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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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Has anyone had radiation therapy for Gleason 8 and refused ADT or stopped ADT because of side effects and still doing fine?
@jmagrina Hi Javier. The issue being discussed in this thread is adding radiation after a prostate cancer recurrence. Your question relates to radiation plus ADT for initial treatment, so I would repost it as a separate topic, and I think you will get the responses you are looking for. Yes, there are certainly men with Gleason 8 disease who either declined ADT or stopped early and are doing well years later. The problem is that individual stories can't tell us whether ADT would have improved their odds further. For Gleason 8 disease, many of the studies showing the strongest outcomes with radiation included ADT as part of the treatment. I'd suggest starting a separate thread and including your PSA, treatment plan, and how much ADT you've completed so far.
@jmagrina
I know people that have done this, but if you’ve got other aggressive issues, it could make the cancer come back even sooner,
Were any of these things found in the biopsy intraductal, ductal, large cribriform, Seminal vesicle invasion, EPE or ECE. (Extraprostatic extensions extra capsular extensions). They can make the cancer much more aggressive.
@jmagrina
If you do not have any aggressive features such as cribriform glands, IDC, seminal vesicles involvement, EPE and especially if you Decipher score is low, you can have RT without ADT added. Yes, we have members such as @jc76 here that did that with gleaosn 8 and with good results.
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2 ReactionsI just posted on my old thread and I just noticed this one.
Right now my RO wants me to stay off any and all ADT he said he wants to see what my PSA does. He said I've looked over your labs and said with all the clear margins, lymph nodes and seminal vesicles from my RP last year it could possibly be the only recurrence you'll have. My concern is that the final pathology was T3a and from what I've looked up that means it had broke through before it was removed why it didn't attach itself in the pelvic area no one knows or why it went for my humerus bone no one knows for sure. He said if my PSA rises again we'll do another PET scan and see if we can find it. He said if it doesn't show up on the PET scan the most logical place it would be is the pelvic bed and we can radiate there. He said if it levels off and remains stable that he wouldn't recommend ADT. Yes he said ADT can help keep it in check but also can mask it to a degree. He said the quality of life can be severely affected in some men once you start ADT. I see my Urologist this Thursday for what I assume is my first PSA test since finishing my 5th round of SBRT Monday. There's still some pain in that bone but it's not as bad as it was. He said if my Urologist really tries to push the ADT on me to have him call him directly. They've been in communication with each other already about my case.
surftohealth88 wrote: Yes, we have members such as @jc76 here that did that with gleaosn 8 and with good results.
That would be me or at least I hope I can get by without ADT.
Here's my early 2025 Biopsy results.
1. Prostate, lesion 1 right posterior lateral mid, needle core biopsy:
- Prostatic adenocarcinoma, Gleason score 4 + 3 = 7 (Grade group 3), involving 70% of one core.
- Prostatic adenocarcinoma, Gleason score 4 + 3 = 7 (Grade group 3), involving 40% of the second core.
- Gleason score 4 pattern accounts for approximately 90 % of the tumor.
2. Prostate, right base, needle core biopsy:
- Prostatic adenocarcinoma, Gleason score 4+4=8/10, (Grade group 4), involving 1 of 1 core, accounting for approximately 10% of total volume of biopsy tissue.
3. Prostate, right mid, needle core biopsy:
- Benign prostatic tissue.
4. Prostate, right apex, needle core biopsy:
- Benign prostatic tissue.
5. Prostate, left base, needle core biopsy:
- Benign prostatic tissue.
6. Prostate, left mid, needle core biopsy:
- Benign prostatic tissue.
7. Prostate, left apex, needle core biopsy:
- Benign prostatic tissue.
@wheel1 Everybody’s after the same pot of gold - YOU!
How is it that with all the crying and hand wringing about lower reimbursement, insurance woes, higher staff salaries, NYU Langone has purchased 45 acres in Melville, LI for $135M and is going to build a $1B+ hospital campus?? They already blanket LI…
They KNOW they’re gonna get it back 10 fold from the tens of thousands of different, specialized, tailored procedures they’ll do every year. It is a BIG business!!
Phil
@im62at2024
Unfortunately, the only thing you provide is your T3a. In order for us to really Comment about what’s going on we need to have information.
What was your Gleason score? What was your PSA before you were treated? Did you get a decipher test or any equivalent test? That could really tell you what your chance of reoccurrence is and whether or not you need ADT.
I do realize that it has broken out of the capsule, but there’s no evidence that it spread. They didn’t find anything in the lymph nodes.
Were any of these things found in the biopsy or MRI intraductal, ductal, large cribriform, EPE or ECE. (Extraprostatic extensions extra capsular extensions). They can make the cancer much more aggressive. I suspect your doctor doesn’t think any of these occurred.
Your radiation oncologist may be right, And the PSA will show what’s really going on.