Advice for men who are about to start hormone treatment for metastatic prostate cancer?

[silver5]

I'm writing to request advice about what tests you would recommend I should get before and during hormone treatment, which I probably will begin sometime in the near future. The treatment will probably begin with Casodex and then add Lupron.

I have an appointment early Wednesday morning with my urological oncologist, so I'd like to get advice by early Tuesday if possible so that I can send email to my doctor with questions about what tests I might wish to get before, during, and after hormone treatment.

I'd also appreciate advice about whether it might be best to get Lupron shots at 2, 3, or 6 month intervals, and what the pros and cons of different intervals might be. In my own mind, one thing in favor of getting shots at shorter intervals is that if the side effects are too onerous, I might decide to terminate the hormone treatment sooner rather than later.

I had a prostatectomy in 2011, with follow-up 6 month hormone treatment and adjuvent radiation treatment of the prostate bed because my margins weren't clear and there was seminal vesicle invasion. My PSA was "undetectable" until 2017, when it gradually started rising situation. My PSA a couple of weeks ago is up to 1.9, with an estimated doubling time of about 9 months. An Axumin PET scan in July showed 3 small metastases -- 1 in my prostate bed and 2 in a lymph node higher in my abdomen.

What tests to get prior to hormone treatment?

I've heard from several people that I ought to get a bone density test prior to ADT. Is there any particular flavor of bone density test that ought to be? Are there other tests I ought to get prior to beginning hormone treatment? If possible, please include information about what each test tries to measure and why it might be useful for me and my care-givers.

What tests to get during hormone treatment?

After I begin hormone treatment, what tests should I get? How soon after beginning ADT should I get them, and how frequently should I get those tests thereafter? (some tests might need to be less frequent than others). Once again, please include information about what each test tries to measure and why it might be useful for me and my care-givers. I

look forward to hearing your ideas and advice in response to my questions about my upcoming hormone treatment.

Thanks,

John McCarthy

[Tall_Allen]

Here are some options for your metastatic hormone-sensitive PC:

pcnrv.blogspot.com/2017/06/...

How often to have a Lupron shot is a matter of your convenience. If you plan to have intermittent ADT, you can move to shorter duration shots just before your planned vacation.

As for tests:

- PSA and testosterone after 3 months

- If you decide on Zytiga, you will want to monitor liver enzymes, potassium, and BP

- DEXA (bone mineral density) after 6 months of hormone therapy/ check blood calcium and Vitamin D

- if your PSA rises while taking Zytiga or Erleada, you will want another PET scan

[GP24]

It is not necessary but I would get a testosterone test to know your baseline testosterone. Once you stop ADT, e.g. for intermittent ADT, you will be interested to know if the testosterone level returns to the level that used to be your personal normal level.

[cesces]

Make sure you get estrogen patches.

There is just no reason not to use them.

[Hawk56]

I had this discussion with my GP when I was on Lupron for 18 months, Taxotere and radiation.

We did CBCs and metabolic and lipid panels every six months.

Things my GP and I kept an eye on because of the SEs from Lupron:

Glucose -

RBC

HGB

I also had the bone scan and at 12 months we did a cardio stress test.

I insisted my urologist check the T along with the PSA every three months, wanted to be sure it was at and stayed below 20.

Kevin

[jmurgia]

I would agree with your statement: "In my own mind, one thing in favor of getting shots at shorter intervals is that if the side effects are too onerous, I might decide to terminate the hormone treatment sooner rather than later." I'm on Casodex monotherapy 50mg/day oral so I can stop any time I like (without anyone knowing or interfering). The cognitive decline is the most troublesome side effect. I wonder if there is a test for that (stupid, stupider, stupidest) on a sliding scale?

The bone density test would be a good idea to get a baseline reading. It is commonly given to old people, not just cancer patients. I believe it is covered by Medicare and commercial insurance as "preventive care". Once you're on Lupron they'll probably try to give you a bone strengthener without actually seeing if you actually need it. Weight bearing exercise was recommended to me to maintain bone health.

Joe Murgia

[j-o-h-n]

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Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 11/19/2019 10:23 PM EST