Hi all, I imagine these two questions have been asked before, so I apologize for possibly asking them again. My predicament is that I am changing my chemical oncologists; therefore, there will be a lapse in my 3 month Lupron injection by as much as 2 weeks, meaning my next injection will be 3 months and 2 weeks since my last. I am also taking abiraterone concurrently. I am also seeing a really good radiologist at UCSF who feels I need to get off both to allow for my PSA to get to .2 before any lesions will really show, since ADT kinds of leaves existing lesions dormant. Once my PSA rises to .2, the radiologist will hit everything he can. Initially, there were two bone mets and possibly one lymph node involved. When I had my RP done in late January this year, none of the 24 surrounding nodes removed showed any signs of cancer. I will be meeting with a new medical oncologist to see if he goes along with that(radiologist) thought process. My PSA and Tare still undetectable since June, 2017. My two questions are , if I stay on Lupron, is there any data as to how long the three month injection remains effective, and also do any of you have any thoughts on the radiologists plans to go off Lupron to allow for the cancer to show its not so beautiful faces? Thank you all very much again!
Lupron lifespan and just a little more! - Advanced Prostate...
Lupron lifespan and just a little more!
Can’t give you a lot of help here with the radiologist’s recommendation, but I know from similar timing problems with Lupron that the drug tapers off in your system instead of just disappearing. So you are safe with your two-week time lag. You seem to be happy with your providers, but if you ever want a second opinion, I can recommend Prostate Oncology Specialists in Marina Del Rey, CA. It is not an impossible trip for you, and they have quite a following amongst MD’s who suffer from PCA.
Hi Reptale, thank you very much for the info on Lupron. That is exactly what I was hoping/thinking. As for Prostate Oncology Specialists, that is exactly who i will be seeing next week. Thank you again!
Don't worry about the 2 weeks - it takes a LOT longer than that for the testicles to ramp up T production.
As for getting off systemic therapy just to find metastases... that is almost certainly a self-fulfilling prophecy. Do you really want to take the risk of the cancer spreading just so you can know where they are?
There is NO evidence that zapping individual metastases increases survival. So to risk progression on a dubious hope seems foolhardy to me. There has been only one very small pilot randomized clinical trial of metastasis-directed therapy (MDT):
pcnrv.blogspot.com/2017/12/...
Dr. Ost wrote: "MDT does not replace ADT and our results should not be interpreted in that way."
Thank you for the info on the duration of Lupron's effectiveness, but more importantly, the "nudge" for continued ADT! Appreciate it a lot!
I totally agree with you, Tall_Allen. Why give the cancer any type of toehold?
Sounds insane to try and beat the cancer by allowing it to come back just so a radiologist can zap it? Sounds more like a guy trying to get business. I’d get a second opinion on that for sure. I also like prostate oncologists on marina del Rey and they do second opinions via phone for out of are patients.
Schwah
Thank you Schwah, between you and a couple of other members, I am still seeing a new oncologist but did make my appointment for a Lupron injection the week after next. Thank you again.
Had the same issue with a Lupron shot and being out of town for an extended period, it was no problem for me to go a week or two past the scheduled injection and just got back on track with a shot as soon as I got back into town.
I too believe that my cancer is currently in a dormant state, I've had an undetectable PSA for some time now, my plan is to keep them there, I don't want to do or change anything that allows it to become active again. All of my medoncs agree - if it's working don't fix it.
Ed
Hi Stick, first congratulations on keeping this bastard at bay. Given the half life of Lupron, in my opinion you will have no negatives effects from a two week miss. I started Lupron in 2004 and, through the Grace of God and the knowledge and skill my Medical Oncologist, was able to stop injections in early 2010. I will state that my two spinal mets were not completely resolved through Lupron.
A point to discuss with your new Medical Oncologist. With mets to bone and lymph node, even if resolved through radiation, minute metastatic cells travel through your vascular and lymphatic system looking for a place to land and grow. It is how cancer spreads. Without aggressive treatment that reached these two highways, the current methodology only serves to delay onset and is palliative in nature. You may gain more than fifteen years with this treatment, maybe not.
An idea method to knock out these small cancer cells, micto-metastasis, is through aggressive chemotherapy. While not a walk in the park, do not fear chemo. Everyone is different; especially when your body is strong and the tumor burden is minimal.
I recognize that men from all over the world participate in this group, some on a national healthcare system which, depending on cost, may not be available. Yet, I advocate aggressive treatment.
Take car my friend,
Gourd Dancer
Hi Gourd Dancer, thanks so much for the congratulations on the "bastard" down. I appreciate it. Also, from a pure logical perspective, to me, chemo combined with ADT would seem a very valid choice. It seems that while I am strong, and the ADT is working, chemo may be better able to control the minute amounts of cancer vs letting it get away first. it is funny, we have asked out current medical onco for chemo but with the two pronged ADT approach, he said that is the treatment of choice and cannot justify chemo. I am actually seeing two medical oncologists this month, Dr Richard Lam in Marina del Rey and then Sandy Sranivas at Stanford. I will take your advice to both. Thank you again my friend and looking forward to our continued posts 20 -30 years down the road! Very best. - Stick
Thanks. Good luck. "treatment of choice", for who? Private and government insurance companies?......,,
I was diagnosed in 2008 and treated with brachytherapy and although my PSA dropped it never fell below 2.0 and in 2013 it began to rise. I underwent a C11 pet ct at the Mayo Clinic and the scan indicated involvement in a two iliac lymph nodes. I subsequently had 46 lymph nodes removed of which 9 were positive. (More than the scan showed)My PSA dropped to .2 and stayed there for 18 months when it again began to rise. A subsequent Pet ct didn’t show any lesions even though my PSA was above 4.0. I did a clinic trial for a year and my PSA was undetectable. It began to rise again in 2017 and I underwent two more pet CT tests after the first I had more radiation but my PSA continued to rise I had the second when my PSA was 8.and it showed more involvement in 2 retro peritoneal lymph nodes. I underwent more surgery and had 26 lymph nodes removed with 14 being positive again higher than the scan. My PSA dropped briefly and I had another PET CT in March which indicated involvement in 2 supraclavicular lymph nodes and I underwent cyber knife radiation treatment. Which my have eradicated those two lesions it didn’t stop the progression as my PSA tripled in three months. Two weeks ago I started ADT with Degarelix and will transition to lupron in two weeks.
Although the imaging is improving and can detect lesions with a PSA as low as .2 they aren’t perfected as of yet
Based on my experience they cannot detect every occurrence and I have undergone them with PSA of 8. 2. 4. And 9 and .4
Your treatment has obviously been effective and your cancer is dormant.
Stopping treatment to let it become active in order to have the scans might allow treatments of those lesions. I have undergone two major surgeries and radiation on three occasions hoping that the eight scans would be able to detect all the areas were the disease was active and after all of that the scans could not identify all the lesions as my disease is systemic and my best hope for managing my disease is ADT.
Have tried what your radiologist is suggesting my choice would be to stay with the lupron since it is working so well.
Warm regards
Boston Mac
Hi Boston Mac, the detail from your own personal experience weighs very large to me. Some of what you went through is not real different than what i was planning on doing. Thank you very much for sharing your experience, and I now more than second guessed the radiation route. I scheduled my Lupron injection for the week after next. Thanks very much again and very best of luck in your continued fight!
- Stick
My husband's standard care of treatment includes Lupron shots, and his are scheduled every 16 weeks. I don't think you'll have an issue.
While I agree that missing a shot by a week or so will not make a difference, to Tall Allen's point of it taking a longer time for T to ramp up, Godschild62, be aware that there are different dosages, 1 month, 3 month, 4 month and 6 month shots. So your husband seems to be getting the 4 month dosage.
Didn't know that. Thank you for the info.
I hope that describing my situation / plans helps! Question#1;
Missing a couple weeks (with me a month) is not an issuse.
My Dr’s were not even fazed!!! No points off but don’t do it on a regular basis!!! My laps in treatment was my contemplating stopping the ADT and waiting to see an Eligard specialist!! Question#2;
I have been trying to get the answer of “how long after you are due for your next regular 3mo injection, do the effects of the drug stay in your system”.
Not totally for your reasoning but because Eligard (equal to Lupron) beat me like a red headed step child. My list of SE’s were written by Stephen King! I have not gotten that answer yet!! I have read many, many opinions ranging from 3, 6 to 12 months. My urologist is hoping to see improvements by my next visit May 9th.
However, I believe that by my ending my ADT treatment, I am doing something similar to what you’re refering to.
I / my Dr’s are stopping my Eligard treatment (next 3mo injection would have been due 2/27/19) and will monitor my PSA and act according to the numbers!!!! They behave, keep monitoring! They raise, then likely there is still cancer (rearing its ugly head) maybe go on intermideate ADT.
My bigest fear is that doesn’t work and I have to decide upon fulltime chemical castration (which offers me ZERO quality of life) or surgical castration!! {Not that I don’t think about that TOO much.......Right}
I am now 63 and my PSA was 19 and Gleasson was 4 - 4 = 8 when I joined the club in April 2017. Cancer only in my prostrate. If that has an merrit on this!!!
Hope I offered some help. Good luck
Jc
Re Lupron. Although I have not found anything definitive in the literature that says Lupron remains in our systems for x months, my docs told me that it takes months (6-9) to dissipate. So, methinks a lag of a few weeks or even months won't make much difference. Btw, I hate Lupron. Just saying.
EdinBaltimore
Isn't Degarilix as good as Lupron?
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