HORMON THERAPY DURATION

Let’s wait and see
RadHope

You did well in starting a new topic on your case. I hope guys here will feed their opinion on the subject.

My opinion is that of a layman making part of the crew in your and my boat. Your doctor is the “commandant” of your case. You should research and get a second opinion from a specialist, if you want to be more secure in any decision.

From the many readings and discussions on the benefits of HT administered as adjuvant after RT, I know that back in 2009 there was a consensus in the administration of HT, based on patient diagnosis. Risk assessment was used to define the protocol.

Low risk patients were recommended for RT of the prostate alone without HT. Intermediate risk patients would be recommended RT of the prostate plus pelvic area with 6 months of HT administered as neoadjuvant (2M), during RT (2M) plus adjuvant (2M). High risk patients were recommended RT of the prostate plus pelvic area with 2 or more years of HT administered as above.
The risk assessment is defined as usually based on the Clinical Stage, Gleason Score and PSA as follows:
Low-Risk = stage T1-T2b; Gs 6 or less; PSA 10 ng/ml or less
Intermediate-Risk = stage T2b and/or Gs 7 and/or PSA 10-20 ng/ml
High-Risk = stage T2c or higher or Gs 8-10 or PSA greater than 20 ng/ml

Your case falls in the parameters of High risk patients, and that may be the judgement done by your doctor in deciding your 3 years HT duration.
The only relevant difference on his recommendation is that your HT protocol is with a single blockade (chemical castration) with the antagonist Firmagon (GnRH). Other doctors tend to recommend double blockade for high risk patients, adding an anti-agonist such as Casodex (bicalutamide) to the cocktail.

It surprises me to read about his comment that your PSA at the fifth month post RT is not low enough at 0.7 when it came from a high PSA of 4.12 before starting RT and from a higher level of 53.99ng/ml at diagnosis before starting the neoadjuvant 2 month HT. I wonder what it is his threshold mark for similar cases.

Many reasons can be behind the mono blockade principle. For example; your doctor wants to check if Firmagon is enough firstly or prefers to reserve the anti-agonist for a later period, or ……(?). Nevertheless, if he thinks that your PSA is not low enough yet, he could start you now on a daily Casodex pill.

Nowadays, some doctors decide in cutting short the duration on the drugs, after verifying the response of the patient to the treatment (through the PSA).

I would wait for a fall in the PSA to levels on the Zeros; keep that level during one year and then stop taking the drugs.
At that time you could experience an increase in the PSA followed by a decrease, but it shouldn’t be considered as recurrence. That would be a signal that your body has started producing testosterone again.
I believe that you will get there on your 2-years milestone. Let’s wait and see.

Sincerely
VGama