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Is hormone therapy necessary with radiation?
Prostate Cancer | Last Active: Jul 19 8:36pm | Replies (104)Comment receiving replies
@jeffmarc What is the point of waiting? For primary treatment ROs routinely treat local SV, lymph, etc. in higher risk cases without any PSMA confirmation that there is any cancer outside the prostate. They just know from experience that it is highly likely to be there with Gleason 8 or even 4+3. The same could be done for RP patients on first recurrence since there is even better information about the stage of the disease, positive margins, etc. If no ADT is done with the radiation another PSMA scan can be done after the treatment if the PSA does not become undetectable. Once ADT is removed from the initial BCR treatment follow on PSMAs can find any additional spots as fast as waiting with less risk for the majority of patients. Kwon stated that only 1/3 of patients had recurrence ONLY in the prostate bed. For the first BCR the percentage that had recurrence only in prostate bed, PV, local lymph nodes will be much higher.
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@jim18
Some people do have severe reactions to ADT. Some people can take it without so much in the way of detrimental side effects to their daily lives, I am one of those . Long term it causes detrimental problems for everybody.
You seem to be discussing treatments that weren’t part of this initial message. Doing PSMA PET scans wasn’t discussed.
Pet scans are done initially in cases where people seem to have advanced cancer, but don’t have biopsies yet. I some of those cases they find quite advanced Cancer with many metastasis. At that point, they do triplet therapy and don’t even bother treating the prostate or doing a biopsy, So they have no idea what the Gleason score is.
Whether or not a PET scan is done ahead of time is based on what is found in the MRI and biopsy. Sometimes those results call for a PET scan, no matter what the Gleason score is.
While Kwon did say 1/3 of patients had reoccurrence only in the prostate bed, That doesn’t preclude the fact that many people will have it in the prostate bed and other places. But the PET scan doesn’t show anything in most of those cases. Is it wise to not do salvage radiation? Studies have shown if people have very advanced cases not doing salvage radiation by .25 causes shorter PFS. You can then wait around for other metastasis to show up, I personally would want and did have salvage radiation when my PSA hit .2.