Hormone therapy AND salvage radiation for recurrent prostate cancer

welcome to HW, sorry you still need to be talking to us.

Sucks that you have to revisit this, but .2 is were most docs say you need to do something.

I've heard of guys on this site use both protocols. Just RT is done in less risky cases while the HT along with RT is often done in guys with more aggressive cancers. The numbers quoted to you seem like the ones I've heard.

It's a tough call. Normally we think of a G6 as low risk and not aggressive but coming back after that many years is a concern. Do have any idea yet which way you're thinking of going?

The radiation treatment isn't that bad - mostly an endurance test to get through all the treatments. Side effects are fatigue, bowel problems, urinary urgency among others - not everyone gets all of these. Most of this clears up with in a few weeks after treatment. Some guys report bowel issues lingering along with mild ED. Most treatable with pills.

I'll leave the HT effects up to those who've done that.

Hang in there and keep us updated on your progress,
Andrew

Steve,

The lingering side effects of hormone therapy depend, in part, on how long it lasts. Six months is on the shorter end of the range. While I had six months of androgen deprivation I can't really speak to the recovery because after my those six months I did 18 months more (I did 24 months). While I am on record here as hating the hormone therapy I would think that six months would be relatively easy time, there should be quite a bit of you left afterwards, and you should expect to get back to something like normal in another three to six months.

Note that this is not, necessarily, speaking to whether you need to add the ADT to your radiation. I am in a very different risk category. I seem to remember seeing studies questioning whether it added any survival advantage with lower-risk disease. I am confident that other members will be able to point you at some research that might apply.

It's a tough call. Whole pelvic radiation therapy (WPRT) as salvage is highly controversial. One recent retrospective study found:

"The advantage of "WPRT with hormone" over "prostate bed RT alone" was only observed in the high-risk patients, and not in other patients. Patient treated with WPRT had more greater than or equal to grade 2 late GI toxicity than those having PBRT (17% vs. 5%, p= 0.01)."

Whole pelvic irradiation for prostate cancer patients with a biochemical relapse following radical prostatectomy

We don't have the results of a randomized clinical trial yet (RTOG 0534) to definitively show what's best.

I think that usually ROs look for an indicator that the pelvic nodes are involved (enlarged lymph nodes, high and rapidly rising PSA, PET scan) before they proceed with salvage WPRT. Otherwise, treating the prostate bed only is standard salvage protocol.

The benefit of hormone therapy with a GS6 is also controversial. However, you had a GS 6 in 2002 - who knows what's in there now? In one retrospective study, they found, "For pGS ≤7, the 5-year biochemical no evidence of disease rates were 58% for combined (short term ADT+ SRT) therapy and 38% for SRT alone." But that may all be for the GS 7s.

Radiotherapy after radical prostatectomy: does transient androgen suppression improve outcomes?

The Stephenson nomogram predicting the success of SRT shows no risk penalty to having a GS 6.

- Allen

Hi there, 55 yo here, new to group.
I had DaVinci in July 2013 with a PSA of 14.3 (had been 1.4 the year before), Gleason 6. Had negative PSA until 12/18 when it went to .2. I elected for a slightly different therapy than yours. I received a 4mo. Luperin shot on 1/16 and began daily anti-androgen pills. Two months in, that is, on Tuesday, I began 34 days of radiation to Prostate bed. Diagnosis sounded very similar to yours.
I am feeling the side effects of the hormones, with hot flashes and general fatigue and what I would call flightiness (I stopped teaching because I had difficulty thinking on my feet). No libido. All of these are supposed to stop when I stop the hormones at the end of the radiation. I will keep you posted. And I will go complete my profile and signature. Best wishes, Howell

Post Edited (Howellsacto) : 3/19/2015 11:58:35 AM (GMT-6)

Steve I had the mother of all HT treatments, an Orchiectomy, 3 months ago. Side effects started imediately as your Testosterone clears your system in less than 3 hours! I would have no problem going to Mexico or anywhere else for that matter, the side effects are quite manageable. Don't let worries about side effects from HT stop you from proceeding with a normal life, maybe at a bit slower pace.

Cheers, Doug

They say it's impossible for G-6 to metastasize, that NOBODY ever dies from confirmed G-6 prostate cancer...Are you 64 years now ? Get a handle on your PSA's doubling time.. If it's long enough, further treatment might not be necessary or warranted..

Steve, I defer to all things Tall Allen says.

My husband's story is slightly different than yours, yet he's also a Gleason 6. Maybe. On guided biopsy, everything was found to be a 6, but he had a high PSA. One of the doctors on the team thinks they may have found higher Gleason samples if he had surgery. His case is considered intermediate with some high risk features.

The docs at MassGeneral are doing the following treatment as a primary treatment, not secondary treatment:

One month of Casodex or bicalutamide, and six months of Lupron. In the middle he'll have 8.5 weeks of radiation. He's been taking the two drugs for 3.5 weeks. He had a couple of "sweats" and chills, but he also had a cold. He said his libido feels normal. We haven't tried to have sex in the past week. He's had a cold and a bad, go to the emergency room, ear infection.

I don't trust this disease so I say throw everything you have at it. I vote for the hormone treatments, the radiation I don't know enough about to have an opinion.