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Hormone Treatment Before Radiation?

Posts: 21
Joined: Feb 2013

Hi Everyone,

I just got a second opinion/MR biopsy which upgraded my G score from 3+4 to 4+3 on 2/4 MR samples and indicated some extension into the stroma of the surrounding tissue (plus a "suspicious" pelvic node).  This seems to take surgery off the table, and my previous TURP "defect" seems to rule out CK or Brachytherapy.  As a result, I am looking at external radiation preceded by homone therapy.  Do you think that HT is warranted in my case?  Also, is there any way to minimize rectal issues from RT?


Thanks for your help.  I am 65 and good health, with a 10 year history of PSA rising to 60 (3 year doubling time) and five negative needle biopsies before finally being diagnosed by a TURP biopsy two months ago.

Posts: 351
Joined: Jan 2011

I had cancer spread to seminal vessels, nerves, and bladder neck.  I went with surgery because, hopefully, you know that part is gone.  Radiation seems to me to bE necessary in certain insTances.  Not sure what to say.  Do you know if the cancer has spread?  Radiation to prostate will cause problems later.  HT is something else again.  It will screw you up.  Side effects just depend on you.  Sorry, but have nothing good to say.  This might be just me.  Everyone is different. 

PI do know if yOu go with radiation you can not do it again.  If you can determine exactly wherethe cancer has spread it would really help.  Should it havE spread to seminal vessels, or nerves I would go with RP.  Nothing to lose.  Then you can go with round two.  Usually radiation, and then, if warranted, HT.  

Worked for me, so far.  

Good luck,


VascodaGama's picture
Posts: 3319
Joined: Nov 2010



You may want to share more details on the diagnosis and status to get better opinions from the survivors here. Your description regarding the second “opinion/MR” is not clear. Was the diagnosis done with basis on the samples dissected from the inner parts of the prostate at the TURP operation or was there an additional/newer biopsy taken at other regions of the prostate?

In your previous thread (http://csn.cancer.org/node/254059) you commented on “clear CT and bone scans”. Have you done any other image study in higher resolution machines?

What is your doctor suggesting you to do?

The Gleason score of 7 with primary pattern 4 and a high PSA of 60 statuses set you at high risk for metastases. Choosing surgery may be OK but radiation may be wiser as a choice in the scenery you present. The "suspicious" pelvic node if found positive to cancer would certainly disqualify surgery as a means of curing treatment. IMRT is otherwise the way to choose when a case is diagnosed not contained but localized.

RT in all forms can be done with a combination of hormonal therapy which is recommended as a means to help the effect of primary therapy. The hormonal adds a 30% success rate to the benefits of a RT outcome. This is when done neoadjuvant to the administration of radiation because it sensitizes the cell’s receptors to better absorb the Grays. Typically the protocol includes an adjuvant portion of HT which varies with the aggressiveness of the case, being two years the maximum recommended but in my lay opinion one year on HT works as well in the context for a better outcome of the radiation treatment.
Surely you can choose to have RT alone and latter start HT if recurrence becomes apparent. This is in fact the typical Sequential treatment used all over the world.

All treatments involve risks and side effects which you should be aware of. RT is not recommended in patients with an history of ulcerative colitis. It will be difficult for you to find a RO to administer RT if you surfer or have shown any symptoms from colitis.

In another way, you should be certain that you have no such problems and going for a colonoscopy is recommended. The hormonal component got is effects too but they are mild to the majority of us.
Hypogonadism can be fought with a series of tactics, fitness and diet changing.

I recommend you to read the book of Dr. Myers; “Beating Prostate Cancer: Hormonal Therapy & Diet”.

Physical fitness programs and proper nutrition are important when dealing with prostate cancer. UCSF got a publication on Nutrition & Prostate Cancer, which copy I highly recommend you to get.



I wish you luck in your journey.

VGama  Wink

Posts: 21
Joined: Feb 2013

Thanks for the replies- you guys are a great help.  As I mentioned in a previous post, I seem to have been an anomaly from the get-go:  Very high PSA with 5 negative saturation needle biopsies, clear CT/bone scans, small centralized PC finally discovered by TURP biopsy.  50/50 decision on whether to do RP or RT, so I got 2nd opinion/MR guided biopsy from UCSF.  MR image report noted concern about possible extension into stroma and suspicious pelvic nodes, but pathology report only found 2/4 positive G4+3 slides with no perineural invasion or extraprostatic tumor.

I was initially disinclined towards surgery due to incontinence side effects, but long term rectal and other side effects from RT scare the hell out of me.  Adding HT as a wild card leaves me even more perplexed.  I can deal with the PC, but the thought of (self-inflicetd) damage from my treatment decision really wigs me out.

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