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Hormone therapy with the cancer still localized within the prostate

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Posted 7/9/2022 1:10 AM (GMT 0)
I have a friend who is 72 and has had a PSA approaching 10. He lives in Az (I'm in Ga.) and to date has not been very involved in his situation. Three or four months ago he said he was taking shots which I assume to be hormone therapy. I asked if he knows that his cancer has escaped the prostate and he believes it has not. I've been asking him to collect copies of his reports and he's trying to get them. He has not had a biopsy in almost 2 years but seems to remember that his Gleason score started at 3+3 and moved to 4+3.

His urologist said he's not a candidate for RP since he has a dystrophy variant and is losing muscle tissue so incontinence would be bad but that he would be a candidate for RT.

So my question is if putting a patient on HT before the cancer has escaped the prostate is a viable approach and why not just move to RT?
Posted 7/9/2022 1:57 AM (GMT 0)
It is common to do hormone treatment before, during, and after RT. So the question would be is there a larger plan in progress with RT one of these days? Other reasons would be cancer too widespread to aim at or his health is generally poor and life expectancy is short. Most at 72 would get aggressively treated, 80’s are different depending on health and situation, and 90’s out of the question for 99% of men.

Hormone therapy can kick the can down the road pretty far for many men by halting the cancer until the cancer figures it out and it picks up where it left off then they can try some other things. No “cure” but may solve the problem for his lifetime. You will have to politely get more information to assess his situation. I assume he has an oncologist or urologist prescribing the shots so there is a plan consistent with his condition, maybe not?

My dad is 95 and has not looked at his PSA in 5 years after treatment, recurrence, and hormone therapy to knock his PSA back down to <0.10. He has a few other maladies that are much more serious and will get him long before the time necessary for PCa to cause issues.
Posted 7/9/2022 2:43 AM (GMT 0)
I think his dystrophy may likely take him before the hormone treatments lose their effectiveness. Maybe that's what the URO is thinking.
Posted 7/9/2022 3:20 AM (GMT 0)
maybe he does not want RT and he was talked into HT?
Posted 7/9/2022 3:28 AM (GMT 0)

F8 said...
maybe he does not want RT and he was talked into HT?

I think he was talked into HT but I don't think he's resistant to RT. At this point my advice to him is to have a 2nd opinion with a RO that does Cyberknife in Scottsdale, Az and let him go from there. Even though I had SBRT (and currently experiencing a PSA rise at 18 mo...) I'm hesitant to make recommendations.

I guess that if the HT suppresses the cancer for a year or two or three then he can move on to RT at that time.
Posted 7/9/2022 4:09 AM (GMT 0)
I am very reluctant to advise what treatment someone should do, but if this man has dystrophy and is losing muscle why would any doctor prescribe ADT?
Posted 7/9/2022 5:06 AM (GMT 0)

Duck2 said...
I am very reluctant to advise what treatment someone should do, but if this man has dystrophy and is losing muscle why would any doctor prescribe ADT?

Could you elaborate?
Posted 7/9/2022 5:39 AM (GMT 0)

Vic Hardy said...

F8 said...
maybe he does not want RT and he was talked into HT?

I think he was talked into HT but I don't think he's resistant to RT. At this point my advice to him is to have a 2nd opinion with a RO that does Cyberknife in Scottsdale, Az and let him go from there. Even though I had SBRT (and currently experiencing a PSA rise at 18 mo...) I'm hesitant to make recommendations.

I guess that if the HT suppresses the cancer for a year or two or three then he can move on to RT at that time.

#############

my buddy was resistant to treatment but the doctor talked him into taking casodex. he eventually received RT but with numbers higher than i like to see for monotherapy
Posted 7/9/2022 5:05 PM (GMT 0)

Vic Hardy said...

Duck2 said...
I am very reluctant to advise what treatment someone should do, but if this man has dystrophy and is losing muscle why would any doctor prescribe ADT?

Could you elaborate?

Low testosterone results in muscle loss.
Posted 7/9/2022 10:08 PM (GMT 0)
Low testosterone results in muscle loss.

Ah, you're right. Didn't make that connection but now I'm curious. I'm visiting him in two weeks and we'll discuss.
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