Lupron vs Zoladex or another adt?

[CBurnett]

My father was taking Lupron (intermittent) prior to his cancer taking off rapidly. He is now two rounds of docetaxal in, +prednisone,+Xgeva. They say to continue with Lupron every four months. I am wondering why they wouldn't change the hormone drug. Lupron was not working so why not try another? Any one experience this? Thoughts. Also he's having horrible swelling in feet and already taking lacix. Seems not to be working. Any tips tricks? Thank you for all your comments to my previous post. I love how active and supportive everyone is. 💕😊

[Dan59]

Lupron is continued during chemo because it is thought though there are cells resistant to Lupron there are still an awful lot of them that are not yet resistant to Lupron. That being said there is nothing wrong with trying zolodex which is another form of adt injected into belly fat. Also one should check their testosterone when toward the end of the 4 month Lupron which is really a 112 day shot and not actually 4 months. I have heard that one month shots are less likely to lose there effectiveness.

Dan

[middlejoel in reply to Dan59]

Dan, what do you mean half a day shot? Are not the shots time-distributed?

jal

[Dan59 in reply to middlejoel]

Jal, I am not sure what you are saying , just saying years ago at the conference in LA they were suggesting that 1 month shots were less likely to lose their effectiveness in some patients. OH and the 1 month shot is 28 days , 3 month is actually 84 days or 12 weeks and 4 month shot is 112 days or 16 weeks

[middlejoel in reply to Dan59]

OK Dan but can't we assumed that the drug is designed to function on a time-released basis? If the highest dosage is at the initial 1/2 hour whether one month or three, the drug will still be as effective following that shot at either period. Am I missing something here?

jal

[Hidden]

I started Zoladex intermittently in 2003, choosing it over Lupron because I read some bad things about the latter including possible cardiovascular issues. I had no regrets. Very minimal side effects and the only negative was that it cost me $25 deductible per cycle of three shots. Small price to pay for a superior product. After 13 years, I reached CRPC and am now on Ketoconazole with Hydrocortisone. So far so good. I hope I have plenty of time to contemplate the next step. Just turned 78 and have enjoyed good quality of life.

[pjoshea13]

You write:

"Lupron was not working so why not try another?"

It's tempting to equate an increasing PSA to Lupron not working, but Lupron's job is to control normal testosterone production. As long as it is doing that, there is no reason to switch.

-Patrick

[Billmac]

Vantis Implant, once a year has worked for me the last 12 years.

[BigRich]

Speak to his doctor about increasing his Lasix dose. Without knowing his current dose; I don't believe it is at the maximun, for they don't usually begin dosage at the maximun dose.

Rich

[CBurnett in reply to BigRich]

Yes his dose is only 20mg. I am thinking he could do that twice a day. He sees urologist on Monday so will ask.

[BigRich in reply to CBurnett]

Have his potasium level and electrolytes checked for his heart health. Lasix is depleting water and postasium from his system among other things. This can be monitored by blood tests by one of your doctors.

Rich

[Hidden]

Every oncologist I've consulted from my diagnosis and prostatectomy 12 years ago up to my recent metastasis and raging PSA is stuck on Lupron. I don't know yet whether that's because of some mysterious medical reason or simply inertia; i.e., it's what they were taught in medical school. My literature research keeps telling me that degarelix is slightly superior in almost every way and far superior concerning flare. My oncs will have some serious persuadin' to do to to get me on Lupron instead of degarelix ... and that's with no evidence yet that I'm resistant. We need to be particularly vigilant about that inertia and about our medical oncologists' monetary incentives to push one drug over another. Their brand loyalty is as powerful as the Pepsi vs Coke bias at movies and restaurants, for the same reason: the kickbacks and/or loyalty discounts are huge.

[BigRich in reply to Hidden]

"Their brand loyalty is as powerful as the Pepsi vs Coke bias at movies and restaurants, for the same reason: the kickbacks and/or loyalty discounts are huge."

Many a truth has been said in jest. Trust but verify.

Rich

[JoelT in reply to Hidden]

You are correct, degareliz is superior, especially in the flare department. However, it costs a lot more money than Lupron.

Joel

[Hidden in reply to JoelT]

One long term cost analysis says degarelix is cheaper, all things considered.. I can guess who issued that analysis, but don't really care. After all, if insurance pays $96,000 for Provenge's 4-month benefit, it can surely afford a few thousand extra dollars for my longer and higher QOL even if that cost analysis is biased(?). Some oncologists are pushing to make degarelix the Standard of Care First-Line ADT drug due to its superiority in virtually every way but initial injection pain, for which there are many cures including Reading The ____ Manual. (I've seen discussions in PC forums clearly indicating that neither the patients, their oncologists, nor the nurses injecting Firmagon have even looked at the very detailed written and video injection instructions on the Firmagon website. This ain't yer grandma's flu shot.)

[ringa in reply to Hidden]

Hidden......Thanks for this post. You are so "right on". I have had monthly Firmagon injections since Aug 2015. The resulting side effects are as variable as the nurses doing the injections. I have two nurses (out of a dozen) who follow the instruction to the letter and with which the side effects are almost non existent. I have tried frequently to test this theory, always with the same result. Waiting in line for the "special" nurse is something you will not regret.

[bluesnjazz in reply to JoelT]

After 6 years on both Casodex and Lupron off and on, I decided to try degarelix because of it's proven to be less hard on the heart. What a mistake. While Lupron and Zoladex are both capsules inserted into belly fat with some short-lived belly pain and swelling, degarelix is two bottles of liquid, injected on both sides of the belly button, causing (in me, anyway) massive swelling and pain, two hard even more swollen bumps the size of apples, and inability to wear pants, bend over, or even move around much for nearly a week. Now, even 3 weeks after the shots, the hard knots are still there--albeit much smaller--and still painful if bumped. Never again.

[garythomas]

Hi Jal,

When Dan says Lupron is really a 112 day shot and not actually 4 months, he means it lasts for one hundred and twelve days, rather than being strongest in the initial half hour.

[Dan59]

As Patrick said , what is important is if the Lupron or zolodex is keeping the testosterone low throughout the entire time of a treatment, that means it is doing its job . As I recall Lupron/eliguard is mixed on site by the oncology nurse or a pharmacy if you have one at the clinic, zolodex is a pellet that comes that way from the factory eliminating any mixing error,I know there are newer ones I am not familiar with, I have been off since being on xtandi which holds my testosterone well below 20.

Dan

[middlejoel]

Dan and Gary,

Went back and re-read Dan's initial pos and----my apology, when I initially read it, my freaking eyesight read that the Lupron shot was essentially a 1/2 day, not 112 days, sorry for the confusion,

jal