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Is a delay in Zoladex past its due date okay? Affect efficacy of radiotherapy? Have prostate cancer.

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I am 77 year old diagnosed with prostate cancer following a biopsy in XXXXXXX 2010, at which point PSA peak of around 20 ng/ml. 9 of 44 cores showed a XXXXXXX score 3 + 4. MRI showed suspicious involvement of the left seminal vesicle. I started 3 monthly Zoladex in September 2010. Subsequently underwent external beam RT in London, which completed in January - February 2011.
I also have a background of hereditary heaemorrhagic telangiectasia, with intermittent nose bleeds and anemia. Hence there was some concern about rectal bleeding following this, but that has not really been an issue so far. In March 2011 I contracted a particularly severe herpes zoster over the left eye, and is only gradually recovering from the resultant trigeminal neuralgia. The main issue now is persistent anemia. My hemoglobin, which remained above 11 earlier, now remains around 9 mg% and responds poorly to oral hematinics and injectable iron. This seems partly due to the recurrent bleeds, but the Zoladex also seems to be contributing. In view of this one of my urologist suggested using the Zoladex intermittently, to see my hemoglobin response off it. However my London Doctor is adamant on continuing it for at least another year.
I am very much keen to get another opinion on this, and hence this query. Do you think a delay in the Zoladex for 6 - 8 weeks past its due date is ok? Can this affect the long term efficacy of the radiotherapy? Alternatively can I consider Erythropietin for HB? please let me know.
Posted Wed, 11 Apr 2012 in Cancer
Answered by Dr. Indranil Ghosh 6 hours later

Thanks for posting your query.

According to the information you have provided, you seem to have a locally advanced prostate cancer. If the seminal vesicle is considered involved at baseline then it is high-risk disease.

The standard treatment for this condition is Zoladex for 3 months, then Radical RT (with continued zoladex), followed by zoladex continued for 2-3 years. (Ref: National Comprehensive Cancer Network clinical practice guideline 2012). There is no consensus to decide between 2 years and 3 years.

Intermittent zoladex may be as effective as continuous zoladex in the short-term but long term efficacy is not well established as of now.

Now coming to your hemoglobin, it is a bit low but not very low. I will be happy with this value if you don't feel very weak and you are maintaining this over time. You do not require erythropoietin for that. Erythropoietin itself has many side effects like hypertension and thrombosis and there is no pressing need for it now.

I would strongly recommend you to continue zoladex for at least 2 years total. Hemoglobin may be monitored from time to time and if it falls further, then we may consider erythropoietin.

I hope, I have answered your query. Please accept my answer in case you have no follow up queries.

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