why only Lupron (every 3months) alone?

I am worry about my 82 year old friend's treatment plan. He has numerous mets throughout his bones and many lymph nodes. His Gleason is 8. All Prostate tissue biopsy came out positive. He started treatment on October 23rd with Firmagon. He is responsive to ADT firmagon.

Oct 4- PSA 947, ALK Phos 273, ALT 68, AST 106

Nov 6 - PSA 267, ALK Phos 331, ALT 101, AST 96, T level less than 12

Nov 20 - PSA 90, ALK Phos 275, ALT 83, AST76

At apt yesterday, MO said liver enzymes needs to be normal before he adds Zytiga. MO changed his monthly Firmagon to Lupron every 3 months and Xgeva every 3 months ( had one Xgeva shot October 23rd and one yesterday)

From what I have read, shouldn't he be on another drug to prevent the initial testerone flare from Lupron. If initial flare, wouldn't that increase cancer cells again and harm him more? Or will Lupron alone be enough?

His next appointment is Jan 8, 2019 for blood work and check up. Is that too long to wait and see if Lupron does the job. HIs PSA has come down but still at 90. T should be still less than 12 from November 6th result.

If Firmagon works for him, does this also imply that Lupron will work for him as as efficiently? My personal feeling is a new drug is always better so why change Firmagon to Lupron unless Lupron will NOT increase his liver enzymes.

[pjoshea13]

You wrote:

"MO changed his monthly Firmagon to Lupron every 3 months ... shouldn't he be on another drug to prevent the initial testerone flare from Lupron."

Firmagon acts immediately to lower testosterone.

"Degarelix {Firmagon} Before Leuprolide {Lupron} Can Eliminate Testosterone Surge"

"onclive.com/publications/ur...

-Patrick

[Hidden in reply to pjoshea13]

I read the study. Thanks for the link. He only had one treatment of Firmagon on October 23rd. The 2nd treatment (November 20th) was Lurpon (every 3 months) Does this mean he doesn't need to worry about the initial flare on Lupron as he is protected from the ONE shot of Firmagon?

[pjoshea13 in reply to Hidden]

Exactly! -Patrick

[alephnull]

Firmagon is one drug used to prevent tumor flare and thus prevents PSA from spiking upward.

I see pjoshea13 just said that, so what they said.

[Fairwind]

Treating elderly patients can be tricky..The side-effects of all these cancer drugs can be cumulative and end up doing more harm than the cancer itself. Adding more drugs when the first line primary treatment is working is asking for trouble...You mess up your liver, your done....