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I recently started hormone therapy as part of my adjuvant treatment following surgery for my Gleason 7 cancer. The pathology showed the cancer had spread to my seminal vesicles and that there were positive margins. After consultation with the local cancer board, my urologist recommended radiation and 2-3 years of hormone therapy. My first post-surgery PSA reading was undetectable, but wasn't taken until after the cancer board meeting. I met with the radiation oncologist today and after lengthy discussions he stated that he didn't feel the hormone therapy was necessary given that the PSA was undetectable.
Now my wife and I are questioning the need to continue on the hormone therapy given the life changing side effects of the hormone therapy. We are now considering going to Seattle for another opinion, hopefully from a doctor that specializes in hormone therapy.
Does any one have any advice for us? We are, needless to say, uncertain of the best treatment option.
I went to Virginia Mason in Seattle, there is also the Seattle Cancer Care Alliance a combination of the University of Washington and some other hospitals. I took hormones for 2 years and hated the results, weight gain, loss of strength and muscle mass and inability to sleep. Most literature says hormones do not kill the cancer cells, only slows them down. I am not sure it was worth it, but I was in a clinical trial so I had to do the ADT. Still it is very hard to turn down anything that they say might help you.
By chance I received the Australian Prostate Cancer Foundation newsletter this morning, in which they discuss various forms of radiation treatment in association with surgery.
The article concludes by saying
Adjuvant therapy right after surgery has been proven to reduce the risk of prostate cancer returning, but commits all men to having radiotherapy, along with the potential side effects. Another approach, widely practiced in Australia is ‘active surveillance’ where men are watched very closely with regular clinic visits and PSA tests. Radiotherapy is only given if the PSA starts to rise. In this situation, nearly half the patients would be spared inconvenience and possible side effects of radiotherapy. There is now evidence that this ‘salvage radiotherapy’ is also effective, but it is not known whether this or adjuvant radiotherapy is a better approach.
The study they quote to support the ‘evidence’ in this statement is Stephenson AJ, Shariat SF, Zelefsky MJ et al. Salvage radiotherapy for recurrent prostate cancer after radical prostatectomy JAMA 2004 PMID: 15026399 [PubMed - indexed for MEDLINE]
The newsletter announced a study to compare the two situations.
In your position I would definitely wait to see if there is any need for further therapy. If and when your psa starts rising I would go for Radiation.Hormones is not going to rid you of the cancer. The reason I would not start radiation immediately is because of the possible side effects.
Quality of life issues are often ignored by doctors. Their job is to rid you of the cancer. I suggest that do all your research and not be in a hurry to do anything until there is a real reason like a rising psa. Why start treatment that might not be neccesary?
Wendell,
I believe this decision really depends upon the specifics of your pathology and the knowledge and experience of your doctors. And your choice.
I had surgery for Gleason 7 cancer and also had a positive margin, but no seminal vesicle invasion. My PSA both 6 and 10 weeks after surgery was detectable at 0.1. I started radiation 13 weeks after surgery and had no accompanying hormone treatment.
My original urologist retired, and midway in my radiation treatment a new urologist came to replace him and said I should be doing hormones along with the radiation. I didn't agree, nor did the literature I had seen suggest hormones to accompany the radiation. So I continued as before.
One week after finishing radiation, and right up to now, 18 months later, my PSA is undetectable and I feel great. Lucky me.
If I read you correctly you have already had at least one hormone injection but are having second thoughts about continuing. Just keep informing yourself and make the best decision you can. It is unlikely that any of us here can really steer you with any degree of assurance.
I got really careful and disciplined with my diet from the moment of my original diagnosis till now. If that is doable for you it could be helpful.
Hi...I had surgery 4 years ago,Radiation 18 months ago..started hormone treatment Jan 2009 after psa went from 0.03 to 0.13 over 9 months. In April 2009 psa down to 0.01. Will probably stop hormones this July that will be 6 months then watch and wait from then.
In your case I would not continue hormone treatment ,no need at present.
AS you know this treatment is not a cure...keep it as an option when your psa rises.
Hope u feeling ok..Im not good with this treatment,but thats life. Take care
