of HT would make the treatment to toxic. My PSA did fall after SRT but then started to rise again. Would the HT have helped eradicate the cancer cells outside of the prostate bed, I will never know.

Thanks Chris 

User
Posted 03 Apr 2026 at 10:46

Hi,

I had SRT without HT in 2022 after my PSA rose to 0.12. HT wasn't offered as part of my treatment plan but I was happy with that. 

I'm now on yearly tests, my last one was undetectable <0.010 back in November. 

Good luck. 

Kev.

User
Posted 03 Apr 2026 at 21:48
C-365, as others have said the evidence is still coming out and I don't think there is definitive advice.

I had SRT in 2022, six years after surgery. The surgeon didn't refer me to oncology until PSA had reached 0.2 and said he had had patients where an initial PSA rise had stabilised below 0.2 and caused no further problems.

Like you I tried to find out as much as possible about the treatment at the time. I found a scientific paper which suggested that for slow growing cancer (PSA under 0.45 and doubling time over 8 months) outcomes of SRT were probably no different with or without HT though it would need a bigger study to establish the thresholds definitively. My oncologist concluded it would be better for me to have HT for a period prior to RT but didn't need it afterwards and I followed that advice.

You currently have pretty low PSA (the lab here doesn't even report numbers less than 0.05) and you don't have a long enough sequence for a reliable estimate of doubling time. So it may be you are a good candidate for RT without HT. If your oncologist with the benefit of more recent clinical studies and obviously his/her own experience of patients thinks you may not need HT I would go with that - both treatments have side effects which can be long term and you don't want more of those than necessary.

User
Posted 04 Apr 2026 at 15:41

Thanks for all the replies - food for thought... 

 

Much appreciated. 

 

 
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