Five weeks ago, started adjunctive ADT in prep for HDR Brachy in a few weeks. Scholz at POS recommended Casodex, Lupron, and Zytiga together. Due to delays in approvals, and whatnot, the first 3 weeks I was on Casodex alone, dropped PSA from 33 to 21. Then added Zytiga+Pred for last two weeks, and PSA dropped to 4 on just 3/4 dosage of 3x250mg (my choice to ramp up). Haven’t had a Lupron shot yet and T measured < 10. I’m tolerating Z very well so far, no major SE’s, ALT and ALP are elevated slightly over ULN.
So the question is, should I even bother with Lupron since T is negligible, and PSA has dropped 86% in 5 weeks?
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timotur
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It's a good question. Some have suggested that Zytiga could be used instead of Lupron. There's just no data to support that.. Zytiga and Lupron work in different ways. There's also no data to support Zytiga adjuvant to brachy boost therapy. Short-term hormone therapy doesn't seem to add anything to brachy boost therapy for high risk PC, so there's some question as to whether any kind of ADT is needed with it.
Effectively Lupron is a male hormone suppressant which denies cancer cells the food it needs to survive and grow. It is a necessary component of any radiation treatment and helps prevent the return of cancer cells to your affected areas. Do prepare yourself, however, to lose all interest in sex while taking Lupron and hope it comes back when the treatment is done.
Abiraterone was approved in combination with ADT (e.g. Lupron). The guidelines recommend to use Abiratone as it was approved - together with ADT. Anything else is experimental.
This trial found no difference, i.e. undetectable PSA at 8 months, when you take just Abiraterone without ADT in a recurrent situation:
I never understood the need for an overload of ADT drugs at the same time. If one works, it's doing the job. If needed you then have others to fall back on before the cancer becomes resistant to all to all of them.
After my prostate was surgically removed my PSA, which had been a sky-high 21, went down to 4.2, which meant that the cancer cells had spread beyond the prostate and required radiation sessions over a 3 month period, accompanied by the required addition of Lupron injections every 3 months, which would go on for 2 years. After my last Lupron injection my PSA was at .01 and I was declared "cancer free". Daily Lexapro 10 mg pills helped deal with the emotionally destabilizing effects of Lupron, however the worst part of Lupron is that all sex drives become nil.
There was a concern that Abiraterone [Abi] as monotherapy, by reducing testosterone [T] levels, induces a 3-4 times increase in luteinizing hormone [LH]. I haven't read anything to suggest that this is an actual problem, but I don't know what the %-effectiveness is of Abi for suppressing T of gonadal origin. Perhaps the addition of classic ADT leads to a more complete gonadal suppression? But it seems like overkill in your case.
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PSA went from 1340 to 2.4 in 2 months on Lupron and Casodex 50 mg
PSA Rising
in zytiga limbo. 
What to do now?
Continue Casodex or move to Lupron?
