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Is hormone therapy necessary with radiation?
Prostate Cancer | Last Active: Jul 19 8:36pm | Replies (104)Comment receiving replies
I had HDbrachytherapy performed at a COE, UVA Charlottesville. Being retired and in the medical profession for over 40 years probably made me a pain in the ass to my doctors. Although, I can’t stress enough that everyone should do their homework. I looked at the studies on ADT. I had 4+3 Gleason contained in the prostate. My prostrate oncologist wanted me to go on orgovyx prior to the procedure and the 25 sessions os EBRT. I told him for less than a 2% survival increase it was not in MY decision to have ADT. He completely said that would be fine. It has to be your choice. QOL should be paramount in your treatment options. In medicine, we look at numerous studies and drug companies data on meds to prescribe. Medicine is not an exact science, it basically changes on a daily basis. I continued at the end of my career that many patients had the same if not more knowledge than I did on a particular condition (I was a family GP). When I finished my residency I thought knew everything. Lol. Now being on the other side I can get the same data as the physician. I had cursory knowledge of radiation and wanted to make sure I found the best oncologist and Center of Excellence. Based on this platform, Mayo is at the top of being a COE. In the US most of us are a 2 hour or less driving time finding one. They’re usually a University Medical Center. Good luck and keep on doing your own research.
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@cbball Yes, doing one’s own homework is crucial to getting a desired outcome (the definition of which can vary person to person).
Similarly, being a retired computer scientist, I was into the technical and analytical details of the treatments. I don’t think I was a “pain in the ass,” but I had questions regarding diagnostics and treatments for which my doctors would comment “No one has asked us those questions before.”
I was initially diagnosed (in 2012) with low-grade, localized disease (PSA 4.2, Gleason 6, with no other adverse risk factors), and the urologist wanted to do a prostatectomy. I chose to go on active surveillance which lasted for 9 years. (But over those years he was good enough to provide me referrals to specialists in any treatment modality I requested, so that I could interview them while doing my own research.)
So, it goes behind just doing one’s homework; it also involves (what I call) becoming a “student of prostate cancer,” learning the language, self-advocating, and sharing in the decision-making.
As for that extra 2%, I would take that small change - with the full understanding that by incorporating a robust resistance-training exercise program, that I could minimize/avoid most of the common ADT side-effects. (And being a gym-rat myself, that’s what I did.) Quality of life was equal priority for me as was successful treatment.
I’ll take that 2% using the ADT (which I did), plus the few % with a rectal spacer, plus the few % with a full bladder, plus the few % with an empty bowel, plus a few % monitoring my diet, plus, plus, plus……..during and after treatment those small plusses add up to something meaningful.
There’s a study that Dr. Scholz cites about ADT providing little benefit for Gleason 7. (It might be the same one you’re referring to, I don’t know.) When I listen to that Scholz video, he refers to Gleason 7 as well as “intermediate disease,” but never mentions whether that’s 3+4 or 4+3 (or favorable/unfavorable). Similarly, when I located the literature on that study he was citing, it also refers to Gleason 7 as well as “intermediate disease,” but never mentions whether that’s 3+4 or 4+3 (or favorable/unfavorable). So, depending on how weighted that study was towards 3+4 rather than towards 4+3 might explain the small % survival increase of using ADT.
(Ultimately, I had 28 fractions of proton radiation + 6 months (two 3-month injections) of Eligard. The radiation treatments were relatively uneventful; the Eligard was a 9-month annoyance.)