Q: I'm 75 years old and will be having brachytherapy for localized prostate cancer. Should I have hormone therapy first?
: A We have increasingly been using hormone therapy prior to brachytherapy. The idea is to reduce the volume of the prostate before radiation treatment, potentially making the radiation more effective. Hormone therapy also may be used to improve urinary flow. There also may be a synergistic effect between the hormone therapy and the brachytherapy.
It's possible that hormone therapy could help men with high-risk disease if used before seed implantation. Hormone therapy has been shown to help men with high-risk disease when used before external beam radiation therapy.
As for men with lower-risk disease like yours, hormone therapy probably won't be necessary. A recent study in Cancer looked at mostly low- and intermediate-risk men who underwent brachytherapy. The researchers found that men age 73 or older who had hormone therapy before brachytherapy had reduced survival compared with men who didn't have hormone therapy. The treatment appeared to have no effect in men younger than age 73.
One of the disadvantages of hormone therapy is that it's not good for the heart or blood vessels. That's why it's important for you and your doctor to carefully weigh the risks and benefits of any procedure for your particular case.