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Lorraine is a nurse specialist and sex therapist and here to answer your questions...
Does anyone know of a/some good study/ies that show why this is NHS "Gold Standard", please?
Sounds like u maybe questioning, like me, the need for Rt and ht together.
I have not come across any reports/studies that can show Rt works better with Ht but as u say it does seem to be the gold standard.
My own feeling is that if the cancer has spread outside the prostate then there could be a case for it.
But if it is contained is it not better to leave the HT as a fallback if necessary.
For myself I just had the RT and hope that was the right move
Hi, this link explains the thinking behind combining HT and radiotherapy.
Please click here
Hope it’s helpful,
Thanks Steve...trying to read NICE guidelines
Yes, I get the thinking but I was looking for actual studies that definitively show the benefits. So far the ones I have read are flawed (think they call it low quality) and the Head of Cancer Urology who I met today did not know which study/ies showed why it was the Gold Standard.
Hi Ketoman, I know what you mean but finding definitive evidence is difficult especially as we are in a fast changing area of research. Articles are very wordy and may contain slightly mixed messages but the ones below certainly seem to show the advantages of HT/RT even for localised PC but only where there is a higher risk of progression.
Best wishes, Ian.
That’s great, Ian, thank you very much. I’ve skimmed them tonight but too tired; I’ll study them properly tomorrow. Cheers
Prostate cancer is a very varied animal. Some are very hormone dependent and can be kept down with HT (mine for instance) and some much less so. HT dependent ones can go on without invasive treatments for years (9 years for me). As a doctor I would have advocated that the men had HT for 1 year or so after diagnosis, with PSAs every three months to assess progress and if they didn't respond as hoped then and only then do something irreversible.
As PC are so variable I don't think that a global best practice exists, much as my erstwhile colleagues would disagree. Each case has to be dealt with on its merits.
You can't reverse the effects of RT or surgery but you can reverse (albeit slowly) the effects of HT.
I hope that helps.
Interesting to read your history, I didn't know that HT worked for 9 years.
I did ask if I could have HT only but was told no, it wouldn,t work long term.
My only thought would be, what about all those HT related side effects for 9 yrs. Sometimes HT side effects can be worse than Radiotherapy side effects.
The given wisdom is that even hormone dependent tumours will "break out" in 5 years or so. Well, mine hasn't. I had Zoladex three monthly for 4 years and then a hormone holiday and after 2 years my PSA had crept up to 16. I gave this a lot of thought and wasn't keen to go back on the injections so took the old fashioned approach of castration 3 years ago. My PSA is now 2.7 and has been going down every blood test latterly.
The HT side effects were no different when on the Zoladex, off it, on no therapy, nor after castration. I have no sexual problems but am 70 and neither my wife nor I are much interested, my borderline diabetes is unchanged as are most things. I do have some bone thinning but impact exercise and calcium supplements control that. I do have lack of stamina but so do my friends so I don't know how much to attribute to age and how much to lack of testosterone.
I only think about it at PSA time and then not much.
I really didn't fancy the nerve damage risks of RT or surgery and that was my prime motivator for a "wait and see, with HT" approach, so that's where I'm at now.
Curious to know why you went for castration, u don't hear too much about that option. Or is that the reason why the HT is still working and psa low?
Also if I ever need HT which is my best option with lowest chance of side effects. I have read about so many different tablets/injections I would,t know where to start and I,m not a great one for taking the consultants advice.
Castration is a quick (afternoon in hospital - general anaesthetic) procedure and I had nothing by way of recovery problems. It reduces testosterone to a minimum, although a miniscule amount is generated by the adrenals. And once it's done it is done. No need for any other action in that quarter. I was fed up with the injections which were sometimes painful and once had an embarrassing bleed all over the surgery floor. My fault for not pressing hard enough (I take 75 mg of Aspirin daily for a heart problem). They were a trial and I wanted that over. I must say that they were a very minor trial in the scale of things and nothing compared to RT or surgery.
I can only comment on Zoladex. It certainly did the job for me.
I don't need the HT now I have no testicular testosterone production to block so am drug free at present. You would have to be sure that your tumour was testosterone sensitive and the only way to do that is to block production with some form of HT for a while and watch the PSA drop. Mine was 80+ at diagnosis and was down in single figures in 6 months and the urinary blockage symptoms due to its size had vanished, so that confirmed to me that I was on the right track.
I would go that way again if I was starting out on this path.
thanks for that info Charles, I would,t particularly like to lose my testicles but it could be the lesser of all evils should the need arise.
I don't actually know anyone who has been on HT for a long time but the nurse who gave me my injections told me that she had a man on HT who had been on it for over 20 years. Not everyone has the side effects and some only have light side effects so can live with them. I didn't realise how many side effecrs I had until I cam off the HT. So although yes, I had hot flushes, and fatigue it obviously wasn't that bad at the time because I got through it well enough.
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