I got my first Lupron shot on 5/25/20 and started the Zytiga on 7/3/20. I'm an original Gleason 8 PSA 50 with extracapsular extension. Now with 4 bone mets about 3 years after HDR Brachy, IMRT, and 8 months of ADT. Here are my numbers:
5/22/20 3.41 ----377
6/19/20 .87 ----9.5
7/16/20 .12 ----26
8/13/20 .09 ----57
From what I've read it's extremely important to keep my Testosterone below 20 for the best long term results. Is this normal for testosterone to bump up?
Ideally you want the T under 20, but Lupron doesn't guarantee below 50. You're fairly close to that, but it's too high really.
This happened to me too, although mine didn't get quite as high as yours. The important thing is that your PSA is still down. I'd want to keep an eye on that as my doctor is doing with me. You might have to switch to a different drug if it doesn't stay down.
Discuss to repeat the study and if the testosterone is about 50 you could discuss getting a firmagon shot which will take your testosterone down to castrate levels in 24-48 hours. Then you should discuss what drug you should get to maintain a testosterone below 20.
According to their 2009 manufacturers study, "Degarelix was as effective as leuprolide in suppressing testosterone levels from Day 28 to the end of the study (Day 364), with 97.2% of the degarelix patients maintaining medical castrate levels compared with 96.4% for leuprolide".
It looks like there isn't much of an advantage after the first month.
I did not say that there is an advantage in using firmagon. You need to have testosterone at castration levels and you do not have it, the way to get to castrate levels very quickly is using firmagon. When your testosterone is below 20 you can discuss with your doctor how to proceed.
Lupron doesn't seem to be doing its job, discuss switching to Firmagon.
I'm sure my insurance company would much rather get rid of the Zytiga. How do I know which one(or both?) is failing?
Lupron's job is to eliminate T production by the testicles, which is the major source. Zytiga targets adrenal and intratumoral synthesis of androgens (not necessarily T). If Lupron were working, serum T levels would be lower.
I'll bring this up with my MO tomorrow. Thanks.
I would get another testosterone test before using a different drug. The testosterone level varies during the day and some test devices are not the best. Your PSA value drops, so this is good.
You might try changing primary ADT to Degarelix as suggested by others. Just seems to be more effective overall than Lupron for some of us. MO started and continued me on Firmagon as primary ADT for 9mos (T consistently < 20). Switched to Lupron at my request to avoid the stomach shots, and saw T rise to 50 in 3 mos like in your case. Switched back to Firmagon and T immediately declined and remained < 20 for a year. After ADT vacation for diagnostic purposes, resumed Firmagon w/ added Zytiga through IMRT. T dropped and remained at < 7 for 1 year TX protocol. My MO indicated he saw this same pattern in some of his other patients too.
FIRMAGON LUPRON NOW ZYTIGA PSA
DRAMATIC PSA RISE W/ZYTIGA
Lupron and Zytiga working, PSA 1000+ to PSA 0.02
PSA results Lupron + Zytiga working beautifully
