As I have been told (the simple version) in the decision process as to using HT or not with my adjuvant RT -
HT starves PCa. If it is starved to death, HT could be curative. The problem long term is what happens if/when the PCa survives and finds something other than T to feed on.
If the remaining PCa is small and limited to the prostate bed, and you use both, the RT should kill the PCa, and the HT may or may not have contributed in a significant manner. If it was important, it is because the PCa is of larger scope, and the weakening by the HT helped.
If the PCa is not limited to the prostate bed, and you use both, the RT will kill some, and the HT will weaken and possily kill that in other parts of your system. Your PSA will still go down, then come back up later (months, years?) if the PCa outside the prostate bed survives.
So, the thread of logic was this - if I use both, but it isn't all killed (i.e. it was out of the prostate bed, and that was only weakened), that reality may be hidden for a while, and I will be hit with BCR sometime down the line.
If I use just RT, I avoid the side effects of HT, but, if there was PCa outside of the prostate bed, I also will not see a flat undetectable PSA immediately . If that happens, the RT failed, and HT remains the alternative.
One RO doctor suggested HT first, then the RT. I think they are trained to prefer that position
, but that is not part of the discussion here.
Two others suggested RT alone, and avoidance of side effects (combined with personal and work considerations) led me to go that route.
Down side - if the RT fails (we really don't know why until something shows up on a scan), and you wait, at that point HT will have to be more aggressive. Not starting HT early may have been an error in that case.
Thus, if you are of the 'kill it now at all costs' school, HT followed by RT sounds good. I felt like the adjuvant RT puts me in the 'kill it now' school. I may be wrong, time will tell.
So, once again, no definitive answer.
Post Edited (142) : 3/5/2011 7:31:13 PM (GMT-7)