Toleration of 8 month hormone therapy

Unfortunately it looks like it might be time for salvage radiation. Briefly, I had a radical prostatectomy about a year ago with Gleason 3+4, extraprostatic extension and a positive margin. My psa has been less than 0.1 until February when it reached a psa=0.1, and when re-measured in March reached a psa=0.11. I have consulted two ROs specializing in prostate cancer. One recommends waiting until the level reaches 0.2 and then having radiation alone. The other recommends beginning treatment now (following bone scan, MRI, and psa retest) and offers radiation with or without 8 months of hormone therapy. He said, for patients with my stats, he has been getting about a 70% BCR free result that is boosted to 80 to 90% with hormone therapy.

So here is my question. For those of you that have had short term hormone therapy, how well did you tolerate it? Were there lasting changes after you stopped?

Most guys recover fairly quickly after HT with a duration of one year or less. Recovery after two years (my sentence, as it happens) takes longer and one guy in ten never recovers. After three years things are pretty dicey. Eight months should be doable. The first three or four months barely suck at all. Then the side effects start to pile up but you will be getting near the end by that point and can expect to recover briskly when the danmable stuff wears off.

I had some similar decisions to make (with different stakes, being a Gleason 9) and the stat that convinced me was that by putting up with the hormones now I could greatly reduce my odds of being stuck on them semi-permanenetly later. If you have a long life-expectancy then putting up with the hormones for a short time now may save you from being on them for a long, long time later.

I'd go with the second doctor and zap it now with the HT to increase the effectiveness. But that's me. Your mileage may vary.

RedWing,

Study after study that looks at recovery time after cessation of ADT has found that duration of the therapy affects the mean time to recovery of T levels within the "normal" range. Often 2 years is the dividing line -- they will look at men with 2 years or more or men with less than two years. The two years or more guys recover more slowly, as do men over 70 and, apparently, white men.

I did a bit of a scavenger hunt and found everything but what I was looking for. Some interesting stuff though...

http://gucasym.org/shorter-duration-androgen-blockade-passes-muster-high-risk-prostate-cancer-more-study-needed

http://www.ncbi.nlm.nih.gov/pubmed/18710743
http://www.ncbi.nlm.nih.gov/pubmed/16329145
http://www.ncbi.nlm.nih.gov/pubmed/18279929
http://www.ncbi.nlm.nih.gov/pubmed/16542340
http://www.ncbi.nlm.nih.gov/pubmed/18710748
http://www.ncbi.nlm.nih.gov/pubmed/12970730
http://www.ncbi.nlm.nih.gov/pubmed/18710743

http://www.ncbi.nlm.nih.gov/pubmed/23484454

You might want to google "prostate cancer nomogram memorial sloan kettering" and put your stats into the nomogram for salvage radiation. You can run the prediction of 6 year remission with and without adjuvant ADT and you'll see how much it improves your odds in your particular case. You won't be able to get a very accurate prediction because you don't have much data on your doubling time which is one of the factors in the nomogram, but you can make a reasonable assumption still and compare with and without ADT.

I'll say in advance - the nomogram is not as optimistic as the success rate that your doctor is reporting. Ask your doc about the number of years out he is assuming in his projections. The nomogram gives the recurrence free projection 6 years out, and that's very different from 3 years, ten years, etc.

FWIW, two docs I spoke to said that it is good to take one of the erectile drugs (cialis, viagra) throughout the ADT cycle because it keeps good blood flow in the penis and that helps the penis come back to life after the ADT is done.

I'm meeting with my surgeon from JH on the 24th on next steps for me as a g9 stage pt3b with rising psa. He's a bright guy who also is a PhD who does PCa research and will not pull punches. I'll ask him your questions re: ADT and report back here.
Bob

SC, thanks for the encouragement! I eagerly follow you occasional progress posts, and it's great to see possible sunshine ahead. :)

Bob, that conversation may be of interest to many here. Hope all goes well with your appointment.

Hi Thomas

Sounds like you and I are following a roughly similar treatment plan. I am on a 2 year Hormone treatment plan (started Bicultamide 10 days ago and go for my first "shot" on Friday). I will be on the Hormones for 2 years, with the salvage Radiation commencing early to mid June. Will post (irregularly) to the forum, look forward to hearing your experiences as well