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Benefits of Hormone Therapy After Radiation?

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Posted 8/2/2013 3:49 PM (GMT 0)
I am just completing four months of HT and eight weeks of RT, and I am trying to understand the therapeutic benefits of continuing HT for the next year or so. As it has been explained to me, HT shrinks/starves PC cells and makes them more susceptible to RT. Assuming the RT has been "successful" (PSA=0), what benefit would further HT produce? Or is it simply a precautionary palliative measure?

Thanks for any info you can provide.
Posted 8/2/2013 4:05 PM (GMT 0)
You are right that ADT is a potent radiosensitizer. However, working in conjunction with your immune system, ADT can also help clean up cancer cells that may have escaped already. The length of time you're on it afterwards depends on your risk level. With baseline PSA of 60, you're categorized as "high risk," which usually has about 2 years of adjuvant ADT after RT. It's certainly a good sign that you had such a complete PSA response to the ADT. Perhaps if your Gleason score and stage was low, your doctor might be willing to reduce that somewhat.
Posted 8/2/2013 4:14 PM (GMT 0)
Radiation Oncologists love it because it sure makes them look good...We can only hope and pray it actually does some good...Several good studies have supported that claim...

I enjoyed "zero club" status for 18 months after SRT + HT but when the HT stopped, the zero club membership was lost....

Best of luck to you!
Posted 8/4/2013 2:01 PM (GMT 0)
I don't know what my PSA will be; I am just trying to understand how length of HT is determined. Is it based on the assumption that some PC cells remain after RT and HT is needed to slow their growth? If so, why limit it to 18/24/36 months? Why not continue HT forever? Thanks for your thoughts!
Posted 8/4/2013 2:33 PM (GMT 0)
The time period is being hotly debated...A couple of controlled studies used 24 and 36 months duration and got good results..From that point on, Radiation Oncologists adopted the 24 or 36 month HT schedule..A more recent study indicated that just 12 months of HT was almost as effective as the longer protocols with far less side-effect load...So R.O.'s are moving in that direction. But for high-risk cases, 24 months is still the most recommended number..

Why not continue HT forever?? Because patients, believing they are cured, see no reason to endure HT past what was necessary to achieve that cure.. Also, should the cancer return and HT is needed to suppress it, you want it to be effective for as long as possible before you become "hormone refractory", which means hormone treatment no longer works. You don't want to burn all that time up during primary treatment.. As a general rule, HT is only effective for 24-36 months before it becomes useless as a cancer treatment...
Posted 8/4/2013 5:01 PM (GMT 0)
Welcome to the jungle, lots of opinions and tons of experts whom often disagree, so it is all so simplistic isn't it? (lol) There are those studies we know about and shows benefits of some HT durations that seem to extend survival over not doing so (aka Bolla studies etc.) Best thing is to realize this is a jungle and rules are skewed or non-existent, but many generalities are available to look at.

Gets really interesting when you see others doing way different HT therapies and getting good results, but the experts here usually don't endorse using some of those items (rarely so or maybe more so in foreign countries). I did way better for much longer without using Lupron anymore, go figure and funny how my drug that cost $130 per year trumped the ADT3 combo drugs costing around $13,000 a year....love how that became transparent. My uro doc wanted me on Lupron for life, cash cow for his palace life style perhaps, he got fired after 2 yrs and was surprised that I jumped ship.(2004)!

Hey if you find any of those simplistic answers on questions like this, send the info and receive a check. Been studying and looking at this jungle for 11+ years now and my conclusion is: question everything and all the time. Seems to hold up over time and issues as they change on PCa quite often now. Good hunting the season of PCa is open 24/7 and there is no limit. (-:}
Posted 8/4/2013 5:38 PM (GMT 0)
Zufus and Fairwind summed it up pretty well--the Jury is "hung"..I should mention that hormones can work longer than 24-36 months..I have a support group member that was on lupron for 3 years and when he stopped his psa started to rise so the doctor put him right back on it--10 years now! It works!
Bill yeah
Posted 8/4/2013 5:54 PM (GMT 0)
zufus +1
Posted 8/5/2013 3:21 AM (GMT 0)
..Just to add, my RO, Dr Nori suggested 6 month of Lupron HT to go hand in hand with 8 weeks of radiation. My MO, Dr T Bradley needed a bit of coaxing on this but I pushed for it as I trust Dr Nori. This will all take place in the coming days to weeks. 6 months is the shortest time frame I have heard of thus far & plans can always change. Got to do it..

..............Appleseed.......................
Posted 8/6/2013 4:29 PM (GMT 0)
PSA 60,

Please read these two studies.

http://www.ncbi.nlm.nih.gov/pubmed/19493260

http://prostatecancerinfolink.net/2013/02/13/18-months-of-adt-as-good-as-3-years-when-combined-with-radiation/

Dave

Posted 8/6/2013 4:37 PM (GMT 0)
I have just had my last three month shot which will take me the planned three years of HT. My uro and med onc both agreed on three years based on studies from SWOG (Southwest Oncology Group) that indicated continuous long term HT for the high risk, like me, was more effective than short term or intermittent therapy.

PSA 60, what were the other attributes of your cancer at diagnosis.......Gleason score, number of biopsy cores positive, percent of tumor involvement, etc.? That will help us better explain why your docs want to us HT longer term. You can see that I was PSA 59.
Posted 8/6/2013 4:53 PM (GMT 0)

In a previous comment, PSA 60 said...
Brief history (all with Kaiser HMO): 10 years of rising PSA (3 yr dbl time) WITH 5 negative biopsies before G3+4 TURP biopsy in January 2013. Got an MRI/Coil biopsy and 2nd opinion from UCSF, changing to G4+3 anterior tumor with possible extension to surrounding stroma and suspicious pelvic nodes due to size and location.

This seemed to take surgery off the table, as well as brachy or CK due to TURP defect, so I am scheduled for 5 weeks 3D-MRT + 3 weeks IMRT starting in June. Starting my 3rd week after Lupron injection with no side effects so far. If my PSA fails to drop substantially before RT, should I postpone or eliminate it as a treatment option?

P.S. I was prescribed finisteride for two years (2010-11) to see if it would correct my PSA level. It did drop by 1/2 initially, but started rising again and jumped back higher than ever after I stopped taking it. Was this accepted medical procedure, and may it have aggravated my PC?

Posted 8/7/2013 2:53 AM (GMT 0)
My father has kept up tne HT through all treatments. His Dr's say though it may not be controlling things anymore, it may he slowing some things down.
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