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Hormone therapy or not ? A helpful tool to decide?
One of you great fellow warriors mentioned what I think can be a very helpful tool in helping you decide risk factors :
As I’m just starting my process towards healing with a Gleason 7 ( 3+4) and a psa of 4.41 my 73 year young inquisitive mind is hungry for all available info and experiences so I love this board ! Thank you Mayo and everyone on it!
As a possible decision about radiation ( and which type but leaning strong towards Proton) is looming, the suggestion came up I may be advised by a -still to meet- radiologist to combine the treatment with hormone therapy. One of you suggested to look into ARTERA AI test;
I did and I will definately ask my dr. to apply !
In short: your dr. puts in all your info including test results and AI will then go thru thousands of records and give you a prognosis based on that in regards to the % of risks so you then can make your own individual decision of that percentage if is worth it to you or not.
Yes, the risks are greater without hormone therapy, but what if for instance your percentage of recurrence is X % higher without it and you would not have to deal with all it’s side effects? Just saying.. This is NOT a test that decides or suggests a yes or no, it will help you weigh the pro’s and cons ..Please check it out and wishing you love & light on your journey ..
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In your decision-making, remember that the miserable QOL side-effects can be minimized with a robust resistance-training program.
In this 2023 paper, they fully describe a study and the rigorous resistance-training program that they used and the outcome: https://journals.lww.com/acsm-msse/fulltext/2023/04000/resistance_exercise_training_increases_muscle_mass.2.aspx
We often hear about the physical benefits of exercise to minimize the side-effects of hormone therapy (https://m.youtube.com/watch?v=YE61HSAsFb0). But, there are also mental health benefits as well: https://m.youtube.com/watch?v=8n0cIhamFvo
So, don’t rule out ADT if you’re able to engage in robust resistance-training.
(In my case, at 65y with a 4+3=7 and a PSA of 7.476, I did multi-joint exercises that utilize the largest muscle groups: squat, deadlift, bench press, row, overhead press, and lat pulldown exercises for a total of 1-1/2 hours each day. On alternating days, I would also add some cardio - either jog 3-4 miles or swim 35-45 minutes.
On the 7th day I rested…..
Though I still experienced mild warm flashes, loss of muscle mass and strength, and libido (but no ED), I didn’t experience many of the debilitating side-effects many often mention. All things considered, I got through the hormone therapy quite well.
Good luck with your decision!
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4 Reactions@jeepio
My diagnosis was similiar to yours. Gleason 3+4=7. My PSA at time of treatments was 3.75. But had steadily increased over the years.
You asked about hormone treatments and type of radiation treatments. Regarding hormone treatments. You do know that it curtails testosterone which prostate cancer feeds off of it. It can help retard growth while you are going throught treatments.
My original diagnoses was intermediate risk and radiation with hormone. I was offered a Decipher test, PSMA, and bone scan. Back then had little knowledge of what they were.
Decipher test came back as low risk not intermediate and the recommendation for having hormone treatments was removed and just radiation. The PSMA showed negative as well as bone scan.
Would really suggest you look into Decipher test, PSMA, etc. before making decisions including second opinions.
Regarding proton and photo radiation. They have almost identical success rates. The difference is that proton radiation goes into body at lower does, releases if full dose at specific location and does not continue through body. Photon enters body and exit body and the diffference is that proton may reduce radiation damage to other organs and tissues.
Those who have had hormone treatments can advise on side affects of them. But for radiation I had very miniumal side affects with 30 rounds of proton radiation at UFHPTI.
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3 ReactionsI think either Artera or Decipher are both excellent to determine aggressiveness and tendency to spread.
Remember - all G3+4’s are not created equal and some can be more aggressive than even higher grades.
As @brianjarvis stated, don’t let the SE’s of ADT scare you - the stuff could save your life and there are ways to cope with it. My PSA started to rise 5 yrs after surgery. One RO said I needed no ADT based on a recent retrospective study.
I disagreed and my second RO at Sloan said that he would strongly recommend it.
In fact, he laughed that most men fight with him about this and he was glad he didn’t have to twist my arm to agree to it. Ask for Orgovyx if you do opt for it - great drug, less pronounced SE’s (in most, not all). Good luck on your decision.
Phil
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1 ReactionCouple of recent patient webinars on PCF.org on hormone therapy, and one last Tuesday which may be posted or posted soon.
Personally, it would be hard for me to reject a short course 4 - 6 mos of ADT, which I understand weakens the PC and makes it more susceptible to the radiation, which is the "killing mechanism".
I did 4 mos Orgovyx with salvage radiation treatment immediately following RP.
However, there seems to be more instances of radiation treatment without ADT in the 3 + 4 = 7 sphere.
Best wishes on your decision making and treatment.