Does anyone have experience with the following: my now 67 year old husband was diagnosed 5 years ago with Stage IV prostrate cancer, Mets in 5 places, Gleason 9. He was treated with the new protocol at the time-6 cycles of docetaxel, radiation and lupron every 6 months. He has responded very well cancer wise but has developed heart problems, having 4 Non STEMI heart attacks—always in the spring(!) for the past 4 years. He has wonderful specialists. His cardiologist -who we sought out after the third heart attack due her speciality in the effects of cancer treatment on the heart,wanted to get him off the but the rest of the team said he needed to stay on it and he was “between a rock and a hard place.” We saw his oncologist in November and she said she wasn’t convinced it was the lupron but he couldn’t keep having heart attacks. She said there weren’t a lot of men in his situation given the new treatment protocol he was given, so not a lot of data. She wanted to do further research. She called this week and said she was taking him off the lupron and not to get the shot due in January. She said his psa will be checked every 3 months and the will jump on it if there is a rise. I know we must wait and see practically speaking but it’s hard to believe he is the only one in this situation. I appreciate any feedback .
Lupron and Heart Issues: Does anyone... - Advanced Prostate...
Lupron and Heart Issues
Lupron contributing to heart attacks does not seem likely . Heart attacks happen more commonly in men and particularly men who are bald (male pattern baldness) because high testosterone causes not only physiological changes but also psychological changes such as hostility ,excessive anger and short temper. Hostility have been already accepted as an independent risk factor for heart attacks.
On the contrary, the rate of heart attacks in women are very low as they have ample amount of estrogens in their bodies Estrogens have anti depressant and cardioprotective effects
After menopause , rate of heart attacks in women rise as they have less estrogen and their testosterone level starts increasing.
Lupron reduces testosterone and indirectly can reduce risk of heart attacks.
The only way Lupron can increase heart attack rate is ...that men on Lupron gain weight and fatty tissue and that can increase their LDL or triglycerides . This abnormal lipid profile can contribute to increased heart attacks.
But ,If men on Lupron exercise regularly, eat right kind of food and keep their body fat to near ideal body fat percentage , then their heart attack rate is same as men not on Lupron.
BS.
I thought that baldness is an inherited state in males. High testosterone. Baldness. ??
You are right, Sir. Male pattern baldness is inherited state. But, the genes are responsible for higher androgens in these men
In novels, we read that bald men are "sexy" or have high sex drive. Its all because of androgens as they make us risktakers, aggressive, hostile and of course give us sex drive. After ADT sex drive goes down and emotionality increase.. can feel more and become less interested in fights. It translates into less road rage..less middle finger and so on.
Coming back to hairs...women have very low testosterone and thus tend to have lot of head hair. After being on ADT, my hairs got thicker and better...My wife is willing to bet on this. She jumped with joy "wow..your hairs are growing back."
That describes me pretty well over the years. Very insightful. Always chasing women and being confrontational even though I didn't really want to be. I would rather have had less sexual desire and more calmness.
I also have heart disease, since 2015 but it's slightly better now than it was four years ago due to healthy eating exercise meds and supplements that Linus Pauling recommended.
Snowbird,
see this video:
"Assessment of Cardiovascular Risk with the Use of Androgen Deprivation Therapy for Prostate Cancer"
urotoday.com/categories-med...
You may try to switch to Degarelix/Firmagon to avoid these risks. Your team will not object, just point out that this is a monthly shot. I think you can accept that if the risk is a heart attack instead.
Since the main mechanism of increased cardiac risk still remains via atherosclerosis, the prevention still involves-
(1) Keeping the body weight at or close to ideal body weight.
(2) Maintaining lipid profile at near perfect level by heart healthy diet, Statin meds, regular aerobic exercise etc.
Remember the dictum: What is good for Heart IS good for prostate and vice versa.
I agree with GP24. Try switching to Firmagon. Search Firmagon or antagonist and cardiovascular risk. There are multiple references to the benefits of an antagonist vs an agonist especially if there is pre-existing CVD.
Hans, thank you for your post but let me point out the video I linked. If Snowbird takes the time to watch it, she will know more than she ever wanted to know about cardiovascular risks with ADT and why Degarelix is most probably better than Lupron if there are pre-existing cardiovascular risks.
The Firmagon hurts like hell. Often causing a mean cellulitis. That in itself can be so stressful
I took Degarelix for nine months and had no problems. However, I made sure the doctor followed the instructions by Ferring:
firmagon.com/hcp/dosing-and...
e.g. "Do not shake the vial as this will cause bubbles"
If the doctor follows these instructions it takes up to 15 minutes to give you the shot.
You may try the 3-month or 1-month Lupron depot injections to see if SE's are reduced.
There are alternatives to Lupron that you may want to discuss with the cardiologist: orchiectomy, Firmagon, or Casodex 50 mg/day. Estrogen is off the table because of elevated risk of blood clots and sudden cardiac arrest.
There is also the possibilty of using Zytiga+Prednisone without Lupron. Grade 3/4 cardiac failure rate was about 2% with Zytiga+prednisone, which was about the same as the rate of Grade 3 or 4 hypertension. So it may well be that that 2% had inadequate prednisone, leading to hypertension, edema, and hypocalemia. (Too much prednisone is also bad) In a very small trial, Zytiga+prednisone (without Lupron) was able to control testosterone similar to Lupron:
urotoday.com/conference-hig...
Your theory that inadequate prednisone leads to the Zytiga mediated hypertension is not very clear. Could you go over it with me
Thanks.
Sure. Prednisone is given with Zytiga only enough in men with mHSPC so that it compensates for the cortisol that Zytiga inhibits. If one doesn't get a sufficient replacement dose, it caused hypertension, hypokalemia and edema. Those can cause heart problems. The proper replacement dose can vary between individuals, so it's a good idea to monitor those closely early on and get the amount of prednisone that's right for you.
Thanks for your expertise
5 mg of prednisone a day is doing great for me. find your exact dose.. not less not more.
I gained 40 lbs in 6 weeks. Dr took me off. I rode bike 1.5 hours daily during treatment. Still put on weight. I had surgery and radiation. Three years out and pSA is undetectable. Am tired more but still ride daily and chase kindergarten kids around
your husband is very sick, he a number of complicated and serious conditions, that is a fact. There is only so much that medical science can do, so no miracles. He has lived a full life and I suggest you try to accept that, live his remaining time as full and wholesome as he can. I understand the wanting to keep staying alive, is perhaps more for you.
At some, we are all going to die, I suggest it is better to live a higher quality of life, than die hooked up to machines and being dragged thru hell, literally.
PC is a very serious illness, and the longer one undergoes advanced medical treatments, the more likely that other issues will arise or compound the existing. There is no winning this last war with life, he will never be 35 again.
I do not mean to negate your efforts on his behalf, but I also think that we all have to understand the life cycle of human beings, and access that after 67 years, one has been able to enjoy life to the fullest.
remember the good days.
It's a bit late for me to start digging through the papers I've saved - maybe tomorrow - but there are several studies showing a strong increase in cardio-related incidents in men on long-term Lupron based ADT (more than 1 year.) Up to a 30% increase in strokes, heart-attacks. blood-clots and other cardio-related problems.
Lupron/ADT is the devil - it's one I hope to only have to bear for another 6 months.
I think your husbands oncologist has made a wise decision.
Catch 22. It’s good if you do ADHT and good for heart ♥️ if you don’t for long.
But there is always a but. My 1st time around with ADHT LUPRON + Casodex 2008-2012 was interrupted by my SCA (sudden cardiac arrest) May 12.2011.
But remember I said but, I had been drinking long long term ~ 35 years till 3 months before my cardiac arrest. My Dx at the hospital CICU for 12 days and 5+rehab was NSVT. Yes ventricular tachycardia. But I was still on Lupron and Bicalutamide.
That thought will be forever ingrained in my mind. My heart was the worst of the worst shape plus I was about 235#’s.
Today :::
I’ve been 8 yrs 10 month in sobriety my heart EF ejection fraction is has been 55% for the last 2years. And finally exercising is my life daily usually 2X daily. Healthy diet eating trying to stay on track. Too!
My EP Electrophysiologist doc says that ADHT could cause Long QTc cardiac Rhythm but not in an improved cardiac functioning heart like mine. Especially exercising and eating very healthy.
I’m gonna keep doing what I’ve been doing
And yes monitor my BP , EKG’s at home, do my blood cardiac follow up labs.
Aren’t our lives worth trying to keep them healthy and active and strong and positive focused??? I’m not giving up my healthy habit energized attitude.
Yeh sometimes it’s tough tough tough like yesterday lots of roadblocks.
Like they say if you fall down it’s not how long your down it’s “your get back up and keep on going” attitude that’s count.
Like they call The US Navy SEABEEs “The Can Do” branch of service.
Stay strong my friend Snowbird1. I’m 67.8 years old and still kicking butt at the gym....
Depotdoug
Well done for your great achievements!!Its true that ADHT could cause Long QTc cardiac Rhythm, but if you have regular EKG’s it should be easier to control. Firmagon lengthened my husband's rhythm, but it wasn't too much and he became castrate resistant. So he's now not on it.
Yes like I think I mentioned. I’ve got 2 EKG home or remote monitoring devices. Both portable.
1. KARDIA EKG Plate my 3rd version. Guess I’m an expert on that one. Can take it anywhere. Plus I can get cardiologists or clinician interpretation if I want.
2. Got my Apple S4 super watch now 15 months old. It cks continuous HR BPM while resting and exercising.
Plus a great EKG monitor on it too.
3. Plus my ICD / pacemaker 2nd device is protecting me and I’m being monitored at home my MERLIN remote.
Monitored monitored monitored
My husband has a chronic heart disease with arrhythmia so we decided not to go for Lupron and felt that Firmagon was better, (we decided on our own after investigating the side effects, because his doc didn't agree) he took it for a year without a major side effect and his PSA lowered considerably, but he became hormone resistant. He's now taking Xtandi.
I have metastatic prostate cancer (PC) (originally gleason 9 and now in my lymph nodes). I have had irregular heartbeat while on Eligard (Lupron) plus Zytiga + prednisone OR Eligard plus Xtandi. My doctor could not definitely tie the irregular heartbeat to either or combination of treatments. I have been exercising and lost weight while on Eligard + either. I have dropped Zytiga and Xtandi but continue on Eligard (shot every 3 months) and the irregular heartbeat stopped. I think irregular heartbeat is connected to Zytiga or Xtandi with Eligard but nobody can prove it.
I'd like to know if you or anyone on this blog has connected above drugs and heart conditions.
I continue to exercise regularly and eat well. My doctor and I are considering switching to Casodex and Daralutamide. I hear they have a lot less side effects. I would not stop androgen deprivation therapy (ADT) just to watch PSA rise and cancer spread. Have you had genetic sequencing of your tumor? There are some new treatments that are very effective with certain gene mutations in PC including BRACA 1 & 2 and ATM. If you have a gleason 9, it would be too risky to stop the Eligard. Maybe switch to another ADT drug(s). I would also focus on scans, not just PSA, to track progression once lymph nodes are involved as some prostate cancers do not excrete PSA or convert to other cancerous cells. Scans include Axumin, PSMA PET (clincal trial only), and C11-Choline-PET scans are the most accurate for PC.
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