question: if the prostate cancer comes back after prostatectomy, do you have to use hormones “and” radiation?

criticism should be a casual conversation

My radiation therapist colleagues often recommend hormone therapy ( although this treatment is often referred to as “hormone therapy” actually they all take away the male hormone testosterone, so it should be “anti-hormone therapy) because they feel it potentiates the effectiveness of the radiation. It is clear that it helps in the unfavorable cancers, the article below indicates it possibly would help the intermediate type prostate cancers, and it has not shown to be necessary for the favorable prostate cancers.

Here’s a dirty  little secret: If you did not do radiation at all  and did just the hormone therapy, the PSA would most probably go down to zero and stay that way  for years. This fact has  confused studies over the years because researchers could never get a “clean” study without the influence of hormones having been given. So although all the radiation guys want the patients referred to them with recurrence after prostatectomy and unfavorable parameters, there is still room in the discussion for the patient to argue that quality of life issues ( the side effects of the medicine) incline him to do the XRT alone. Or for that matter, trying something like Avodart, a weak antiandrogen, just to see how long it will be effective and with a little luck one might safely postpone radiation or the hormone shots for a year or two. 

I have a friend who is an  internist who has a patient who  is a friend of his who has been on Avodart for over three years in this type scenario. He did it without my recommendation however if the PSA stays at bay and the patient had no side effects and is comfortable with the pros and cons…this too is a reasonable option.

Hot flashes, (women will never give any sympathy to the man who is having hot flashes because of the hormone shots-they are uniformly funny that way) but they can be debilitating to some. Casodex can cause breast enlargement. I have a patient who has had his prostate out, radiation and now is on Casodex. His only complaint, ” I look like a girl and I have to wear extra-large shirts now.”

The gynecomastia associated with hormone pills or shots can be prevented with radiation to the  breast but must be done in advance of the treatment. Did you know that? 

What would I do if my cancer “came back?” I had relatively good parameters so… I’d play around with Avodart a while and follow a PSA very closely. I’d see how long I could hold off on radiation. I have good control of my bladder, my sexual function is good, I’d be a bit afraid that the XRT would mess that up. I would understand that hormones, any kind, given at any time in the treatment scheme, in and of themselves only window dress the PSA. In other words, it will make the PSA will go down and cancer cells abate but hormones don’t eradicate prostate cancer…they act like “taking the oxygen away from a fire” reducing it to faintly glowing embers…but embers nonetheless. Everything you do should be throughly vetted by your doctors. Although I have some thoughts about using hormones in this situation, I always defer to what the radiation therapist recommends. My feeling is that he or she is “up” on the latest studies and “knows what’s best.”

Anti-hormone therapy making radiation work better Think of it this way…Goodies headache powders. There are ingredints in that concoction powder that are not pain meds but the make pain meds work better…i.e. potentiates. There is a word for things that make radiation work better but I can’t think of it… it ends like     something optosis.  Can someone help?

Side effects of a LHRH Agonist (This one is Lupron, however all the LHRH’s would have a similar profile.)

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