Hormone treatments resistance

Hello Dafna, some 26 years ago my father in law was diagnosed with stage 4 prostate cancer and was commenced on hormone injections. I don’t know what specific drug it was but we were told he would probably last a year as the cancer would learn to evade it. As far as I am aware that was the only treatment available for advanced PC. In fact he lasted about another 4 years. However, nowadays the medics have a whole armoury of drugs and there are more coming on stream all the time.

sorry this does not really answer your question but I would hope you can take some messages away from this! 1. Doctors cannot accurately predict how long until somebody’s cancer will escape the control of the hormone therapy - it differs for everyone 2. The initial first line treatment is no longer the end of the road - there is a lot of Hope to be had out there!

I wish you and your husband all the very best on this journey none of us wanted to find ourselves on. It’s taught us a lot about ourselves as both individuals and as a couple! It’s also taught us to appreciate every day and to make the most of our time together! Not bad lessons too learn!

Hi Worriedwife,

Thank you so much for your encouraging words! It does help a lot.

Best wishes to you

Dafna

Hello Dafna

I can only agree with Worriedwife above - no one knows how your body will react to any treatment, let alone Hormone Treatment.

I don't have Advanced Prostate Cancer but I am on Hormone Therapy. I am just coming up to my first year 3 injection and my PSA is still fine at  0.438!!

Take whatever treatment is offered, it's being offered with the best of intentions and as time goes on new treatments are being developed. Who can say what new developments will be around in 3 years time!! He's started with the Hormone Treatment, we just don't know it could work for him for the rest of his life!! (and indeed I hope it does).

Personal view - half the battle with this cancer is your attitude, go into the treatment plan and think positive, you will win and don't forget 98% of men with Prostate Cancer die  WITH it not OF it!!

We are with you on this journey and you are both doing great.

Best wishes - Brian.

Dafna, I have been on HT just over 6 years.  I am just starting to get resistance although not enough to start next stage.  Hope that helps.

David

Hello Dafna.

As others have said it is difficult to predict if and when hormone resistance may occur. I note that you have updated your husbands profile but haven't put the Gleason score up. This is written something like 3+4/7 and also a grade group from 3 to 5. This is an indication of how potentially aggressive the cancer could be with the higher numbers having the greatest potential. My understanding is that those with a higher Gleason score tend to be treated upfront with the second generation antiandrogens such as Abiraterone, Darolutamide, Enzalutamide and Aptalutamide as research has shown that they are more effective than staying on Bicalutamide. Even if you start to develop hormone resistance then you will continue with the 3 or 6 monthly implant provided the body can still tolerate it and you can cope with the side effects. Some oncologists will recommend chemotherapy as additional treatment up front for advanced prostate cancer usually given as 6 cycles given at 3 weekly intervals. My husband has also had Radiotherapy as an upfront treatment to the prostate area including the lymph nodes but radiotherapy can also be used at a later stage to aid pain relief or to treat affected lymph nodes if they are causing an issue. Anecdotally l have heard of people being on Enzalutamide for 5 years but my husband started to develop resistance after a year. We have obviously asked the question 'what next ' and have been told that additional cycles of chemotherapy are possible provided he can tolerate them. After that there are additional treatments available if we choose to opt for them. The oncologist will recommend treatment provided your husband still has a good quality of life and you have the right attitude. It is best to take one step at a time, get through this initial treatment phase and live life to the full without worrying too much about what may happen in 3 years time as by then I am sure that new developments in treatment will have been made. 

Hi Alwashope,

Thank you so much for the detailed reply. It does help me a lot!

I did not updated the Gleason score as we do not have any. As per my understanding the Gleason score is only obtained after biopsy. Is this correct? I am not sure. My husband did not have a biopsy yet, he only diagnosed last Thursday with conclusive MRI. And yes, we were told that probably after the first PSA he will start on Enzalutamide in addition to the 3 months injection.

Am i right re gleason score and biopsy?

Thank you Alwasyhope and bless you

Morning Brian,

Yes you are right, I need to think positive and be positive. He only diagnosed last week and already started treatment so need to be calm. But it is hard. He is so active and strong and he is the rock of us all.

Thank you for all your kind words, it does help!

Lots of love

Dafna

Morning David,

Thank you for the info. I just read your profile and you are amazing! I hope that we will settle into routine with this and more years together. Anyway he is in the pool now swimming his daily 80 laps.

Lots of love and thanks you for your help

Morning Dafna.

You are right that you get a Gleason score after the biopsy. Try to make sure your husband has a transperineal one as there is less risk of an infection.

As Brian says a positive attitude is essential as this releases the bodies natural healing mechanism but do delve into the benefits that diet can have in beating the cancer into submission.

Have a good day and do something nice today.

Thank you Alwayshope. This reassure me that I start to understand the ins and outs. We live in Brighton and the sun is just rising beautiful over the sea. Yes I am taking a big breath and be positive.

Lots of love

Dafna