Lupron and Prostate Cancer

[dac500]

I have come across statements like: Lupron can kill prostate cancer, prevent cancer cells from growing, shrink tumor, etc. I am just curious to know what fraction of cancer cells are killed by Lupron and what fraction is kept dormant while on Lupron.

[LearnAll]

Lupron doesnot kill prostate cancer. Lupron shuts down testes cells (leydig cells) which produce testosterone. When Testosterone goes down and reaches less than 20 ng/ml (castrate level) then, prostate cancer cells can not live as they require testosterone to survive and multiply.

What percentage of cancer cells will be killed by very low testosterone is a very individual matter. There are people like myself, whose PSA went all the way down to 0.2 ..and that means almost all cancer cells might have died.(except some small number of cancer cells))

Then, there are men whose PSA only goes down to say 5 or 6 or 8 ng/ml and does not go further down. In those cases a larger number of cancer cells stay alive and likely to multiply again.

The lowest level PSA goes down with lupron treatment is called NADIR PSA...and lower the Nadir ..longer the survival.

In cases where Nadir PSA is still high with use of Lupron, it is a good idea to add bicalutamide or Abiraterone or Enzalutamide ...to reach lower Nadir PSA.

[dac500 in reply to LearnAll]

I know Lupron lowers Testosterone and lack of Testosterone will slow the growth of tumor.

[ctarleton]

As a layman, I would not be very well qualified to discuss "exactly" how lowering one's androgen/testosterone level using something like Lupron works to initiate either the "death" or "dormancy" (whatever that may or may not mean in the context of an individual cancer cell of any type). I suspect that it is a VERY complicated molecular biology question that is far from completely known, despite so much that is already known about such things.

I have a feeling that sometimes those exact answers may not be relevant for many Individuals in their particular prostate cancer states, or in making treatment decisions.

I recall that my initial PSA with Lots of bone and other "mets" was a ridiculous 5,006. When I went on Lupron my PSA went down to 1.0. Did that mean that roughly 99.98% of my prostate cancer cells were either killed or went dormant within only a few months? And, if so, what might have been the purported "mix" of dead vs. dormant cells?

About 3 years later, after Lupron alone became less effective by itself for me, I recall having a PSMA-PET/CT scan and a PSA rising again to as high as 95.0, with around 10 "hot spots" showing up on the scan. Those kinds of numbers probably imply mutated/adapting cancer cells re-proliferating in numbers totaling in the millions upon millions again. Adding some secondary treatments took my PSA back down to 1.2 again.

In my own mind, the rumination and anxious over-thinking about some of these perhaps unknowable "details" more often causes me more undue anxiety and suffering than not, and would not have changed any basic treatment decisions. Easier said than done, though.

Charles

[dac500 in reply to ctarleton]

In your case, you may have castrate resistant cancer cells not responding to Lupron alone.

There are cases where men have gone through several IADT cycles. Every time they stop ADT, the PSA starts rising once Testosterone rises above castrate level. PSA goes down once ADT is restarted. In such cases, hormone sensitive cancer cells become dormant under ADT to wake up during ADT holidays. That seems to be a plausible answer.

[LearnAll in reply to ctarleton]

A simple analogy is that cancer cells are like weed growing in your garden...you spray the weedkiller called "Lupron"...almost all of the weed dies except very small patches here and there...

but just like weed..the leftover cancer cell tend to grow back reflecting as increase in PSA...

sometimes this new weed is more hardy and harder to eliminate (think neuroendocrine)

More weed is eradicated in initial attempt..less weed remains to regrow..and therefore takes much longer time to grow back.

[j-o-h-n in reply to LearnAll]

Smoke the hardy weeds..........(but rinse first - dog pee)

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 05/16/2020 6:27 PM DST

[Tall_Allen]

ADT kills hormone-responsive prostate cancer but not any hormone-independent prostate cancer you may have in your body. Early on, it's mostly hormone-responsive. Later, it can still control the growth even when its castration-resistant.

[dac500 in reply to Tall_Allen]

Thanks for your reply. You can clarify some of the confusions I have.

Is there any difference between hormone-independent and castration-resistant prostate cancer? When Testosterone is at castrate level, does hormone-independent prostate cancer produce little or no PSA?

Recently, there is news that Lupron can lower the risk of getting or dying from Covid-19. Is this news significant enough for someone to end ADT holiday and restart ADT even when PSA is still undetectable ( < 0.10) ?

[Tall_Allen in reply to dac500]

Is there any difference between hormone-independent and castration-resistant prostate cancer? No. Not for the patient overall. But on the cellular level, prostate cancer cells may continue to express external androgen receptors that are activated by testosterone and other androgens.

When Testosterone is at castrate level, does hormone-independent prostate cancer produce little or no PSA? Yes, the prostate cancer continues to produce PSA.

Recently, there is news that Lupron can lower the risk of getting or dying from Covid-19. Is this news significant enough for someone to end ADT holiday and restart ADT even when PSA is still undetectable ( < 0.10) It's a judgment call of course. I would.

[LearnAll]

Hormone independent and castration resistance are basically two different names for the same condition.

I will not stop lupron to avoid Covid 19. I will rather wear double masks and practice social distancing meticulously. and wash my hands many times with Isopropyl alcohol.

Moreover, I will stay with minimum clothes in bright sunlight as ultraviolet light from Sun kills coronavirus. Vit D is bonus for doing it.

[j-o-h-n in reply to LearnAll]

Forget double masks..... that's to guard the public against you (not visa versa).... wear N95 mask by 3M company (if you can find them)...

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 05/16/2020 6:32 PM DST

[Don_1213]

You said "I will not stop lupron to avoid Covid 19" - when I think what you meant was "I will not restart Lupron to avoid Covid 19" - happily (perhaps) I still have a month or two to consider that option. Last shot was April 2nd.. and that was supposed to be the last of Lupron for me.

[LearnAll]

I did not express it right. What I meant is that mere protection from Covid 19 is not a good enough reason to start lupron..if you do not need it.

But there are many valid reasons to not continue lupron...due to toxic side effects..and thats why I am in OFF period of intermittent ADT currently.

For protection from coronavirus, I am on my immuneboosting concoction..called KADHA..

which contains Turmeric, ginger, black pepper, cardamom, cloves ,small amount of Manuka Honey ...boiled for 5 minutes in water. Add 10 drops of ionic zinc ...strain and drink daily.

This concoction boosts immune sysytem and may make covid19 infection less fatal even if one gets the infection.

This concoction is being used in millions of households in India and public health dept is promoting it on TV, internet and radio. If you look at data at website, WORLDOMETER,

the infection rate is high in India but death rate is one of the lowest in the world so far.