Is hormone therapy necessary with radiation?

@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.

@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.

@pesquallie

@jeffmarc

My initial comment had a typo, and I meant to say that my long tern PSA before cancer was about 1.0 for about 15 years.

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 1.0 for 15 years before it began to rise because of cancer.
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.

Very good information. Thank you @jeffmarc

One question I still have is about the magnitude of the survival benefit for patients who receive treatment when their PSA is greater than 0.5. Is the benefit truly significant, or is it relatively small—for example, an improvement from 82% to 85% survival?

A second question that this study does not appear to address is whether patients with high-risk disease (either biologically and/or pathologically) derive a significant benefit from ADT, as Dr. Kishan and others have suggested in the past.

@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.

Jeff,
I know most studies always discuss PFS, Progession Free Survival which is different then OS, Overall survival. When I do see these mentioned together there is often little statistical differences between PFS and OS at five or ten years, yet going for the certain treatments always recommended for Standard of Care seems to rely on those PFS results over OS results. Often times the difference’s in treatment approaches can mean significant side effects for what appears to be little overall gain in benefit of survival by some of these studies just show differences in months. I feel it is so important for the second opinions and not to feel restricted by the National Cancer guidelines which make it so easy for Oncologist’s to say this is your recommended treatment and not really compare alternatives since Standard of Care does not offer other options with maybe less side effects even if the Standard of Care is arguably not that much better. Is it reasonable in a situation which certainly they are all different for individuals and their degree of their PC to say look PFS and OS are really not much different in this situation although the SOC based on the PFS studies will likely result in certain side effects, yet since OS is not much different in going another route with less side effects ho that approach.
Do you see much discussed regarding PFS and OS.

@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.

Jeff,
I know most studies always discuss PFS, Progession Free Survival which is different then OS, Overall survival. When I do see these mentioned together there is often little statistical differences between PFS and OS at five or ten years, yet going for the certain treatments always recommended for Standard of Care seems to rely on those PFS results over OS results. Often times the difference’s in treatment approaches can mean significant side effects for what appears to be little overall gain in benefit of survival by some of these studies just show differences in months. I feel it is so important for the second opinions and not to feel restricted by the National Cancer guidelines which make it so easy for Oncologist’s to say this is your recommended treatment and not really compare alternatives since Standard of Care does not offer other options with maybe less side effects even if the Standard of Care is arguably not that much better. Is it reasonable in a situation which certainly they are all different for individuals and their degree of their PC to say look PFS and OS are really not much different in this situation although the SOC based on the PFS studies will likely result in certain side effects, yet since OS is not much different in going another route with less side effects ho that approach.
Do you see much discussed regarding PFS and OS.

@wheel1 Anecdotal evidence is non-scientific, but I'm at nearly 5 years progression-free survival after a 2021 diagnosis of stage 4b prostate cancer metastasised to my spine.

10–15 years ago, that diagnosis would have meant progression in 18–24 months and death in 3–5 years, so doublet therapy (ADT+ARSI) and MDT/PDRT for the win! They literally gave me a second chance at the life that I thought was about to run out when I was diagnosed at age 56.

Understood that optimal treatment for low-risk, early-stage PCa is a different discussion, but I personally don't mind ADT side effects too much as long as I'm still alive to experience them. 😉