A few nuances about prostate cancer and hormone therapy.
- Hormone suppression does not cure prostate cancer. It will allow a person to live longer. Whether you start hormone suppression early on in the disease or later has very little affect on the ultimate life expectancy.
- Different prostate cancers ( volume of disease and Gleason’s score) respond differently to hormone therapy.
- There are varying populations within a particular person’s prostate cancer of hormone sensitive and hormone insensitive prostate cancer cells. ( The more hormone sensitive cells the better response to hormone deprivation.)
- If there is a beneficial response i.e. the PSA goes down, how long that effect lasts varies from person to person as well.
- If there is a beneficial response… in time the cancer figures that out and begins to populate more hormone insensitive cells.
- As a result hormone therapy delays, to varying lengths of time and degrees, but does not cure prostate cancer.
That is all for now… I will lay out later the most probable scenario for the L.B. For any urologist to even try to predict the life expectancy of a patient, the patient would have had to been well beyond the phase of androgen insensitivity i.e. the PSA went down and then over time it went back up and there was evidence of metastatic bone disease. (Androgen refractory) At the very least a doctor should have said that the time to death was unpredictable given the known nuances of prostate cancer and hormone therapy.
Prostate Diaries 
One of the numerous authors, I have read, claims that ADT started initially precludes one from having surgery as it makes the tissue friable and difficult to deal with.
What is your opinion?
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Hormonal treatment is often used as an adjunct to radiation, but uncommonly with surgery. I have done several hundred prostatectomies and only a few had had extended androgen suppression. With surgery it is usually given to ” hold off ” the cancer because of delays in getting to surgery (like scheduling issues or domestic trips etc.) In the patients I have done, I remember no untoward consequence. There are also articles on the subject that I recall that noted no significant difference in operative ease. To the contrary, radiation before surgery is very much problematic.
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