So, our next question regarding hormone therapy is — this person's kind of saying, is chemical
castration through hormone therapy the same thing as an orchiectomy? And obviously an orchidectomy
is when they remove the testicles, but that seems like a permanent thing where hormone therapy is
temporary. Am I right in my thinking that it's the same kind of mechanism, but a temporary action?
It is the same if you're talking about the common injectable hormone blockade agents like Lupron,
Trelstar, Firmagon, Zoladex, Eligard. It's medically equivalent to a surgical castration
except that it is reversible. It's not medically equivalent to something like Xtandi, Zytiga,
Nubeqa, or Erleada which have the capacity to block testosterone inside the cancer cell.
So, this is one of the things about the nastier high-grade cancers is that they learn how to make
their own testosterone, and orchiectomy and Lupron-type drugs do not block that.
And as far as those types of hormone therapies go, once those are, you know, discontinued, will the
person be able to regain their testosterone levels back after Zytiga or Xtandi or anything like that?
Yes, they are in theory all reversible. There is a problem in the more elderly men
with tired and aged testicles. Some of these men that have been on Lupron for an
extended period of time do not resume making testosterone at normal levels
even though they've been off treatment for six to 12 months.
So, the next question is from a child of a prostate cancer patient. Their father
is 86 years old and he has prostate cancer in his pelvic lymph nodes.
His urologist wanted to start him on Lupron and he's kind of concerned about the quality of life.
Would it be safe to try Casodex instead? Do they check the testosterone and PSA levels
to see if the Casodex alone is enough to control the cancer without Lupron?
I think he's just really concerned about the hormone therapy side effects at 86.
I think it's a very cogent concern. We know at age 86 that we're not going to be here
forever. Perhaps he'll be happy if he can get another five to ten years of survival
just under normal circumstances, so why not use a milder medicine with more predictable reversible
side effects like Casodex? It makes a lot of sense because you can monitor the PSA levels;
you can continue doing scans to check the lymph nodes if they were picked up on a cat scan,
for example, and as long as the situation is in check with PSA levels controlled,
most men describe better quality of life on Casodex than they do on Lupron — less fatigue,
some men will even retain a little bit of libido on Casodex.
You have to watch out for higher incidence of breast enlargement, but that can be blocked
out with estrogen blockers like Femara or Arimidex, so I think it's a very cogent idea.
So our next question comes from a patient who is wondering about the possible side effects
of radiation to the lymph nodes. Their doctor wants to do it prophylactically and they're
kind of worried about the side effects and they'd rather wait and see if any disease
appears on scans before treating pelvic lymph nodes with radiation automatically.
A lot of this — if the person was elderly perhaps they should wait. If they're
younger—and in the prostate world younger means and probably still in your 60s and early 70s—the
idea of jumping ahead and zapping the lymph nodes to improve cure rates in someone that's
going through treatment to be cured makes sense because prophylactic radiation to the pelvic lymph
nodes can be delivered at centers of excellence with very little side effects. So historically,
lymph node radiation was a rather frightening concept and many of the radiation therapists,
though they were paid to do this, wouldn't do it because they saw so many ugly effects
on the intestines which were long-lasting afterward. With skillful treatment these
days that concern has been eliminated, and so in select patients who have high Gleason scores
and high PSAs in whom the doctors suspect lymph node involvement, prophylactic—or we
call it adjuvant—radiation therapy to the pelvic lymph nodes makes a lot of sense.
Hey everyone, it's me and sirhunterthedal, our PCRI mascot. Please subscribe to our
YouTube channel; Hunter definitely wants you too, and if he can high five me, you
have to subscribe right now. Oh, you're already high-fiving me, good job. Thanks so much visit
our YouTube channel and also our website for more information at pcri.org. Say bye!