Different ADT medicine ?

[lewicki]

Instead of Fermagon or Lupron there is a drug that only stays in the system for a month instead of six months. This allows to go on vacation as drugs are out of the body. Just finished my fourth treatment at University of Heidelberg for AC-225 and LU-177. After only three weeks PSA is .2. Planning on after six months may try a vacation. What is the name of the ADT drug. Thanks

[Tall_Allen]

Relugolix is a pill, but it will not be available in the US probably for 9 months or so. It lasts only as long as one takes it -not a month. Lupron and Firmagon can be given in monthly shots.

[lewicki in reply to Tall_Allen]

Other than a pill instead of shots I wonder if will be easier on us?

[Tall_Allen in reply to lewicki]

It's just a GnRH-antagonist, like Firmagon, in a more convenient form. I wouldn't expect any difference in side effects.

[lewicki in reply to Tall_Allen]

You can then go on vacation faster.

[tango65]

I believe Firmagon stays in the system for about 40 to 50 days.. Lupron depot 3.75 mg it is supposed to last only for a month .

[RonnyBaby in reply to tango65]

Lupron lasts more than a month, unless you've only had a single shot given to you on a one time only / one month basis.

Research / reading has indicated that Lupron has a 1/2 life, similar to some radioactive stuff.

Basically, it boils down to a one to one ratio - time on Lupron = time (off) to full recovery.

One year on Lupron, will take about 1 year to clear out completely.

That's what I was told and it has been my experience that this was pretty accurate.

I went on an ADT vacation, after being on the drug for nearly 18 months. It took about 1 1/2 years for my 'T' to fully recover and at least one year before my PSA numbers moved off the undetectable range and start to slowly climb.

It was predicted that this was a likely outcome - and it happened the way they said it would .... time on = time off = recovery time - assuming no BCR .... to the 'normal' PSA reading that one would expect (trace around ~ 0.5 or less)

[tango65 in reply to RonnyBaby]

The time to recover normal T values after stopping Lupron depends on how the testis were affected by the lack of hormonal stimulation. This is very variable from man to man and it may be worse in older people and people with low T values when Lupron was started.

I had only one shot of 3 months Lupron and my T is less than 12 four years after stopping Lupron. Basically it put my testis to sleep forever. It is call free Lupron for life.

[RonnyBaby in reply to tango65]

Your comment points to the fact that any shutdown duration has some variables that could make the recovery prospects worse. It is a prediction that I would be reluctant to make, but I've learned by reading what others have experienced over the years that some never recover. It took me a fair length of time to stop the hot flashes due to my low 'T' while I was 'recovering'. I was closely monitored, but in reality, the flashing became my 'test' as to what was really happening ....

[tango65 in reply to RonnyBaby]

If you get a doctor willing to prescribe transdermal testosterone to get a normal testosterone blood level, this problem is solved. I believe intermittent ADT and continuous ADT do not have a significant different outcome because most people in intermittent ADT continuous to be castrate or hypogonadal for a long time. The real problem is to get doctors to prescribe testosterone when one has PC. I could not get any doctor I consulted with to prescribe it.

[RonnyBaby in reply to tango65]

I'm in Canada, where different SOCs and practices exist, although there are some similarities.

Getting a doctor to play ball with various patient requests is not easy and sometimes, what we see as hope or relief doesn't fit their mindset or training.

QOL means different things to different people.

[lewicki in reply to tango65]

My oncologist will prescribe it. Since I was having great luck going to Germany we are holding off. Although it may be a good idea to do now since the cancer has been weak and adding T just might finish the cancer. At this time I do want to go off ADT and feel normal.

[lewicki in reply to tango65]

Not good. Oysters ?

[GP24]

I took Bicalutamide after the Lu177 infusion. Makes you feel like being on an ADT vacation. When you stop taking the pills the drug is cleared from the body very quickly.

[lewicki in reply to GP24]

Does Bicalutamide act similar to Fermagon or Lupron without side effects of no T ? I have been on an ADT for a very long time. Body is hurting.

[GP24 in reply to lewicki]

ADT shall stop the cancer from growing further and often makes it shrink to some extend. This can be achieved with Bicalutamide as well. Doctors are convinced that it does not work all that well as Lupron or Degarelix. But with a PSA value of 0.2, I think you can use a drug which may be a bit less effective.

[noahware in reply to lewicki]

Bicalutamide acts on the androgen receptor in cells, so it limits some cellular action of T (for a time) but does not limit the production of T, as do Firmagon and Lupron.

Many of the side effects of no T are actually from having low estrogen, which results from cutting T production. Bicalutamide avoids this, and estrogen levels actually rise to the point where breast growth/pain is possible (the drug Tamoxifen can help prevent this).

So yes, fewer SEs with Bicalutamide. The other possibility is to add low-dose estrogen to the ADT to reduce SEs related to estrogen loss, if ADT is continued or resumed after vaca.

Bicalutamide is generally well-tolerated and effective, but less effective than newer meds. It also may ultimately (after years?) switch actions to promote AR activity rather than block it, and start feeding cancer progression. This would normally be readily seen by noting a rising PSA or new/renewed metastatic activity on scans, and the med discontinued.

[noahware in reply to noahware]

I will add, older men looking for QoL improvement are no longer totally discouraged from pursuing TRT (whereas only a decade ago, any replacement of T was almost universally contraindicated in men with PC).

[It makes sense to suppose the body and the cancer might respond differently to the injection of supraphysiological levels of T into the bloodstream than it would to natural T production by the body. Huggins in 1940 said: “malignant cells can regress from too little or too MUCH hormone” but one should also emphasize the word "CAN," because we know cancer can also PROGRESS in environments of low or high T.]

This of course carries risks and unknowns, and should be researched and discussed in depth (with docs, patients, researchers) before considering its pursuit.

[lewicki in reply to noahware]

Thanks

[Hidden in reply to lewicki]

5 years for me buddy ..😂

[lewicki in reply to GP24]

Thanks

[mangeycritter]

Nalakrats is on sabbatical until October, but he may still reply to your post. If not, search for his posts on using Vantas (histrelin), which he uses. A capsule is inserted in arm. Rather than a jolt of drug, it produces a steady daily drip that usually lasts for about a year. To stop the drug, simply have the capsule removed. According to Nalakrats, a much friendlier drug with fewer side effects. As best as I can determine, not commonly used. Don't know why.

mangeycritter

[lewicki in reply to mangeycritter]

Received Fermagon today . Achy in the abdomen. Have to get a break from this.

[Magnus1964]

Casodex (Bicalutamide) would be a good choice. It's a older ADT drug with less side effects.

[lewicki in reply to Magnus1964]

Next visit to MO will be going over this with him.

[Coastguy]

I have been taking a 50 mg tablet of Bicalutamide daily along with a 10 mg tablet of Tamoxifen since last August when my PSA had reached 65 and a non operable tumor was found on the wall of my rectum. My latest PSA<.02 and the tumor had shrunk by 33% following an Axumin last October, I’ve been fortunate to have very few side effects and continue to walk 7 miles and play golf daily.

[Hidden in reply to Coastguy]

Good report Coastguy .

[JTrack]

I was on Firmongon, monthly injections for 4-months and it took almost 6-months for the hot flashes to stop. I really didn't have any other side effects aside from the hot flashes.

[lewicki in reply to JTrack]

I think I recall Nalakrats saying it takes 6 months. What he now takes only is a month.

[TheTopBanana in reply to JTrack]

How long were you on Firmagon?

[lewicki in reply to TheTopBanana]

Still on it. OM and urologist suggested to go off it. German doctor says no. Been on it and Lupron for 6 plus years.

[TheTopBanana in reply to lewicki]

May I ask their reasons for you to go off it?

[lewicki in reply to TheTopBanana]

Fatigue, muscle loss, 2.5 inches of height overall feel good.

Was not given meds for bone loss, did not know to ask. Urologist and MO I think did not think would live so long ??? Poor doctoring?

[lewicki]

Looking to doing a possible vacation from this stuff. Hoping adding alternative supplements and that after four treatments of LU-177 and Ac-225 I might have an improved life . Wishful thinking?