March 16, 2009 -- Question: Will I need hormone therapy with my radiation treatment?
Answer: The situation with radiation therapy and hormone therapy, the combination, varies depending on various factors. And those are, the size of the tumor in the prostate, the PSA at the time of presentation being elevated at least above 10 or even above 20, and the Gleason score in the pathology of the prostate biopsy, or the prostate cancer biopsy, indicating that is a Gleason score seven or above.
If you are within the group of men that have as we call low risk features, that is, a PSA below 10, a Gleason score six or below, and a small tumor, sometimes not even palpable, just detected by a biopsy done for a PSA elevation. In those cases, most of the time, hormone therapy is not needed in conjunction with radiation therapy. However, in men who have intermediate or high risk features -- that is, for those who have PSA elevations about 10, certainly above 20, a Gleason score seven or above or a large primary tumor in the prostate that would indicate that maybe it's going into the margin, maybe it's invading into the seminal vesicles -- in those cases, the combination of hormone therapy with radiation therapy has proven to be much more efficacious than radiation therapy alone, or than hormonal therapy alone.
And the question remains is how long should the hormonal therapy last. Indeed the studies that were done in Europe would indicate that for these high risk men, at least three years is needed. Studies in the United States found that two years may be enough. And there's more recent evidence, and this is not a final question answer that may be as short as six months to one year may be efficient, because certainly the addition of hormone therapy to the radiation therapy. If indeed it helps to sterilize so to say the prostate and remove all cancer in the prostate, it does have a number of additional side effects that over time will add to impairment in the quality of life. Therefore, studies are ongoing trying to narrow the time at which the use of androgen deprivation hormone therapy is needed to achieve maximal local control of the disease.
So you really should understand well the issues that are involved with this combination which as I said improves disease for survival and overall survival over radiation therapy alone. And there are definite cases where this is the only option, and that we strongly recommend you do it. So you have to understand what are your particulars related to your prostate cancer, and the PSA, what is your health status, and what you should expect from the treatments in the short and the long run.