Lupron vs oorchiectomy

[Bobkar]

Brothers Lupron shot was 800$ after insurance paid. it’s just crazy that you have to worry about your life and the insurance gets away with charging this much!!! Dr did say in the future my brother should start thinking about oorchiectomy as an option. Anyone can share their opinion on this. He will be starting the trial ODM-201 this month and then he has to wait a couple months on that drug and then chemo. He is Gleason 8 and his PSA 2580 with Mets to all bones except legs.

[pjoshea13]

Bob,

From 2016 [1]:

"Overall, 3295 men with a primary diagnosis of metastatic PCa treated with GnRHa or orchiectomy were identified between years 1995 and 2009, and in adjusted analyses, patients who received a bilateral orchiectomy had significantly lower risks of experiencing any fractures (hazard ratio [HR], 0.77 ...), peripheral arterial disease (HR, 0.65 ...), and cardiac-related complications (HR, 0.74 ...) compared with those treated with GnRHa. No statistically significant difference was noted between orchiectomy and GnRHa for diabetes and cognitive disorders. In individuals treated with GnRHa for 35 months or more, the increased risk for GnRHa compared with orchiectomy was noted for fractures (HR, 1.80), peripheral arterial disease (HR, 2.25), venous thromboembolism (HR, 1.52), cardiac-related complications (HR, 1.69), and diabetes mellitus (HR, 1.88) ... At 12 months after PCa diagnosis, the median total expenditures was not significantly different between GnRHa and orchiectomy."

...

"Against a backdrop of increasing demand for better value in American health care and the continued need for long-term castration in select men with advanced PCa, these results suggest that some consideration should be given to better incorporate the use of bilateral orchiectomy for men who need permanent androgen suppression. This option may be advantageous for the patient (ie, increased avoidance of long-term adverse effects) and possibly the health care system. Both GnRHa and bilateral orchiectomy represent equally effective ADT for locally advanced or metastatic PCa. However, since the introduction of GnRHa, surgical castration has been on the decline.13 Indeed, 7 of 10 patients would opt for GnRHa given the choice.28 Certainly, the reason for this dramatic shift is multifactorial. The preference of medical over surgical castration is likely largely associated with patients’ fear of the less desirable cosmetics, psychological factors about self-image, stress of the surgical procedure, and the irreversibility of the intervention. However, several investigators have shown that the actual psychological effect of surgical castration may not be as significant as it is perceived to be. For example, Bonzani et al29 examined quality of life and body image among medically and surgically castrated patients, and found no difference. Data from the US Prostate Cancer Outcomes Study showed that GnRHa-treated men were more likely to worry about their disease and more often expressed a general dissatisfaction with their overall health compared with those who received an orchiectomy (67% vs 51%) (P = .004).30 Apart from the patient’s perspective, other reasons for the dramatic rise of GnRHa therapy may possibly include the lack of discussion of both treatment options in an unbiased fashion, the urge to provide treatment in the setting of a rising prostate-specific antigen, and/or financial incentives to clinicians. Our results highlight the importance of continuing to present patients with the pros and cons of medical vs surgical castration."

-Patrick

[1] jamanetwork.com/journals/ja...

[Bobkar in reply to pjoshea13]

Thank you !!!!

[Gary94]

$800? He got off easy. The last lupron injection I got from a private doctor my cost after insurance was $3400. Definitely get the orchiectomy, I did last July. Don’t miss them at all.

[Bobkar in reply to Gary94]

That is just insane.

[Tjc1]

Im going to go that way soon as there is no reason to get the shots because ill never br done lupron

[noirhole]

yep. My hormone Eligard costs about that much and the Xgevia approximately $950 out of pocket until I hit my yearly max of $6,500. I wonder what the surgery would cost. It was never mentioned to me as an option. The only way it became known to me is when Eric Winter discussed. I wonder if it is not discussed because it is more evasive or the fact that most would rather have a shot or a pill rather than a knife?

[larry_dammit in reply to noirhole]

My doctor won’t remove the prostate now, said as long as we can control the PSA they don’t think I can recover from the surgery

[Tall_Allen]

Orchiectomy is a great idea! Why suffer the cost and side effects of Lupron? I understand that they fit men with prosthetic testicles.

[Grumpyswife]

My husband is scheduled for orchiectomy on 3/22. We were talked out of it by his MO when he started Lupron 2.5 years ago. I wish we would have done it then. One less thing to schedule around.

[larry_dammit]

My doctor just switched me to elagard instead of lupron said it was the same thing

[Gary94]

Just so you know these injections are a huge money maker for urologists. That’s why you won’t hear them recommend orchiectomy very often. I attended the Prostate Cancer Research Institute seminars in L.A. last year and talked to a drug rep about the cost of lupron. She said it costs the doctors about $150. To confirm this my medical records from the VA lists their costs on the medications I’m taking. A 3 month injection of Elligard cost them $125. I’m sure there are occasions where the orchiectomy is not the way to go but I needed to have to have injections for the rest of my life and it made sense to lop them off. Didn’t regret it at all.

[Dabear]

I was on Lupron for a few years when I had good insurance. When I was about to retire I opted for bilateral orchiectomy. As far as how I feel, there is no difference. I have mets to the abdominal lymph nodes but PSA is now and has been undetectable since 2000. So, I think that path has worked for me except that my wife left me after 28 years.

[j-o-h-n]

The only thing I would miss is scratching them when I wake up in the morning....

Good Luck and Good Health.

j-o-h-n Sunday 03/04/2018 12:55 PM EST

[TenscTexan]

I agree with Gary94, it is a huge profit item for the clinic or hosptial, and it comes 4 times a year. The surgery will probably be less than one shot and last forever and there will be no question whether your hormone therapy is working. I did it six months ago not liking the side effects of Lupron after 2 shots and it wasn't working as well as we wanted it to, so I had the surgery.

[Bobkar in reply to TenscTexan]

Did you have the same side effects with the orchectomy as you did with the lupron shots?

[TenscTexan in reply to Bobkar]

You know its hard to say. I don't have hot flashes any more, but they say those can come from Zytiga. I do have fatigue and I had severe joint pain, but the joint pain has gotten better. I think fatigue and joint pain are a result of any hormone therapy, and I know more exercise would help with both. I had two shots of Lupron during chemo, and surgery Sept 29, of 17, so 5 months ago. I'm not sure I was on Lupron long enough to know what side effects it really had since I was taking chemo in tandem and one of those two kicked my butt! My PSA was all over the chart during chemo and I feared the Lupron wasn't 100% effective where as surgery is. Two shots of Lupron had rendered the twins down to the size of peanut m&m's, so I don't regret it and I'd do it again.