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Salvage radiation decision: with or without hormone therapy?
I had a prostatectomy in 2021. PSA was undetectable for 2 years. Then PSA went to 0.1 in 2023, and then 0.2 in 2024. I saw an Oncologist last month who recommends salvage radiation to the prostate bed. I will do that soon, but first need to make a decision on whether I should do hormone therapy with the radiation therapy. I have a family history of prostate cancer, and my PSA was fairly low (5.0) when I had the initial biopsy and diagnosis, which showed prostate cancer existed in all samples. The Gleason score was the bad 7. I had a PET scan and bone scan before surgery which did not show any signs of metastatic prostate cancer. So my question to the group is: should I do hormone therapy at this time? Or just do radiation and see if that works? I'm 64 and in good health.
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My prostate cancer doesn't produce PSMA. Had the PSMA pet, nothing lite up. If i go with radiation to the prostate bed, how can i be assured there is not cancer elsewhere. What test is there for this situation?
For prostate cancers that don’t express PSMA, you go back to the older Axumin (F18-Fluciclovine) PET/CT scan or C11 Choline PET/CT scan (that Mayo Clinic uses). In the absence of PSMA, those are preferred.
Dr. Kwon (of Mayo Clinic) indicates that only 1/3 of men who have recurrence following prostatectomy have recurrence only in the prostate bed, and that they should not get salvage radiation there unless they’re absolutely certain of the location of recurrence. He says to first confirm where the recurrence is. (See Dr. Kwon’s presentation about recurrence: https://youtu.be/Q2joD360_pI)
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3 ReactionsOne other scan that works well to see cancer that doesn’t produce PSMA Is the FDG scan. It uses Fluorodeoxyglucose and it can identify the presence of cancerous tumors, determine their spread (metastasis), and monitor the effectiveness of cancer treatment.
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1 ReactionI am continually told that adding hormone therapy before and after radiation increases the effectiveness of the radiation. The differing opinions I receive are more around the duration of ADT and have ranged from 4 months to two years. I think two years may be outdated and 18 months is sufficient for those choosing to be safer on the longer end. Personally, I would get ADT if I was getting radiation again.
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1 ReactionThe duration of ADT depends on the aggressiveness of the disease and any other risk factors. NCCN Guidelines call for ADT duration of:
> Unfavorable intermediate: 4-6 months
> High or Very-High Risk: 12-36 months
Adding hormone therapy lowers testosterone, which removes the “food” prostate cancers need. This starves/weakens the prostate cancer cells, making them more susceptible to DNA damage from radiation (and also weakens their repair mechanisms),
The length that you take hormone Therapy is based on your Gleason score 1st and your case second.
If you have a Gleason 7 Six months of hormone therapy is recommended
If you have a Gleason 8 18 months of hormone therapy is recommended
If you have a Gleason 9 24 months of hormone therapy is recommended
These numbers can change based on your cancer. If you have Gleason 8, but a very mild case, they may not keep you on 18 months if your PSA stays undetectable. The same is true for the other groups, But it does make sense to Keep to the standards for most people because it allows them to have the best overall survival.
My prostate cancer was already in the bone when my PSA was 3.6 or so. As far as hormones, they don't seem to bother me too much. Minor hot flashes and a tendency to stop at all garage sales and more viewing of the Halmark channel. I've noticed that my muscle mass is going down, so I need to get more protein and workout more. My motivation has gone down some.
So, for me it's a no brainer to take the hormones as I deal with them relatively well and the outcome appears to be better. I'll do anything they tell me to have a better chance at life. I guess I'm kind of selfish.
BTW, I'm going to Sloan Kettering for my needs.
Good luck whatever you choose to do!!!!
Dave
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2 ReactionsLike your attitude!!