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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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@garyhu
One of my reoccurrences was after being on Zytiga for 2 1/2 years. My PSA never got above one, but it only was undetectable for one month. That’s when a metastasis started growing on my spine. At that time I started Darolutamide and my PSA dropped to .1 and then rose The next month to .2 As the metastasis got bigger, I had it zapped in 2023 and two months later I was undetectable, now 31 months.
The first time was in 2014 when my PSA hit .2 and I had radiation
The second time in 2017 my PSA hit 6.4 before I started lupron
The third time my PSA hit .3 in 2019 showing I had become castrate resistant
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2 ReactionsWondering if You knew your testrone level - I know everyone's different - seems thier is know guarantee if - T - is not being fed that cancer will not spread. I failed to mention I had 28sesions ebrt
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1 ReactionSpratt published on this recently as well, i.e. "Further Randomized Data Confirming Minimal Benefit from the Addition of Hormone Therapy to Postoperative Radiotherapy"
Mira Keyes has a graph taken from the Spratt paper in slide she used in her recent presentation that makes it clear that it is not accurate to generalize this idea of "minimal benefit" from the addition of ADT to all cases where patients receiving radiation are prescribed the treatment. I've attached a screenshot of the Spratt graph taken from a Keyes video to this post.
Keyes video "Treatment of Prostate Cancer: Androgen Deprivation Therapy (ADT) and Radiation with Dr. Mira Keyes"
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4 Reactions@garyhu
I wasn’t having my testosterone checked the first time I had a Reoccurrence
On the second occasion in 2017, it was below 20, But that was as low as they tested it
The third occurrence in 2019 it was below 20
for the fourth occurrence in 2023.it was below 5.
@jeffmarc Yes, words are important but, they’re not problematic. As Dr. Kwon points out in an earlier video, it’s important to correctly stratify the disease. That will help us - as patients - understand and feel comfortable with what the appropriate treatment might be.
So, whether it’s localized, involves lymph nodes, oligometastatic, or metastatic matters. We just have to know what exactly is going on.
If the PSMA PET scan can’t find it anywhere, Mayo Clinic falls back to their old C11 Choline PET CT scan; everyone else has access to the old Axumin (F18-Fluciclovine) PET CT scan.
But, if scans (including MRI) can’t find it anywhere (life isn’t always perfect), I would then have to wing it - and decide to either wait or to treat (possibly) unnecessarily.
Having only had primary external radiation (+ ADT) myself, all that would factor into my decision.
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2 Reactions@brianjarvis
The vast majority of people with prostate cancer will produce PSMA. As a result, a PSMA pet scan will find it unless it is too small to see, Or there is nothing there yet.
In those cases, neither of the other scans will be any good.
That’s why they usually do salvage radiation, even if it might be somewhere else it is likely to also be in the prostate bed or the lymph nodes near it.
People can wait for metastasis to show up. I suspect that could cause some anxiety
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1 ReactionAppreciate the info. Ty
@jeffmarc Yes having recently been in this exact situation I find these lines to be really ambiguous. I was at .23 when radiation started but PSMA was negative. I got radiation to pelvis and bed. As the stats would show there is in the low 30 percent probability that the recurrence is ONLY in the bed. I am getting four months ADT with what must be a corresponding 60 odd percent chance that the radiation did not get my recurrence. Now we know I have a recurrence somewhere. But because it didn't show on PSMA I am getting 4 months whereas if it showed on my spine etc I would probably get years of ADT and doublet therapy. It seems an odd dichotomy based solely on a scan result when the PSA tells the tale. Also in addition to the confounding variables others have mentioned, I would like to see an analysis when time to recurrence and doubling time are considered in addition to the initial staging. Finally, I have not read the article yet, but Jeff with regard to the studies saying start before .25 regardless of PSMS, didn't they also show benefit to combined radiation and ADT? That is my recollection.
@jeffmarc They estimate that about 15% of prostate cancers are PSMA-negative (or PSMA-naive). In fact, that can even occur within a patient - some of the prostate cancers may be PSMA-positive others may be PSMA-negative/naive. If recurrence is suspected (i.e., PSA rising) but, PSMA is negative, it’s important to look further.
Yes, PSMA PET scans are superior to all the earlier scans (Axumin, C11 Choline, F18-NaF, & F18-FDG). However, when there is no PSMA expression (& PSMA PET scans become blind), those older PET CT scans rise back to the top.
@dhasper
They used to require combining radiation with ADT, but there’s been controversy lately that the ADT isn’t needed, and that’s why I posted that other article that shows that longevity is almost the same whether or not you’ve had ADT.
Now it does fairy if somebody has a very aggressive cancer, they will need ADT, but for most people it probably can be avoided.