My Dad was dx two years ago. G 3+3 PSA 26 No mets. He will be 81 in October. He completed 33 sessions of RADS and has been receiving Lupron injections for a year…Onc says 18 months. He is having terrible side effects such as leg pain, trigger finger, hot flashes, fatigue, weight gain and loss of strength. He is a very active 80 year old and this is very hard on him. His current PSA is 0.1. I wonder if there is a real benefit for him to continue lupron for the full 18 months.
Thanks in advance.
With PSA 0.1 and one yr of lupron already done...I think it is time to stop Lupron and monitor PSA once a month. If PSA starts rising, lupron can be restarted.
Hi wvvvb ... this is just my own personal perspective...I’m not a doctor. I am however very experienced with your situation. Your dad “ is “ having some significant SEs but I can tell you they could be a lot worse. You have the bug asleep and hibernating at undetectable 0.1 psa. That’s exactly what you want .. optimum results. If it’s not broke don’t fix it. Going on vacation or plain off the meds allows the bug recover and start growing.
As long as he remains castrate sensitive stick with it. It won’t last forever and every day gained is a day of life saved to spend with family. It’s ever so much better than the alternatives. Yes the SEs are tough , but do able . I’m 74 and enduring SEs worse than those ... I’m sticking with it ... .
There is the consideration of is it worth it at his age ? And that’s an important consideration. At 80 he probably could have many more decent PCa years ( with treatment up into his mid 80s at least ) ... then tho you might consider the balance between treatments and QOL In a time when he could pass from natural causes anyway. You should talk about “ all “ of this with your medical team and seek their advice as well. Wish your father good luck from us, thanks.
Best wishes 💪💪💪👍👍👍
The standard of care is 18 months. At his age, if they stop lupron now most probable his testosterone will continue at castration levels for more than 6 months. They can stop lupron now and check testosterone every 2 months and proceed accordingly.
What probably happened is this: his GS 6 is a hallmark of low-risk PC (which would not require any treatment), however, his PSA of 26 puts him in the high-risk category. Why do these point in different directions? The reasons include:
- the biopsy may have missed any higher Gleason score tumors in his prostate
- the PSA may be a result of prostatitis or urinary retention
So the quandary is whether his prostate cancer is truly high risk. If it is, 18 months of adjuvant ADT (after the radiation) may be necessary to cure him. If it isn't, no adjuvant ADT is necessary to cure him. Let's suppose he is genuinely high risk (the biopsy by chance missed the higher grade areas). In that case, it may not be necessay to cure him completely, just to slow the cancer down enough so it won't bother or kill him for the next 15-20 years. He has already done this.
As Kaliber said: " I can tell you they could be a lot worse." I would compromise on one additional three months shot. Most doctors require 24 to 36 months of ADT in this case, so 18 months is at the lower end.
The Question is how important is QOL. At this point another ADT drug might work as well with fewer side effects, i.e. casodex, zytiga or xtandi.
This is a judgement call. My personal opinion? A Gleason 3+3 in an 80-yr old likely does NOT need the same "standard" treatment as a younger man or a man with more aggressive/advanced cancer. I would suggest that the Onc is doing what many Oncs do: the same thing most other Oncs do, for most other men.
Realize that 18 months is not a definitive duration that would logically apply to all men under all circumstances. It was defined as "the standard" by consensus and by statistical averaging that necessarily ignores the particulars of actual individuals. Does he have actual symptoms of PC that REQUIRE a definitive treatment, or is it merely the high PSA? Many docs might say Gleason 6 alone is not a big concern at that age, and the PSA is NOT definitive for "measuring" cancer..
My 83-yo father-in-law was on Lupron. His doc said stay on it. He happened to switch docs, and the new doc said, why are you even on that? We'll stop. The new doc had no worries that his PC had any chance of killing him before something else did. Why not enjoy the life you have left?
Docs are different. Patients are different. Treatment protocols include "rules" than can be broken.
My own MO told me, a 60-yr with Gleason 3+4 and a few mets, that the milder meds I'm on (bicalutamide, finasteride) are a treatment he generally only uses on older men who might not do well on Lupron... like your father. So perhaps get a second opinion?
But if it were me, I would not subject myself to an extended period of low QoL without a really solid assurance of solid benefit... and I think you are right to question if any potential benefit really outweighs the significant costs of this treatment. For myself, I would go on ADT vaca, and if PSA comes back hard or there are other signs of progression, perhaps renew treatment WITHOUT the Lupron.
Life is short, and it gets shorter after eighty!
As you can see there are a number of perspectives on this subject and all that I see here ...very valid and well thought out. Of course there are so many variables and circumstances that apply as well ...many well considered schools of thought are presented here.
Myself I have pervasive mets and spread everywhere except the meat ...my starting psa a whopping 1400 - 1600. I’m in the school of thought of thought that says “ hammer it down and keep it there as long as you can “ ... but QOL comes into play in the mix and that is very individual. Quite frankly I’d have to say my QOL totally sucks ..it’s the worse, ...I can really see why so many men just can’t take this for what seems like forever. It’s brutal in my case. Still my wife and family are happy that I won’t give up or take a vacation and risk letting the bugs wake back up ... they want me to be here long as possible and I want to be here with them too. I want to be here for ME! Yayahahahaya
I just won’t willingly risk waking the bugs back up and they surely will ... they haven’t gone anywhere . Of course they will wake back up on their own , I can’t stop that but not of my hand. It doesn’t really matter to me how miserable things can get ....there are many really effective ways to slay the “ miserable “ dragon and live comfortably and I’ve learned to master those pretty well.
In all of this tho .. still you want to consider everything you see here and talk this over , at length, with your medical team. We are speaking in generalities but your team will have specific knowledge and information that we could not. Your medical team and your dad need to be the ones to come to a consensus and draw up the final choice. At 80 QOL starts to grow To be a much larger consideration ...
Best wishes wvvvb hoping for good things for your dad.
💪💪💪👍👍
My advice...take Kaliber's advice....
Good Luck, Good Health and Good Humor.
j-o-h-n Friday 06/26/2020 8:57 PM DST
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