Why concurrent Lupron with Zytiga? - Advanced Prostate...

Advanced Prostate Cancer
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Why concurrent Lupron with Zytiga?

Dachshundlove
Dachshundlove

My husband finished chemo, and is moving on to the next phase of treatment. We are wondering why he is told he should do both Lupron and Zytiga, as opposed to just Zytiga?

From what we understand Zytiga does comprehensive job of stopping androgen production, so Lupron sounds redundant to us. Thoughts always appreciated from the malecare brainiacs (many here, IMO).

22 Replies
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Very small trials suggest that Zytiga might be able to do that. But that is far from proven. I also don't know how well Zytiga lowers testosterone after the cancer becomes Zytiga resistant.

I was told by my oncologist to have monthly injections of Lucrin as regular ADT for rest of my life, or until I get remission, which is extremely unlikely.

I had Zytiga added to ADT because it functions to close down adrenal gland production of testosterone and interferes with dy-hydro testosterone production in the Pca. ANY testosterone generated in any way in my body is likely to fuel the growth of Pca.

Chemical castration MUST be allowed to be virtually permanent. I did have pause after first 2 years of ADT in 2012 and Psa rapidly went from 0.08 to 8.0 in 6 months. Same thing happened in 2015, but when I saw the Psa increase to 5, I went back to ADT. The rise in testosterone during that second pause was little, showing that my testicles were becoming atrophied, and by now I might guess that they are now completely unable to re-start Testosterone production.

Therefore the monthly Lucrin does very little if anything in my body, but just costs Medicare about $4,800 each year.

So after Zytiga stopped working, I ceased taking it, and I continued ADT and went through 5 chemo shots that didn't work, and then 4 x Lu177 shots, which appears to have worked, but chemo is said to re-sensitize Pca to Zytiga or Xtandi where they previously had stopped working, and that the period they work again can be much longer.

But afaik, the Pca is not re-sensitized to normal ADT after chemo. I am now on Xtandi that I began during Lu177 right after 3rd shot, and Psa reduction has been dramatic. But the PsMa follow-up scans after the 4 shots of Lu177 showed huge reduction of Pca mets, so much so that giving a 5th shot of Lu177 would have been useless. I can only guess that Lu177 killed much of my Pca, and anything left was / is well supressed by Xtandi, and maybe Xtandi after Lu177 helps killing action to continue, not just Pca suppression.

There is no way I want to allow any testosterone to come back because its a risk I just don't wish to take. So ADT has to be permanent, and without testosterone I am managing to stay physically fit and mentally alert by use of a bicycle and a very strong amount of positive willpower. I am 72, but many others my age are in far worse condition than I am, even though they have normal testosterone levels, and have never had any challenge from cancer.

Meanwhile, life here in our summertime between Xmas and New Year is somewhat tedious with many days over 35C and I don't have air con, and never have had it so house heats up, but I have gotten use to using quiet fan when trying to sleep with T about 25C. Air has lots of smoke from bushfires that have been going on here for months.

I had a terrible stomach blockage of intestine 5 weeks ago, from adhesions to scar tissues, and this needed an operation. I lost 8Kg in 13 days. I have regained some strength, and found how to raise iron levels to get some relief from the anemia that followed, and weight is slowly coming up and so is my speed on the bicycle. I cycle between 7am and 10am, to avoid the heat.

I don't care if I am a bit slow to recover, that's all part of being 72, but hey, I am ALIVE, and I even have friends, and so I am doing OK.

Now its a case of whatever will be, will be, but then doctors might interfere with that idea. They really enjoy upsetting Lady Destiny, who can be a real bitch.

So CHEERS! to all,

I'll have a glass of cabernet sauvignon dry red tonight and maybe cycle a few km tomorrow morning, 40km every second day is plenty for now.

We have at least 12 weeks after NY where fires could still be a Royal Pain in Arse for so many in our area on the Planet. If the drought we are enduring continues then fires may break out around here. But its no use worrying about it, I probably won't be affected much, but there are so many others who have lost everything in the fires, so my problems seem to be trivial.

Patrick Turner.

Check the Stampede trial which showed that Zytiga + ADT increased OS significantly in mCRPC men. That's what MO's base their decision on, and it's what Zytiga was approved for. I personally dropped Zytiga after a few months because of high BP, and Lupron alone has helped drive my PSA to <0.01 after HDR-BT and IMRT radiation tx.

In the trial which led to the FDA approval of Zytiga, the control group got Lupron and the other group Lupron plus Zytiga. So Zytiga without Lupron was not tested and the FDA approved Zytiga in Kombination with Lupron or an equivalent drug only. Therefore Zytiga is used together with Lupron only.

The side effects are caused by the low testosterone. Even if you would determine that Zytiga alone works just as well as in combination with Lupron, this would not reduce the side effects because these are caused by the low testosterone. If Lupron would not reduce the testosterone it would have no side effects.

Glad you asked this question. This has been on my mind for a long time. Still no definitive answer.

In the meantime, i am studying Intermittent ADT where lupron can be stopped for some time while carefully watching PSA. If PSA rises to above 2, Lupron restarted,

I have a paper from China which claims that Intermittent ADT has become a Standard of care in China.

GP24
GP24
in reply to LearnAll

Where did you read that you should restart ADT when the PSA value gets above 2.0? Since you had a PSA of 830 before ADT, your testosterone will not have recovered fully when you reach 2.0 ng/ml already.

You may want to look at this study:

europeanurology.com/article...

In your case they started ADT at a PSA value of 20 ng/ml.

LearnAll
LearnAll
in reply to GP24

Yes. On the day of diagnosis 7 months ago my PSA was 830, this week it is 0.6

I never had Radiation, chemo or surgery. Prostate is intact.

I am just studying about Intermittent ADT and Bipolar ADT. At present, I do not have enough knowledge to say anything definitive about these modalities. My T at this time is less than 5. (it was 650 seven months ago)

GP24
GP24
in reply to LearnAll

In your case I would just continue with ADT because you had an excellent response. I would not touch that. If you start with a holiday, the PSA value will rise very quickly and the holiday will be so short that you will ask yourself if it is worth it.

BAT is a concept you could try when you become castration-resistant.

LearnAll
LearnAll
in reply to GP24

Thanks GP24

. Atleast for next 2 years I dont plan to touch current treatment. I am optimizing treatment with vegetarian food, many herbs and spices ..and this strategy is working beautifully and I have absolutely NO symptoms and minimal side effects at this time.

LearnAll
LearnAll
in reply to GP24

thank you

Whimpy-p
Whimpy-p
in reply to LearnAll

That’s a great drop !😎

Good job completing the chemo.... I’m not the brain here. I think the combo is proven effective. It’s like a one two punch . After the chemo let it be a knock out for pc . Its a treacherous path . Iv yet to do chemo . I do think that Lupron and my Tak -700( that Stops adrenal t production ) was the combo to remission for me. I hope the same for your man . Recovery takes time.

Thanks Lulu700

Chemo response was unremarkable, even with Carboplatin. A bummer, and of course feeding my current suspicion that he just might be a remarkable non-responder. I hope I’m wrong about that.

I’ve never heard of Tak700? I’m going to look it up. Thank you for being here and sharing your love & information— it’s always appreciated.

Chemo is an equal opportunity killer of cancer cells..chemo doesnot discriminate between Androgen sensitive and Androgen independent cancer cells. Hopefully he might have a delayed response.

I just gave blood this morning for checking my Serum prolactin level . The reports say that sometimes the cancer cells are prolactin dependent and they die if you lower serum prolactin level. This test costs only $45 .Something to consider.

Thanks LearnAll

Do we need a baseline prolactin? I’ll have him Get prolactin tested.

Your efforts to research, understand and convey your PC insight to all Of us here is an awesome blessing— keep doing what you do!

Yes...we need a baseline prolactin reading. The reason I got this blood test today is to get my baseline prolactin level and follow it over time

If prolactin level comes at lower end of normal, I will not do any intervention. If it comes high, may use supplements or cabergolin.

The tak-700 trial failed to extend life and was halted . Works for me and a few others . Peace to husband and you . Maybe now recovery can come . Hang in there .. keep hope alive always for good things . Happier New Year !🥳🥳

The Tak test failed and was terminated but they still give it to me . Hope is that his next step will knock it back .. Thank you 🙏

Happy New Year to you! Thank you for being a light here— I appreciate your insightful commentary all the time😊

Dachs...My prolactin level came 9.5 ( normal range 4.0 to 15 ) so its right in middle.

I have read several research papers including Dr Leslie Castello's . Its making a lot of sense to me. I thought of calling Dr Castello to ask her if androgen sensitive (in my case) PCa pt. should be using Cabergolin from now or wait until it becomes Androgen independent.

Cabergolin is an inexpensive med..comes in tablet form costs $20-30 for a months supply.

Side effects are not too bad. Trying to accumulate more info about prolactin inhibition as it seems pretty promising intervention.

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