Timescale of Hormone treatment

Hi !

from what I can read your husband probably had a diagnos of T3B and basically had recurrence after prostatectomy so at least T3BN1. I don’t see that you’ve Done a PSMA Pet Scan to hopefully see any spots / lessions

Is he only Bicalutamide? have they not added a real ADT. bicalutamide doesn’t block the production of testosterone but inhibits the possibilty for prostate cancer cell to have Testosterone

With a T3B and probably a N1 you are high risk locally advanced even when you’ve had prostatectomy and normally with salvage radiation you’re talking 2-3 years of ADT even better adding a 2nd like Abiraterone, Apalutamide or etc. Just going on Bicalutamide, it effecient but not as efficient as real ADT but could be in combination of course. But with your diagnos long term with ADT for up to 3 years.

Best wishes - Ulf

Good morning Christine. I have read back through your posts to get an idea of timelines and issues that you and Peter have experienced. In the end it appears you have had the appropriate salvage radiotherapy to the whole pelvic area which is good. It is now recognised that the addition of hormone therapy improves the statistics in terms of time to biochemical recurrence with the question being how long this should be. When there is still an intent for cure then the term is determined by the number of aggressive factors each patient has but usually up to a maximum of 3 years. If the PSA reaches undetectable levels then men will be taken off the HT and the PSA is monitored to provide a new baseline from which any future recurrence can be measured. As Ulf has said, the Bicalutamide stops cancer cells from getting at the testosterone thus depriving them of food. Recent evidence indicates that the addition of ADT therapies can further improve the outcome for medium and high risk patients undergoing salvage radiotherapy. The radiotherapy will continue to work for 18+ months post treatment and your husband's numbers will be monitored in accordance with the guidelines for radiotherapy so they will be looking for what the PSA value settles at and then any increase. A recurrence would be evaluated as a PSA above 2 (+nadir) or 3 consecutive rises plus the doubling time.

I think you have 2 choices at the moment. The first is to go back to the professionals and ask if there is any benefit on being switched over to some form of ADT whereby the testosterone is stopped from being produced. The second option is to leave things as they are, monitor the PSA and then act quickly if a recurrence happens knowing that you still have the whole armoury of different hormone therapies available to you plus additional focal therapies depending on where the recurrence is located. The Bicalutamide can work for a long time but it is better to try and come off it if possible as the cancer cells, if present , can find another way to get to their food and become more difficult to treat. Plus all these different therapies can affect the quality of life. The positive side of your situation is that Peter is still being treated as if he is on a curative pathway. Also intermittent hormone therapy can be of benefit so plenty of options for you.

Hi and thank you for such a quick reply 

I am unsure what ADT is so will investigate that thank you 

Also there was no node involvement in his diagnosis.. but as they never did anymore scans post Prostectomy only prior when it showed no involvement. We actually don’t know if any nodes were infected or not .
I know everyone is different but I appreciate what you have said thank you 

Thank you so much again for always coming back with a reply so quickly 

I take on board what you say ofcourse 

We obviously remain in the hands of our oncologist 

But I now understand why they stop the Bicalutimide after a period of time 

So it remains a wait and see situation.. we are just happy at the moment it’s steady! and as you say there are other options if we need them 

Our oncologist has always been clear that it would be unlikely we can expect a cure .. but he went ahead with salvage despite that 

thank you so much again best wishes Christine 

Hi again. ADT (androgen deprivation therapy) is any hormone drug which stops the testosterone being produced in the first place. This is usually initially via an injection/implant which is administered 1, 3 or 6 monthly. Names to look out for are Leuprorelin (Prostap), Goserelin. There are also tablet versions but they are usually reserved for later on in the treatment.

Again thank you 

all is passed onto my husband and he is very grateful for all your help and information 

best wishes 

Hi !

What your husband is on now is Bicalutamide which doesn’t stop your husbands testicles from producing Testosterone at all (the ’food’ prostate cancer use to live, grow and develop).

Then there is ADT, androgen deprivation therapy, which basically stops the testicles from producing Testosterone.

Bicalutamide inhibits the prostate cancer cells from taking up and use Testosterone and does it well.

It’s however not that efficient as doing ’chemical castration’ e.g. Being on ADT or hormone therapy which starves prostate cancer by lowering the amount of Testosterone to basically nill

If you for example then combine ADT with Bicalutamide you have a even more efficient treatment by both suppressing production of Testosterone (ADT) and inhibit the possibility for prostate cancer cells to take up or use the extremely little Testosterone left in the body