Is Hormone therapy necessary With radiation

But they have been pushing 24 month ADT for a long time now in cancer guidelines and it seems for little to show in overall survival rates but a lot to show in side effects affecting the quality of life of all those put on it. I think this is why we are seeing so many oncologists now pushing shorter durations of ADT even if counter to guideline recommendations

@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

@jeffmarc
Can doctors use MRI scans or 'bone scans' to detect non-PSMA producing prostate cancer? If they suspect that is the case?

Ask the Dr if we do procedure A (e.g. radioactive seeds) what is my likelihood of cancer gone in x years (e .g.x=5) without Hormone therapy? With Hormone therapy?

@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.

@cbball Yes, doing one’s own homework is crucial to getting a desired outcome (the definition of which can vary person to person).

Similarly, being a retired computer scientist, I was into the technical and analytical details of the treatments. I don’t think I was a “pain in the ass,” but I had questions regarding diagnostics and treatments for which my doctors would comment “No one has asked us those questions before.”

I was initially diagnosed (in 2012) with low-grade, localized disease (PSA 4.2, Gleason 6, with no other adverse risk factors), and the urologist wanted to do a prostatectomy. I chose to go on active surveillance which lasted for 9 years. (But over those years he was good enough to provide me referrals to specialists in any treatment modality I requested, so that I could interview them while doing my own research.)

So, it goes behind just doing one’s homework; it also involves (what I call) becoming a “student of prostate cancer,” learning the language, self-advocating, and sharing in the decision-making.

As for that extra 2%, I would take that small change - with the full understanding that by incorporating a robust resistance-training exercise program, that I could minimize/avoid most of the common ADT side-effects. (And being a gym-rat myself, that’s what I did.) Quality of life was equal priority for me as was successful treatment.

I’ll take that 2% using the ADT (which I did), plus the few % with a rectal spacer, plus the few % with a full bladder, plus the few % with an empty bowel, plus a few % monitoring my diet, plus, plus, plus……..during and after treatment those small plusses add up to something meaningful.

There’s a study that Dr. Scholz cites about ADT providing little benefit for Gleason 7. (It might be the same one you’re referring to, I don’t know.) When I listen to that Scholz video, he refers to Gleason 7 as well as “intermediate disease,” but never mentions whether that’s 3+4 or 4+3 (or favorable/unfavorable). Similarly, when I located the literature on that study he was citing, it also refers to Gleason 7 as well as “intermediate disease,” but never mentions whether that’s 3+4 or 4+3 (or favorable/unfavorable). So, depending on how weighted that study was towards 3+4 rather than towards 4+3 might explain the small % survival increase of using ADT.

(Ultimately, I had 28 fractions of proton radiation + 6 months (two 3-month injections) of Eligard. The radiation treatments were relatively uneventful; the Eligard was a 9-month annoyance.)

@jeffmarc It was the SPPORT trial I was thinking of. The key SPPORT result was freedom from progression (FFP) at 5 years.

The three arms were approximately:

Treatment Arm 5-Year Freedom From Progression
Prostate bed RT alone ~71%
Prostate bed RT + 4-6 months ADT ~81%
Prostate bed RT + pelvic node RT + 4-6 months ADT ~87%

So the absolute differences were roughly:

RT + ADT vs RT alone: +10 percentage points
RT + pelvic RT + ADT vs RT alone: +16 percentage points
RT + pelvic RT + ADT vs RT + ADT: +6 percentage points

@klein505
They can use bone scans, though they tend to be not real great at finding cancer Compared to a PSMA PET scan. Of course that doesn’t help if you don’t produce PSMA.

Many doctors use repeated CT scans comparing one to the next to see if there’s any changes that look like they could be cancer. Because that kind of scan can be done every three months with insurance some doctors use it a lot. The MRI scan is a lot harder to justify, but if used the same way, it could be just as effective, Or maybe even more effective..

@jeffmarc Since my PSA is fully suppressed (meaning nothing would likely show up on PSMA-PET), that's exactly what they use for my ongoing monitoring here in Ontario: bone scan + CT/contrast + MRI/contrast.

Any one of the three might not be as sensitive as PSMA-PET, but they work even when PSA is suppressed with hormone treatment, and they give 3 separate "votes". There's never been any issue justifying using all three to OHIP (as long as my oncologist says that they're medically necessary).

My next bone scan is on Monday.