Is Hormone therapy necessary With radiation

Posted by Jeff Marchi @jeffmarc, 2 days ago

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

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

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@bikeman1
You’re on Casodex (Biclutamide) now, Which usually means they’re going to give you a Lupron shot. Here’s the opinion on that.

Orgovyx is actually considered to be easier on the heart than Lupron. In clinical trials, Orgovyx demonstrated a significantly lower risk of major adverse cardiovascular events (such as heart attack or stroke) compared to Lupron. Your testosterone also comes back quicker when you stop. Lupron has been shown to cause arterial sclerosis buildup in the first year of use.

I would talk to the doctor and find out if you can get Orgovyx instead of a leuprolide.

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@jeffmarc
Jeff - his heart medication interacts badly with Orgovyx. His cardiologist put veto on it. 😟

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@northoftheborder
That’s why I was puzzled that they did about the CT scanned and an MRI. It seemed to be that it was regularly done. I would definitely prefer an MRI if I had a choice between the two and they did equal testing.

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@jeffmarc

CT is better for detecting lung mets since lungs are filled with air. MRI has trouble seeing things in lungs.

Combination of CT and MRI definitely covers all structures in the body.

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@jeffmarc
Jeff - his heart medication interacts badly with Orgovyx. His cardiologist put veto on it. 😟

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@surftohealth88
This is funny timing. While I was reading this thread, I got a message that my MO has prescribed the Estradiol patch for me at CVS::)) Yay! I have been telling all my docs I want that. So now the only questions for 6/16 MO appointment are: 1) do I stay on bical or switch to something else to go along with the patch? I am hoping for Nubeqa, and 2) for how long? I am currently setting up a Telehealth appt with MSK to get their opinions too.

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Profile picture for surftohealth88 @surftohealth88

@jeffmarc
Jeff - his heart medication interacts badly with Orgovyx. His cardiologist put veto on it. 😟

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@surftohealth88
I remembered there was some issue with Orgovyx, So I went back and looked at what he said, And missed the small bit where he mentioned the conflict with his heart medication.

I’ve never heard of a problem with heart medication and Orgovyx. Would definitely like to hear what drug he has a problem with, since one drug I take is supposed to be a problem. It could be an Antiarrhythmics. Considering I have problems with heartbeats and just had to have cardioversion after an afib event, Makes me wonder if I have a conflict.

Just looking at drug Conflicts and I see that Diltiazem is listed as one of the drugs that can cause more Orgovyx To stay in the system. It is interesting that none of my doctors have ever mentioned that, and I take Diltiazem. I’ve had doctors pour over what medication’s I take before surgery so they can tell me which drug to stop and no one’s ever said stop that drug. Another drug I used to take, Coreg, Is also listed as a conflict. I’m the one that told my doctor I want to stop taking that I wanted to start taking metoprolol instead, both beta blockers.

I am actually going to do a little more research. Maybe my heart rhythm problems are due to a conflict.

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@brianjarvis
Brian, you’re correct. Medicine advancements happen daily. A quick example: I went to a symposium at Stanford in the early 90’s where Dr Schatz was discussing his new invention, the heart catheter stent. I sat next to Dr Norman Shumway. Dr Shumway was a world renowned thoracic/heart surgeon. Dr Shumway was in total denial that stents were a good option. I think everyone knows how that went. The “gold standard” was open heart surgery and a very long recovery process. Cath labs were being built all over the US. I wouldn’t call radical prostatectomy a gold standard today. It’s certainly a focused mindset for urologists. I commend you on asking all the questions back in 2012. It would take too long to list all the new tech for prostate cancer over the last 14 years. Unfortunately, doctors need 5, 10, 15 survival rates before making decisions.

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@cbball
Like you said advancements are constantly happening and as the prostatectomy was falling out of favor due to side effects and better radiation , boom it’s back now state of the art single port robotic, Retzius sparing technique, home same day as surgery, good chance of immediate continence for many, less ED. I think today treatment can be so tailored, with results becoming more comparable , it’s deciding between side effects you might need to live with, even the rectal issues from radiation have been minimized.

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@surftohealth88
I remembered there was some issue with Orgovyx, So I went back and looked at what he said, And missed the small bit where he mentioned the conflict with his heart medication.

I’ve never heard of a problem with heart medication and Orgovyx. Would definitely like to hear what drug he has a problem with, since one drug I take is supposed to be a problem. It could be an Antiarrhythmics. Considering I have problems with heartbeats and just had to have cardioversion after an afib event, Makes me wonder if I have a conflict.

Just looking at drug Conflicts and I see that Diltiazem is listed as one of the drugs that can cause more Orgovyx To stay in the system. It is interesting that none of my doctors have ever mentioned that, and I take Diltiazem. I’ve had doctors pour over what medication’s I take before surgery so they can tell me which drug to stop and no one’s ever said stop that drug. Another drug I used to take, Coreg, Is also listed as a conflict. I’m the one that told my doctor I want to stop taking that I wanted to start taking metoprolol instead, both beta blockers.

I am actually going to do a little more research. Maybe my heart rhythm problems are due to a conflict.

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@jeffmarc I don't have heart issues, but I was on Perindopril Erbumine (Coversyl) + Diltiazem to control mild hypertension (aviation medicals are strict about that).

When I started on ADT and Apalutamide, they stopped the Diltiazem and switched me to Perindopril Erbumine / Indapramide (Coversyl Plus).

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Profile picture for Jeff Marchi @jeffmarc

@surftohealth88
I remembered there was some issue with Orgovyx, So I went back and looked at what he said, And missed the small bit where he mentioned the conflict with his heart medication.

I’ve never heard of a problem with heart medication and Orgovyx. Would definitely like to hear what drug he has a problem with, since one drug I take is supposed to be a problem. It could be an Antiarrhythmics. Considering I have problems with heartbeats and just had to have cardioversion after an afib event, Makes me wonder if I have a conflict.

Just looking at drug Conflicts and I see that Diltiazem is listed as one of the drugs that can cause more Orgovyx To stay in the system. It is interesting that none of my doctors have ever mentioned that, and I take Diltiazem. I’ve had doctors pour over what medication’s I take before surgery so they can tell me which drug to stop and no one’s ever said stop that drug. Another drug I used to take, Coreg, Is also listed as a conflict. I’m the one that told my doctor I want to stop taking that I wanted to start taking metoprolol instead, both beta blockers.

I am actually going to do a little more research. Maybe my heart rhythm problems are due to a conflict.

Jump to this post

@jeffmarc
Jeff, I was taking Flecanide and Metropol for my very occasional tachycardia (not AFIB). It was the Flecanide that conflicted with Orgyvx. My cardio said stop Flecanide to allow me to use Orgyvx and just take more Metropol if I have an episode (which happens about 5x/year). This is now somewhat moot, since MO is prescribing the patch instead of Orgyvx. I will ask if the patch conflicts with Flecanide. If not, I may ask to go back on, since it seems to work well for me.

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