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Is hormone therapy necessary with radiation?
Prostate Cancer | Last Active: Jul 19 8:36pm | Replies (104)Comment receiving replies
@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.
Replies to "@jim18 Some people do have severe reactions to ADT. Some people can take it without so..."
@jeffmarc We are saying the same thing. The study was about patients that had RP which would not have occurred if it was already metastatic. What I said is if the standard of care is just radiation to the prostate bed and local area with no ADT than a PSMA PET can always be done later if there is still rising PSA. Without the ADT there is no impairment of the PSMA PET scan in finding any distance metastases. I am in favor of hitting it early and hard with radiation. Just agree with the study that if PSA is still low the ADT should not be used until it is shown to be required.
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@jeffmarc
Why is a PSA of 0.2 critical when normal PSA before any treatment is typically around 1.0. It would seem to me that if a PSA of about 1.0 is normal for someone that a 0.2 PSA would not be a concern. I had a PSA near 0.0 for 15 years before it began to rise because of cancer.