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Why isn't hormone therapy used in all prostate cancers?
An observation and insightful comment by one group member here: "Lupron/Eligard both shrink the prostate and stops the production of testosterone which feeds the growth of prostate cancer." If so, why don't all treatment options of prostate cancer include hormone therapy? I am waiting on a second opinion for my treatment (Lupron + EBRT) from Mayo hoping I can do without the often dreaded side effects of hormone therapy. I realize one size doesn't fit all, but why is hormone therapy used in some prostate cancers and not in others?
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Thanks so much.
I do not understand 'my doctor told me...' I believe you are part of any decesion and it rather falls on you to do some...or a LOT of research...so you are part of, or drive the decesion. ?no?
Thanks Colleen, that's a very interesting study. Imagine the yokels demeaning it as horse medicine.
Yes I agree but I wanted to believe he knew but then me.
Thanks
That sounds like sexual disinhibition and emotional deregulation. Internet diagnosis is no diagnosis, but one possibility is that as this was starting there was a medical hypothesis that a hormone shot would help--and it didn't. Here is the first article that popped up when I googled causes of sexual disinhibition.... (NOT a diagnosis, just pointing out there are other things to consider besides side effects of a hormone shot.) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8563511/
Hernia repair is one of the simplest and most common surgeries. I had it in 2011. It was still a surgery :-(.
Regarding whether your hormone therapy stimulated the cancer, that's a possibility, but it is also water under the bridge. We can't change the past any more than we can change our heredity. If the hormone therapy did stimulate the cancer, it was likely the earlier longer term use of the hormone, not just the recent round. I think the general medical consensus is that hormones don't cause the cancer, although they do affect the rate of growth in most but not all prostate cancer. Someone can correct me on that if I'm not understanding correctly.
This is an interesting thread and I have not had androgen deprivation therapy [ADT.] (So far, anyway--my time may come.) But here is my understanding: Most, but not all prostate cancer [PC] is stimulated by androgen hormones. (Testosterone is an androgen hormone.) PC that is not suppressed by ADT is called "castration resistant"--the castration being referred to is ADT, sometimes called biochemical castration.
The reason for taking ADT together with radiation is that they believe the suppressed cancer is more responsive to killing by radiation. Because most if not all men really dislike ADT, a major focus of study has been how to minimize the need for ADT in treatment protocols. However, it's hard to study because the results are evident over a number of years, not a number of months. This is true for a lot of aspects of PC diagnosis and treatment. It's also true that men in their 60s (when PC is most often diagnosed and treated) may have issues with sexual function even when PC is not a factor. A PC diagnosis doesn't seem to change this.
While ADT has been tried as a treatment for PC without radiation or surgery, this is not a current standard of care so far as I know. (Someone I know chose this as a treatment.)
My understanding is that if PC progresses, eventually it [maybe? often? always?] becomes "castration resistant." This also is a concern in medically recommended courses of treatment.
Since all PC treatments affect health-related quality of life [HRQOL], treatment protocols often involve tradeoffs. The big PC HRQOL issues are bowels, urine, and sexual function. The general consensus is that surgery* has a quicker, but less progressive impact while radiation has a slower, but more progressive impact on HRQOL. Of course, some of us get to experience surgery, radiation and ADT, and the disease still progresses.
*Also, some immediate HRQOL issues after surgery are from the abdominal surgery itself, and those can improve for up to two years before we actually reach our post-surgical baseline. The surgery I'm talking about is radical prostatectomy [RP], either open or laparoscopic [LRP], and if laparoscopic, typically robot-assisted [RALP].
So, I am grateful for the health I do enjoy, yet aware that even that is not a guarantee for the future.
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1 ReactionExcellent post Spino. I have Gleason 9, stage 3C , seminal invasion PC and I had 6 months of ADT before RP, in a clinical trial at UCLA. My surgeon and medical team, advised me that the ADT before surgery was not presently the standard of care, but it would make the cancer softer and facilitate cutting out all of the cancer and perhaps get a cure of my aggressive, CR , advanced, PC. (a cure is defined as cancer free for 5 years). Getting ADT before RP was possible for me due to the clinical trial. I was also on ADT and Erleada for 6 months post RP. There are many ways to skin a cat with this damn PC but I think that the most important thing is having excellent and caring and very experienced medical practitioners, at an excellent, modern facility, and being a good listener and doing your homework. I think that no matter how much homework you do, and how smart you are, your knowledge is still that of a layman and not equal or superior to your excellent medical team. I have a pet scan and blood test scheduled in the next 2 weeks and hopeful for a good report
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1 ReactionI am agreeing with hbp on spino's recent post. This is one of those decisions in life that you can use all the intelegent assistance you can get. Hang in there and best wishes on your next scan and blood work hbp.
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