Side effect comparisons: Adovart vs Lupron

[ron_bucher]

I'm interested in hearing a comparison of side effects. I have not had Avodart but might consider it down the road. My main complaints about Lupron include: decreased metabolism leading to obesity, loss of muscle mass, loss of bone density, fatigue and lethargy.

[Tall_Allen]

It's apples and oranges. Avodart is a drop in the bucket vs Lupron - it's not at all a replacement.

[ron_bucher in reply to Tall_Allen]

Can you elaborate? Drop in the bucket in terms of side effects? Or effectiveness? Both? Don't both have the same purpose?

[Tall_Allen in reply to ron_bucher]

Both side effects and effectiveness, actually. No, avodart does not do the same thing that Lupron does. Avodart only blocks conversion of T into DHT, leaving tons of T around to activate the androgen receptor. Lupron prevents T from being formed.

[ron_bucher in reply to Tall_Allen]

When guys report low PSA on Avodart, is that false confidence?

[Tall_Allen in reply to ron_bucher]

Sorry, I don't know what guys you are referring to and what their diagnosis is. Avodart is a treatment for BPH, prevents PC, and delays progression on active surveillance. It has no role post-prostatectomy.

[ron_bucher in reply to Tall_Allen]

Why does prostatectomy change the role of Avodart in preventing PC progression?

[Tall_Allen in reply to ron_bucher]

Because GS3+3 tissue in the prostate is a whole different beast from metastases. Avodart doesn't even have any effect on higher grade PC in the prostate.

[ron_bucher in reply to Tall_Allen]

I have a friend who has very advanced cancer and has reached very low PSA with Avodart.

[Tall_Allen in reply to ron_bucher]

No, he didn't - but I don't doubt that's what he told you. Advanced PC is too serious a disease to manage by anecdotes from friends.

[ron_bucher in reply to Tall_Allen]

I find it offensive to have one of my good friends called a liar. He's 18+ years into his prostate cancer journey and knows as much about prostate cancer as any patient I know.

[Schwah in reply to ron_bucher]

I find weight training to be very effective for muscle loss, bone density loss and weight gain. But I trained very hard 3 days a week for almost 1.5 hours. Lots of reps. I was actually able to lose weight and gain a little muscle. But it wasn’t easy. Well worth the effort tho.

Schwah.

[Tall_Allen in reply to ron_bucher]

I'm saying that you are fooling yourself by believing something as untrue as Avodart is as good as Lupron. You think that what makes it true is that your friend said so. Neither you nor your friend understands the science, apparently, and acting on your mistaken beliefs can harm you.

[ron_bucher in reply to Tall_Allen]

"Avodart is as good as Lupron" are your words, not mine nor my friend's. My question was not about efficacy. I rely on my oncologists for that. Patient feedback in comparing side effects is what I was seeking.

[Tall_Allen in reply to ron_bucher]

The side effects of taking an 81 mg aspirin are minimal, but the side effects of fentanyl are substantial - what is the point of comparing side effects of 2 drugs that are so completely different?

[ron_bucher in reply to Tall_Allen]

Allen, I make all my medical decisions based on risks and benefits to me. My regular MD believes my benefit from 81mg of aspirin does not outweigh the risk, so I stopped taking aspirin. If my oncologists think Avodart might be a reasonable alternative to Lupron for my case, I will consider it. I'd rather have RP, IMRT, or Taxotere again than Lupron. At some point, I might need to make a difficult decision between quality and quantity of life. Only I can make that decision, and accept the consequences.

[ron_bucher]

I'm looking ahead. PSA is currently stable but detectable after RP, IMRT (twice), and Taxotere. Lupron gave me the worst side effects, so I'm hoping to avoid it.

[ron_bucher]

decreased metabolism leading to obesity, loss of muscle mass, loss of bone density, fatigue and lethargy

[ron_bucher]

Vegetarian with seafood. 40-60 miles per week cycling, tennis weekly, full time desk job.

[DarkEnergy]

I hear you, but the side effects of unabated caner cells running around in our bodies would be devastating.

[noahware]

So far as I know, Avodart (or the similar drug, Proscar) is never used to replace ADT drugs in PC treatment but used either along WITH the Lupron or else AFTER the Lupron is discontinued.

So certainly the side effects would be different, since Lupron limits T production and those drugs only limit the conversion to DHT, the most potent form of androgen.

I think those drugs have been used as stand-alone post-ADT-treatment by some MO docs, like Myers and Liebowitz, but are not used INSTEAD of ADT for the primary prevention of PC progression. Regarding your friend's use of it, it would be interesting to know his treatment history and/or who his docs have been.

[MSTI in reply to noahware]

Hi Noahware,my onco told me that he wouldn't give me Avodart because of post RP adjuvant EBRT which had changed my androgen receptors.

pubmed.ncbi.nim.nih.gov/314285576 was about Avodart to near BCR patients, but people with ADT or EBRT administered after RP were not included.

It seems that benefits were not significant (for majority).

[noahware in reply to MSTI]

Interesting. My MO would not agree to bicalutamide monotherapy WITHOUT adding finasteride, I believe because there was a study using both that led to a possible conclusion of increased efficacy.

[ron_bucher in reply to noahware]

My friend started Avodart after Lupron. He's seen a dozen or so docs over the past two decades including those you mention.

[noahware in reply to ron_bucher]

So then it makes more sense now to me (but probably not to TA), because after a period of ADT some MOs like Liebowitz would recommend what he called "Proscar maintenance" where they would use just that drug , alone, and watch for progression (via scan or PSA).

So it amounts to a version of ADT "vacation" which proponents of a Lupron-for-life approach would not approve of.

Never having done Lupron, I am on bicalutimide + finasteride (= Casodex + Proscar) and have very few SEs, but have also been taking tamoxifen to prevent the breast-related SEs. The main SE for me is loss of libido.

With these drugs I actually have an increase in serum levels of both T and E, since they are working mostly on the receptor. Assuming you recover some T (or even get TRT) I don't see that you would have SEs even close to what you get from Lupron, so far as obesity, loss of bone density, fatigue and lethargy go. But some men do have issues like depression, as well as the sexual SEs.

[ron_bucher in reply to noahware]

Thank you!

[ron_bucher]

I should have made my request more clear. I'm interested in hearing from men who have had Lupron, and Avodart without Lupron, and how their side effects differed between those two treatments. I rely on my medical oncologists for advice on treatment efficacy for my specific case, so I'm not really looking for efficacy information in this forum.

[MateoBeach]

Ron I seldom take exception to the Tall One's views. But there is an alternative to Lupron (and similar) using Avodart (dutasteride) combined with bicalutamide for some patients who are BCR with rising PSAs and are intolerant of Lupron.

Such was the case with me. I found the following article and discussed the possibility with my MO and then consulted with the renown Dr. "Tia" Higano (from Seattle Cancer Care Alliance) about it. She signed off on it saying that it might not be as durable of control as Lupron drugs, but that it was acceptable as an alternative.

sciencedirect.com/science/a...

Bicalutamide blocks androgen receptors (not androgen production) so you actually have functional testosterone levels while on it. Cancer cells' AR receptors, if not mutated, do not "see" it. But the more potent DHT is still a problem, so dutasteride (or finasteride or both) is added to block the conversion to DHT and keep a low androgen environment for the cancer.

The side effects are minimal compared to Lupron because you still have some circulating testosterone. Minimal or no weight gain and muscle loss. Minimal hot flushes. There can be some breast tissue stimulation from testosterone being converted to estrogen. This can be controlled either by having preventive low-dose radiation (1 to 3 treatments) to the breast tissue (was very easy). Or by taking tamoxifen 10 mg when/if this starts to develop.

Of course you must continue to monitor progression, especially regular PSAs. Goes without saying.

Eventually the ARs will mutate and come to be stimulated by the bicalutamide rather than blocked and PSA rises. That is the end of the road for this treatment and it must be stopped. PSA will often fall again for awhile upon stopping.

I started bicalutamide 50mg/day plus dutasteride 1.0 mg/day as an alternative to Lupron ADT when I was BCR after RP and SRT and my PSADT was around 3 months. The regimen brought my PSA down from over 5.0 to the 0.1 area but not undetectable, and stayed there. I felt great and had 4+ good years on this regimen before the bicalutamide failed me.

I assume, since you are asking, that your PSA is no longer undetectable, Ron. Keep fighting and keep living your best life. For me this approach was reasonable and beneficial and I knew I could always fall back on standard ADT (which itself is doomed to fail anyway!) Best of luck and good humor. Paul

[ron_bucher in reply to MateoBeach]

Paul, thank you very much for sharing your experience. I appreciate it very much. Best of luck to you. Ron

[j-o-h-n]

I like Lupron.....cause I get a smiley face bandaid on my injection site........ 😊

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 12/12/2020 9:51 PM EST

[jazj]

Advodart seems to be a really hot topic on here. You might read this other thread. This is a reply to my last reply there (notice my last paragraph and the following image of the graphs.) I am speaking from a data standpoint and not first hand experience going through ADT. Just scroll to the top and you can read all the replies.

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