Lupron, aricept, estradiol?

[kreg001]

Are folks combining an acetylcholinesterase with ADT (Lupron)? Is this being combined with transdermal or cream estradiol?

[Tall_Allen]

Do you have diagnosed dementia? Do you find that Aricept causes incontinence? Are you taking estradiol for hot flashes? Using tamoxifen with it?

[kreg001 in reply to Tall_Allen]

No, not yet, not yet, no.

When I did radiation (IGIMRT) to start this journey I also did Lupron. Got fat, grew breasts, had sore nipples, some hot flashes, and memory issues. Biochemical recurrence after two years followed by salvage brachytherapy. Eventually a second biochemical recurrence. Scans remained negative. The doubling rate led to ADT using spironolactone synergistic with lowering BP and T. Got PSA into the ones. But, spiro is antagonistic to vesicare and stress incontinence was an issue.

Stopped spiro in February. PSA doubled in two months and then doubled again to the sevens. Can’t find an onc in Cleveland who will prescribe patches or cream so I bit the bullet and got another Lupron. When/If it knocks the PSA down I’m wondering if combining it with aricept will help the memory issues and if estradiol will help calcium uptake and make me more ‘comfortable’. Thought some members of this forum may be going down those roads.

[Tall_Allen in reply to kreg001]

Have you been diagnosed with "memory issues?" You can take a neuropsychiatric exam to determine that.

Tamoxifen may reeduce the breast and sore nipples. What is your bone mineral density on a DEXA scan, and are you taking anything for it? Why do you think you need help with calcium uptake? What do you mean by "more comfortable?" Do you have painful bone metastases?

[MateoBeach]

Estradiol topical (patches or transdermal gel) can be used either alone to provide ADT in lieu of drugs like Lupron, LHRH agonists, or antagonists like Firmagon. Or it can be used in combination with these to improve side effects including hot flushes and even help cognitive adverse effects of ADT, which may be considered a form of "chemo brain" even though from hormonal rather than chemotherapy effects. At the same time the estrogen helps protect bone mineralization and preserving lean body mass (muscle) vs. the fat accumulation from ADT. All of this is to the good as long as you follow PSAs as in very advanced PC the androgen receptor can start to be fed by the estrogen and then it must be stopped.

Tamoxifen (i.e. 10 mg/day) can help protect against gynecomastia and nipple tenderness.

If you search "PATCH" or estradiol on this site you will find much related discussion.

Alzheimers disease drugs such as Aricept (donezepil) and others might provide some help from the cognitive effects of "chemo brain" But I am not sure about the effectiveness for the cognitive effects of ADT rather than from chemo.

The following is from the Mayo Clinic patient oriented information on medications for chemo brain:

"No medications have been approved to treat chemo brain. Medications approved for other conditions may be considered if you and your doctor agree they may offer some benefit.

Medications that are sometimes used in people with these symptoms include:

Methylphenidate (Concerta, Ritalin, others), a drug used to treat attention-deficit/hyperactivity disorder (ADHD)

Donepezil (Aricept), a drug used in people with Alzheimer's disease

Modafinil (Provigil), a drug used in people with certain sleep disorders

Memantine (Namenda), a drug used to improve memory in people with Alzheimer's disease, may help during radiation therapy to the brain."

mayoclinic.org/diseases-con...

[MateoBeach]

Here is more on the cognitive effects of ADT in prostate cancer. It is real:pubmed.ncbi.nlm.nih.gov/281...

Furthermore, FSH (Follicle stimulating hormone) may mediate several of the adverse effects of ADT therapy. Since Estradiol therapy decreases FSH by inhibitory feedback on the hypothalamic-pituitary axis this might be a mechanism for its beneficial effects.

pubmed.ncbi.nlm.nih.gov/283...

[kreg001 in reply to MateoBeach]

Thank you. My experience was loss of short term or maybe loss of concentration. I’m a research scientist. Read a lot of papers. Make notes in my notebooks. During my Lupron year my notebooks became confused. I’d read a paper and couldn’t condense it well. I’d start a written sentence and couldn’t finish it. In hindsight and by documentation I was struggling.

I like the estradiol approach. At least it’s ‘natural’ and there is literature suggesting E helps neuron growth.

[MateoBeach]

Thanks for that perspective. Must be frustrating. As for me I’m a physician (retired) but used to digesting and integrating much information.

My experience became clear on ADT when I was studying Sanskrit with an online teacher. I found I could understand everything conceptually. But could not memorize the vocabulary at endings, declensions etc. had to look up everything over and over again.

When I went on estradiol patches everything seemed to clear up over the course of a few months. It is not objective but I feel my brain is operating close to 90%. Close enough to feel like myself again.

[kreg001 in reply to MateoBeach]

Thanks again. Good luck with the Gita. I’ll continue searching for a doc who will ‘script patches.