hormone shots prior to radiation

[spk958]

what kind of side effects can i expect with the shot or is it better to skip the shots?
the doctor wants me to have the shots wait awhile then implant gold seeds prior to seven weeks of radiation.
i have a gleason score of of four sixes and one seven.
psa 4.1

[spk958]

Originally Posted by spk958

what kind of side effects can i expect with the shot or is it better to skip the shots?
the doctor wants me to have the shots wait awhile then implant gold seeds prior to seven weeks of radiation.
i have a gleason score of of four sixes and one seven.
psa 4.1

[IADT3since2000]

Hello spk958,

I'm a fan of hormonal therapy, so I'll give you my view and hope you get others.

Shots for hormonal blockade prior to seeds and external beam radiation are used routinely where the prostate is large. The blockade will shrink the prostate by up to about 30%, often bringing it within the bounds of conventional seeding technique, small enough that the pubic arch does not preclude placement of seeds in some areas. (At least one expert doctor, Dr. Dattoli in Florida, has developed a technique that enables him to insert seeds even when the pubic arch would interfere with a conventional approach.)

Hormonal blockade also serves other purposes. For one thing, it knocks the cancer back on its heels, kind of sterilizing the area through which the seeds will be inserted, it's thought by some, thereby decreasing the likelihood that cancer might escape along the path of insertion. My impression is that that risk is quite small, but apparently it does exist.

Blockade can also in effect stun or even kill some of the prostate cancer cells, especially if it is maintained for a number of months, with maximum cell kill achieved around the nine to twelve months point, according to current opinion. However, it appears that it rarely can knock out the cancer completely, and therefore it is rarely curative.

A lot of research has been done on radiation plus hormonal blockade, and the evidence is strong that many patients will do much better with the combination instead of just with radiation. On the other hand, patients with very low risk cases will probably gain a minimal benefit that makes the value of blockade of questionable worth. I'm a layman with no enrolled medical education, and I have not had radiation, so I haven't kept up with this combination approach as much as I have with blockade itself. I hope you get other responses from those of us who have had to make this choice.

There is a set of side effects with blockade, with most patients experiencing at least some of them. One of the best sources for information is the section on blockade ("androgen deprivation therapy") in the book "A Primer on Prostate Cancer - The Empowered Patient's Guide," by Dr. Stephen B. Strum and Donna Pogliano. There are also important countermeasures that will help make the time on blockade as tolerable as possible. Often doctors are not very good at passing that knowledge on, unfortunately. A key point is that the side effects are reversible when blockade is stopped, though they gradually tail off - not a sudden recovery. Another key point is that the length of time on blockade makes a difference for most of us, with a short time usually being associated with an easier time with side effects.

Take care,

Jim

[IADT3since2000]

PS - My last post did not give details regarding side effects, and I realize that that is what you probably wanted.

While the Primer has much better detail, here are some of the main ones, with statistics from the medical co-author's practice as stated in the Primer:

- hot flashes (about 48% get them to some degree, with 25% getting them to a really annoying degree). They can be counteracted with medication very effectively for most men, but more of us will have milder flashes that don't require medication A book by Dr. Mark Moyad considers the incidence to be 50 to 66%, not far from the 48% used in the Primer. (The Primer's author is an expert; Dr. Moyad is generally knowledgeable about prostate cancer but is not expert in blockade; I assume he is basing his numbers on a research study.) A book with particularly strong coverage on countering flashes is "100 Questions and Answers About Prostate Cancer," Ellsworth, Heaney, and Gill; the 2003 edition describes them around pages 133-135. It goes into the specifics of several different medications and the possible role of soy.

- decrease or loss of libido (quite common, with about 90% having at least some decrease). Sets in gradually over several months. Partial to substantial ED also for most of us. Both are reversible when blockade is stopped, but radiation may affect ED.

- bone and joint pain (30% of us, with 4% having it to a really bothersome degree)

- decrease of bone density (quite common, though probably quite mild with short term blockade. Can be very effectively counteracted with a bisphosphonate drug (like Fosamax, Boniva, Actonel, etc.) plus calcium and vitamin D3 supplementation (wise to have a Bone Mineral Density scan - Primer discusses DEXA scan vs. qCT scan).

- Anemia (45% with 13% having substantial anemia that might require medication such as Procrit) This means that about 87% of us will not have a significant problem with anemia. It's important with all these side effects to think of the glass as half full, not half empty.

- Weakness (56%, with 5% experiencing substantial weakness). Aerobic and weight bearing exercise are particularly important and effective here, though they generally help counteract many of these potential side effects.

- Hypercholesterolemia (57%, with 34% having it to a substantial degree). Statin drugs help with this side effect as well as with overall survival of prostate cancer. Nutrition, diet, supplements and exercise will also help.

- Gynecomastia (breast growth and tenderness - 38%, with 19% experiencing it to a bothersome degree) Possible but not common from just the shot alone or in combination with an antiandrogen drug. Very common with an antiandrogen (like Casodex or flutamide) used alone.

- Mental/Emotional changes (17% with 14% reporting these changes to a quite bothersome degree)

The Primer has a table covering most of these on page 153. It covers impotency on page 151 and bone density issues on pages 142-143.

I've just mentioned some of the main countermeasures. There are others, and it's helpful for us to use them.

As a general rule, younger men, say in their 50s or younger, have stronger side effects on blockade than do older men.

I've been on intermittent hormonal blockade as my sole therapy for a challenging case for over 8 1/2 years. Like most men who are treated with hormonal blockade, I have found the side effects to be a nuisance and somewhat bothersome but basically quite tolerable. Some of us have a very hard time. One approach is to start blockade with a one month shot and see how you do. At the end of that time, you should have a pretty good idea. If the side effects are too strong (usually hot flashes and sweats) and uncontrollable, then you can knock off the blockade or switch to just an antiandrogen or antiandrogen with finasteride or Avodart. The main issue there is gynecomastia, and there is an optional approach to counteracting that - a short course of radiation to the breasts. Liver function is affected in a few of us, and this can be serious if not addressed, so Liver Function Tests are routinely performed until it's clear how the patient handles the antiandrogen drug.

Again, I'm not a doctor or medically trained, so please just take these as suggestive leads and not as authoritative information.

Jim

[mike999]

This is a message to Jim:

I read your response regarding hormone shots...do you I read you correctly that you have been taking shots as your only treatment for cancer ?

Thanks,

Mike