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Timing of hormone treatment with salvage RT

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Posted 12/19/2021 1:49 AM (GMT 0)
Here we go again. Different opinions regarding when to begin hormone treatment in combination with salvage radiation.

Has anyone heard of starting hormone treatment at the same time as starting radiation?--as opposed to starting HT a month or two before radiation.

Does the timing change if you're radiating the pelvic lymph nodes in addition to the prostate bed?
Posted 12/19/2021 3:02 PM (GMT 0)
My understanding is that ADT renders the cancer cells more sensitive to radiation treatment, which is why it is normally initiated in advance of RT. See this discussion on HW from a couple of years ago:

https://www.healingwell.com/community/default.aspx?f=35&m=3675293
Posted 12/19/2021 3:21 PM (GMT 0)
That's my understanding as well; moreover, the concept seems to be accepted by the majority of radiation oncologists (including mine at the time).
Posted 12/19/2021 4:25 PM (GMT 0)
That was my understanding as well—that you start hormone therapy before SRT with the goal of weakening the cancer cells and making them more sensitive to radiation.

DH’s RO is suggesting concurrent HT based on a recent study (or studies?) that showed better outcomes with HT on the back end (his words). He said that the study looked at timing of HT for first treatment RT (so not BCR post-prostatectomy) but still applicable.

Just wondering whether anyone else had heard of this.
Posted 12/19/2021 4:30 PM (GMT 0)
Okay, I just googled it and found this:

https://www.health.harvard.edu/blog/the-sequence-of-hormonal-therapy-and-radiation-affects-outcomes-in-men-treated-for-prostate-cancer-2020112421518

The amount that is still unknown is pretty scary
Posted 12/19/2021 6:10 PM (GMT 0)
In this 2016 study ADT was initiated at the same time as RT. It showed that results were better with ADT. It seems that it is respectable practice to start ADT and RT at the same time.

https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(16)00111-X/fulltext
Posted 12/19/2021 6:48 PM (GMT 0)
i started ADT about 6 weeks before brachytherapy, and brachytherapy was followed with IGRT. i had 12 of 12 cores positive, and at least one core was 70%. i was given a 60% shot at a cure. different doctors have different opinions and approaches. my doctors believed in hitting the cancer fast and hard. so far so good smile
Posted 12/23/2021 8:10 PM (GMT 0)
After my surgery I had persistent PSA of .40. This is with a Gleason upgrade to 4+3=7 and positive margins. RO recommended I get the ADT two weeks ahead of beginning SRT. The RO also stated recent studies that treatments could be concurrent and we didn't have to wait to start SRT.

Got good news last week that PSA is still undetectable and we can go a year before testing again.
Posted 12/29/2021 1:13 PM (GMT 0)
I had salvage radiation when my PSA reached 0.12. My oncologist did not want me on ADT probably because he wanted to see the effect of radiation without the help of ADT. 4 months after radiation my PSA was 0.13. He wants to wait another 3 months to see what the PSAADT is. I think he is trying to spare me the ADT side effects because of my age (80 years old)
Posted 12/31/2021 5:48 PM (GMT 0)
As noted in a previous post. We started SRT at .13 w/o ADT. 4 months later... undetectable.
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