HT for High Risk Disease How Long ?

Hi Sandberg 

Such a big conundrum this one, how long.

Some of the time I feel they go for the full 3 years to be on the safe side, fair enough I suppose but it doesn't make it any easier.

On the face of it your stats not too bad, Gleeson 8 , not 9 or 10., PSA not particularly high before treatment started, T2 not T3, 

So, I possibly would query it at some point, also hopefully someone will post who was in a similar situation.

Good luck

Steve 

Ps. U don't mention tumour size in mm cos that should be a consideration as well

Hello Sandberg 

This is personal opinion - T2c - it's cancer in both lobes, Gleason 8 - it's pretty aggressive.

I would go the whole hog - the full 3 years. i don't want it coming back, the more I can do to ensure it's gone the better. I am a T3a Gleason 9, just completed 3 years on HT. Would I do it again - yes I would for a "curative pathway".

Of course you can call it a day after 24 months - stick with the 3 monthly PSA tests and see if there is any rise.

I am a firm believer in "belt and braces" but let's face it, like you not medically trained but going off personal experience and what I read.

Best wishes, whatever you decide.

Brian.

Hi !

With your diagnos I think it”s fair to perhaps talk max 2 years of hormone therapy. If I understand your profile correct you seem to have done 20 fractions of Hypofractionated IMRT (perhaps something like 20 fractions x 3 GY)

So I think it’s a really fair question to discuss with your medical team or perhaps even have a second opinion about.

Best wishes - Ulf

Hi Sandberg  well, I’m having a similar conversation with my consultant next month.  I will be having my next HT jab on 18 December and I’m hoping that it will be my final jab. That is 15 months after my first jab and it will take me to the 18 months after point of being actually “on” hormone therapy as it lasts for 3 months.

However, my case is different to your case. I had brachytherapy boost, with external beam to the whole pelvis (up to L5), so a much wider radiotherapy blast. I have been reading medical papers that have research showing that 18 months is the optimal duration for BBoost patients (as the radiotherapy covers all the pelvic nodes, where cancer cells would most likely spread to first).  The papers also suggest a little longer for pure EBRT patients- but the percentage benefits aren’t that much, so age and patient quality of life are also concerns.

If I had only had EBRT to the prostate area, I would be thinking in terms of 2 to 2 and a half years HT.  Don’t forget to add on the 3 months effective time for the final jab, as I did above.  Also, don’t forget that it takes at least 6 more moths to wash out of the system.  In my case, if my consultant agrees, I will have had 18 months full dose HT, and a further 6-9 months hormone suppression during the exit phase.    AW

Hi Sandberg. I have had a look at the Pivotal Boost trial which appears to have 4 arms with radiotherapy to the prostate only arms being either with or without boost. Do you know which of these arms you are on? They also give guidance on ADT duration based on your risk with anything from 6 to 36 months. This is their information.

............

1.1.11. Androgen Deprivation Therapy
In a meta-analysis, neo-adjuvant, concurrent and adjuvant androgen deprivation therapy (ADT) combined
with radiotherapy and demonstrated a better survival (HR 1.3; 95% CI: 1.2-1.41; p < 0.00001), disease free
survival (HR 2.51; 95% CI: 1.32-4.76; p = 0.005) and metastases–free survival (HR 2.53; 95% CI: 1.75-3.67; p <
0.00001) in the combined group [59]. The total duration of adjuvant ADT in the CHHiP trial was 6 months; in
the high risk group, the 5-year biochemical disease free survival was 84.5% and compares favourably with
other randomised trials with longer-term ADT in this risk group (unpublished data). In EORTC 22961, a 36-
month ADT regimen was compared with a 6-month ADT regimen. ADT used for 36 months achieved better
5-year overall survival rates than a 6-month ADT (85% vs. 81%, respectively, HR 1.42, 95% CI: 1.09-1.85).
Longer duration had a detrimental effect on quality of life and sexual function [60]. In a recent review of the
evidence, 28-36 months of ADT is recommended for patients in the localised high risk group [61]. In
PIVOTALboost, patients in the intermediate risk group will receive 6-12 months of ADT, and patients in the
high risk group may receive 2-3 years of ADT; in selected high risk patients, shorter duration hormone therapy
(6 months) is acceptable. Patients undergo planning after 2-4 months (maximum 11) of neo-adjuvant ADT
and commence radiotherapy at a maximum of 12 months. Use of Androgen Receptor Target Agents (e.g.
Enzalutamide [62], Abiraterone [63], Darolutamide or Apalutamide [64] will also be permitted, provided this
is in accordance with national/devolved nation guidelines.
During the COVID19 pandemic (starting in the UK ~March 2020) treatment recommendations based on
expert opinion were to extend the length of time prostate cancer patients are on ADT prior to radiotherapy
beyond 6 months in order to mitigate against a delayed start to radiotherapy. For patients recruited to the
trial and affected by the COVID-19 pandemic, they should start radiotherapy within 12 months of starting
ADT [70-71]. Other reasonable causes resulting in delay to the start of radiotherapy to up to 12 months from
starting ADT, should be discussed in the first instance with the PIVOTALboost Trial Manager at the ICR-CTSU.
1.2. K

.........

The high risk group are recommended to have 28 - 36 months of ADT but with some leeway. In your favour your cancer responded very quickly to ADT which is a good prognostic indicator for failure free recurrence, plus your initial PSA was below 10 and your current PSA is undetectable. I think it is worth a conversation with the oncologist to see if you could reduce the length of time on ADT to 2/2.5 years if your quality of life is affected.

Hi Sandberg 

I was T3A N0 M0 with a Gleason score of 4+5=9 when diagnosed over six years ago. I was told by my original Oncology consultant that I would have three years of HT but we moved house during treatment and I was moved to a new NHS trust and a new consultant (whom I have still never met as the very few subsequent appointments have all been by telephone). The new Oncology department told me that I should stop HT after two years as that was "their policy". However I contacted my previous CNS who I had got to know quite well and asked their opinion. He recommended staying on HT for the full three years as my original diagnosis was very aggressive.

As I was tolerating the HT well, I decided to go for the full three years. My PSA was <0.1 from three months after finishing 20 sessions of RT in early 2019 and stayed at that level throughout the HT. It has been stable at 0.2 for nearly three years now.

Sorry, that's a rather long winded way of saying that I would stay on the HT for the full three years if you are tolerating it well 

Many thanks to everyone who has taken the time to share their experience and treatment.

I've been feeling the effects of HT a bit more over the last six months and generally a bit down with my cancer journey,

I had a fall in March which broke a hip and landed with me in A&E with a new hip the next day. I'm pretty well recovered now but struggle a bit to keep as active as I should. The fall showed I have Osteopenia which the HT is probably not helping !

I have been prescribed alendronic acid but am waiting for some dental treatment before I start taking it.

I'll have to get more motivated in the new year and hope this provides an uplift to my mood.

Merry Xmas and a positive new year to all at MacMillan and on the cancer forums.

Sandberg

I had a review with my Oncologist yesterday and my latest PSA is 0.02. He is recommending that I stop HT after 24 months observing that the risk from side effects now outweighs the potential benefits of a further year years treatment.

I appear to have responded well to treatment and he appeared reluctant to continue HT for the full 36 months taking into account the risk to my bones.

This seems sensible so I have only one more injection to look forward to !

There is an interesting thread on the Prostate Cancer UK forums on the optimum duration for HT which I won't link as I'll get my post deleted ! This suggests an optimum duration for HT as 18-24 months and is interesting reading.

Thanks again to everyone who contributed to this thread. Sandberg

Hello Sandberg 

That's good news and I wish you all the best going forward. I do hope the Hormone Therapy side effects go quickly as I am aware that in your earlier posts you weren't too happy with them to say the least.

Sandberg said:

There is an interesting thread on the Prostate Cancer UK forums on the optimum duration for HT which I won't link as I'll get my post deleted

Feel free to post this link if you wish - it's from a "Trusted Source". (it's only links where we can't verify the information that are removed!).

Best wishes - Brian.

Please do post the link. My husband was advised to stop the ht after 18 months because he was struggling so much with the side effects. I have been worrying ever since that it was too soon!