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Is Hormone therapy necessary With radiation
A few different people have asked about this in the last few days so here is some information about it.
Advantage of radiation and hormone therapy given at the same time greatly reduced
Overall survival—the chance of being alive years later—was nearly the same whether or not men received hormones with their radiation. After 10 years of follow‑up, 83.6% of men treated with radiation alone were alive, compared with 84.3% of men who also had hormone therapy, a difference of only 0.7%. Statistically, that small gap did not reach the usual bar for significance, meaning it may simply be due to chance.
However, the story changed when researchers looked at PSA level before radiation. Men whose PSA was 0.5 ng/mL or lower when they started radiation did not live longer if they added hormone therapy—whether they took it for a few months or for two full years. Men whose PSA was higher than 0.5 ng/mL, on the other hand, did see some survival benefit from adding hormones, suggesting that hormone therapy makes the most sense for this higher‑risk group.
The study also examined how long hormone therapy should last. Short‑term therapy (about 4–6 months) performed just as well as long‑term therapy (about 24 months) for most men in terms of overall survival. Longer treatment appeared to reduce the chance of the cancer spreading, but it did not clearly translate into men living longer overall in the general study population. Based on these data. Kishan summarized: for men who truly need it, a short course of hormone therapy is usually enough.
https://prostateblogmonthly.substack.com/p/do-all-men-need-hormone-therapy-after
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00137-6/fulltext
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From MSKCC website :
What are the advantages of MRIs, and when do doctors choose them?
MRI offers even greater detail when a more focused view is needed, especially for certain organs and soft tissues. It can detect certain cancers — such as those of the prostate, breast, or liver — that may be harder to see on CT. MRI is also the preferred method for evaluating cancer that may have spread to the brain or bone because it can detect subtle changes. One major benefit of MRI is that it does not expose patients to ionizing radiation, making it a safer option for people who need repeated scans or who are particularly sensitive to radiation, such as children or pregnant women.
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PS: The reason that it is not offered readily in the USA is COST
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3 ReactionsAll,
I asked a somewhat similar question in a different thread that discussed the Kwon approach of waiting for treatment until a met shows up in a PMSA PET scan. Much of the discussion there is recounted in this thread, with some helpful additions here. I will repeat one point I made that is relevant to those with aggressive pathology and very high Decipher scores:
On the question of "who benefits from ADT and is it worth the side effects"? I just had an appointment with my RO at Johns Hopkins where he considered whether to add ADT to SRT. (Short story: I had RALP in 9/25; PSA still low but rising; aggressive cancer (IDC, Cribriform, EPE, Decipher .89, but clean margins and clean pre-surgery PET). The determining factor for him to add ADT was the detailed report that accompanied the Decipher one page summary. It showed I had Luminal B, an aggressive subgroup. The trial (which has not yet been peer reviewed) NRG GU006 (BALANCE) showed a clear benefit of adding apalutamide to SRT. If you have a high Decipher score, ask your doctor to get the detailed report that accompanies the one page summary. You can also google "NRG GU006 (BALANCE) and Luminal B" to see a discussion of the study.
Subsequent MRI and PET scans confirmed 2 pelvic nodes, so now the question for me is, in addition to SRT, which drug(s) will I get and for how long? This will be answered on 6/16 during an appointment with my MO.
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5 Reactions@bikeman1
The quick return of a rising PSA after a prostatectomy and all of the aggressive features found in your prostate cancer make ADT really essential,
You can say no, But it will almost definitely result in reoccurrence sooner, rather than later.
Unfortunately, you are not among the group that can safely have salvage radiation without ADT.
Are you prepared for that? Are you really questioning it at this point?
I’ve been on ADT for eight years, it is one of the reasons I’m still alive.
@bikeman1 Thanks for your post Bikeman. Very interesting. Best wishes.
@cbball Though the “gold standard” for prostate cancer has always been a prostatectomy - because for 150 years that was the medical go to - data show that with modern radiotherapy, success rates comparing surgery and external radiation are statistically equivalent - the choice of therapy involves weighing trade-offs between benefits and harms associated with treatments. (Basically the choice comes down to what side-effects one is willing to deal with.)
When I was initially diagnosed with PCa in 2012, my first comments to my urologist were, “I don’t know anything about prostate cancer so, I’ve got a zillion questions to ask before you cut anything out of me, or bombard me with radiation, or inject toxic chemicals into me……” That set the foundation for our future discussions and decisions.
@jeffmarc
Jeff, no, I am not questioning the need for hormone therapy. Actually, I was annoyed it took so long to start it due to certain complications (e.g., Orgyvx was contra-indicated with my heart drug). At my last RO appointment I pushed to get on ANY drug NOW; I am taking bicalutamide for about a week. On 6/16 I will discuss with my MO which drug(s) I should take and for how long, as the bicalutamide was just the easiest/quickest one I could start.
@jeffmarc Often the MRI+contrast is more focused on a specific area of concern (for most PCa patients, the prostate bed, but for me, the middle spine) while the CT+contrast is the more broad "anything going on elsewhere?" scan. And then the bone scan is because my cancer was de-novo bone metastatic in 2021, so if it shows up again, it's likely to be in my bones first.
@brianjarvis
Brian, you’re correct. Medicine advancements happen daily. A quick example: I went to a symposium at Stanford in the early 90’s where Dr Schatz was discussing his new invention, the heart catheter stent. I sat next to Dr Norman Shumway. Dr Shumway was a world renowned thoracic/heart surgeon. Dr Shumway was in total denial that stents were a good option. I think everyone knows how that went. The “gold standard” was open heart surgery and a very long recovery process. Cath labs were being built all over the US. I wouldn’t call radical prostatectomy a gold standard today. It’s certainly a focused mindset for urologists. I commend you on asking all the questions back in 2012. It would take too long to list all the new tech for prostate cancer over the last 14 years. Unfortunately, doctors need 5, 10, 15 survival rates before making decisions.