On my first 24 month round of hormone therapy I was on Lupron monthly. Now on my second round of hormone therapy, after a 24 month vacation, had a 4 month shot of Eligard followed by a 6 month shot of Eligard. Two months into the recent shot my psa has doubled to 1.16.
Could the 6 month shot have failed?
I get 3 mos....and will forever.....i guess your rising psa is why my mo wont allow vacation....
Pharmaceutical mix-ups can happen, but usually don't. Always a good idea to get a bone scan/CT to check for clinical progression.
Wouldn't monthly psa testing provide more effective monitoring with more data points?
Certainly much less expensive.
And if you seen any anomalous data, you can nail it down with a scan.
I agree on monthly psa testing and thatis exactly what I do. Onco however says quarterly.
This last test was two months because we were out of country when the one month would have been done. Over the 2 months rose to 1.16 from 0.79.
Onco not worried & until I insisted on monthly test said 3 month test was fine.
Any onc that is good with quarterly is just phoning it in.
That may be soc, but I need more from my docs.
I fully agree. Monthly might be excessive if stays within a few digits up and down.
But if shows a progressive increase that increases in amount each month that is different. 0.56 to 1.16 in 5 months is what I speak of.
Tall Allen, can you shed any light on this dosing issue?
If there hasn't been marked progression, monthly PSA is unnecessary - quarterly is fine. I already responded to the dosing issue.
The dosing issue I was referring to was the choice between 1 month, 3 months, 6 months and Vanta.
And potential surges and drops in blood levels as you go from one injection to the next.
It doesn't matter. Leuprolide reaches a steady state concentration in the blood. That's why higher dose depots last longer instead of creating peaks and troughs.
So everyones concern about varying blood levels is misplaced.
Vanta seems to have some clear advantages over shots.
Are you aware of any potential disadvantages of Vanta?
I don't know who you mean by "everyone." Certainly not anyone who understands how the bolus injection works.
Thanks. Sounds like my 6 month Lupron shot is just as effective as the monthly and etc. shots.
Yes Monte...you are okay with your 6 mo Lupron injections....
Good to know. Last time was 6 mo. Eligard because of Lupron shortage. 5 months later, still have a small lump. How can there be a Lupron shortage? A computer chip shortage? The average cost of a new car $40,000? All cars will be electric tinker toy cars in 20 years. Of course, I won't be able to pay my electric bill and will hobble around because I can't afford to drive. I hope they have taken j-o-h-n's driving license away. Clowns should not be allowed to drive. I'm guessing you are TomTom because you stutter? Or maybe you beat TomToms. You should quit beating things.
What do you define as marked progression?
That's judgment, although there is a quantified bone scan index.
So would a rise in psa from 0.7 to 2.18 in 2 months meet your definition of Marked Progression? And NADR was 0.16.
Well, with that kind of PSADT, I don't really see the point of waiting a month for a PSA - I'd be getting an Axumin PET.
Thanks for your input.
I understand but after the one month shot of Lupron my psa dropped to 1.4 so doc waiting until next monthly test and shot. She has not mentioned the Axuimn PET scan yet probably because they are limited to a max of three and had one already. But she offers up going on apalutamide. To be honest she seems to be waiting until worse before doing much. But the psma scan will soon be available and I am in line for that. So maybe that is her goal then treat accordingly.
I will be seeing my Rad Onco for follow up and discuss the PET scan however.
Again Thanks.
Burnett1948 Tall_Allen. I’m having a 3 monthly Lupron injection because I have Low Volume Prostate cancer. How can my Doctors measure the volume of my cancer? I had one lymph node shown on my PSMA scan last August when I started having hormones. I was told the low volume was the reason I wasn’t given Chemo at the same time. My PSA is now almost gone. I have been told it is planned I will be on Lupron for three years. My Medical Oncologist told me Lupron kills Prostate cancer. Is that correct?
They measure the detectable cancer volume from the PET/CT. There is controversy about use of chemo for low volume - I support it. I don't know why they are limiting Lupron to 3 years - are you sure that didn't say that you may become castration-resistant in 3 years? Lupron does kill hormone-sensitive PC.
Burnett1948. Tall_Allen My Radiation Oncologist didn’t say I would become castration-resistant in 3 years. I think I understand what Hormone-Sensitive means: I can only think that with castration-resistant the Hormone stops me from any benefit from physical castration? Thank you for your advice.
No. One continues using Lupron even after it becomes castration resistant. That's why I found the 3 year limit strange.
I didn’t know they offered a 6 month my dad always gets the 3 month one
They also have a 4 month shot.
my experience after 15 years of 6 monthly Eligard there should be no difference -my PSA is 0.024 but I also taking xtandi for 4 years-Eligard on its own lasted 8 years
Wow! bryson! That’s a fantastic run .
Leaving aside the difference between Lupron and Eligard, I was always dubious about the difference in accurate release between 1 month, 3 month and 6 month injectables.
Does anyone have any data on the reliability of the dosing. And the stability of the dosing at the start and the end of each dosing period?
Does anyone have any data on the relative performance of Lupron and Eligard and vantas.
I have always assumed their actual performance of the acting ingredients was the same. I have always wondered about stability of dosing though.
I find it difficult to believe that there are not material differences between them in stability of dosing.
Nalakrats mention about the ability to remove vantas makes it a particularly interesting option.
Does anyone have any hard data on the stability and control of blood levels with the various dosing options between and among these three options, and their concomitant dosing options?
I am asking the same question.
Principal of adaptive therapy...NAT
How does the physical aspects affect dosing....a person with BMI 30 and 6' and another BMI 18 and 5'6''.......can't be the same dose input volume or weight wise....
Sure in protocols....easy to have one number fit all....
Can one extend 3 months to 4 months with low BMI.....
Is Vantas available globally ?
Mean data for Eligard formulations (graphs starting on page 24):
accessdata.fda.gov/drugsatf...
[Edited the link to get more directly to the PDF]
Testosterone control by the drug is the parameter of interest. Other sheets are out there for Lupron, etc.
Great information! Thanks.
Suggestion on finding the sme info for Lupron.
I have found anecdotal evidence that men who work for the Lupron mfg as reps that also have Pca only take one month shots due to longer duration wearing off.
During my first go around I had the 3 month shot once and felt the side effects stopped mid 3rd month. Mentioned this to the Rad Onco staff & Doc. All agreed. Then back on monthly.
I did monthly Lupron for 18 months, preferring to lower the initial peak of Leuprolide in the system, and maintain a lower average concentration. I really didn't buy into the time-release mechanism claim that is supposed to keep a constant dose profile.
"Maybe 12-15 months, then go back to the once a month Lupron, for @ 12 months,"
Should the vacation lengths not be governed by the monitoring of psa levels, at least in large part?
Thanks, I think the vacation was until failure. Then back on ADT.
FYI - My initial Gleason was 9, aggressive and incurable. So return within 5 years or less was 93% chance.
I've been on Eligard for three years now and my PSA is at 0.1. All of our Cancers are Advanced Prostate Cancer but if all I have read and researched every person's Cancer is different in some way so what might work for me doesn't for you. Have faith in your medical team. Never give up Never surrender. Leo
Thanks, that is the way I feel too. My onco was very reluctant to agree on one monthly test in three weeks. Then will have her NP call to discuss.
My psa was Aug 0.55, Sept 0.64, Oct 0.66, Nov 0.68, Dec 0.76, Feb 1.16
Cannot imagine this next test will be lower.
My plan is to push back harder than I did to get her reluctant action. And she knows that.
Will report back on results, 3/17/21, and NP response, 3/19/21.
Unless you've had your prostate removed, that PSA is exceedingly low.
But tgere is a standard followed by many relating to velocity of change and doubling time.I do agree that my psa is low but under my first round of Lupron it hit 0.16 for a few months.
So my concern relates to doubling time not the actual psa. Present onco dor seems to not feel the same.
I agree, the doubling time is more important than the number itself, and most of the research I've read shows the same. But the number itself is also important, as most of us with micro metastasis (no detectable tumors) can allow it to increase multiples but not worry about tumors showing up until it's way into double digits. Every guy reacts differently to ADT and everyone's situation is different, but for me, after discovering micro metastasis but no detectable tumors, I just change my diet, and continued a program of supplements and vitamins for a year and a half till my PSA went from 7+ to 45+ and a tumor was discovered in a lymph gland near the prostate. I did double ADT for 6 months at which time the PSA had dropped to near-zero and the swelling in the gland disappeared. I stopped treatment then and didn't start again for a year, till my PSA reached above 5. From then onward (now nearly 5 years), I've done nothing but intermittent treatments--avoiding them during summers at all costs as the hot flashes are horrific for me, and my PSA has bounced around from as low as .003 to 30 (just last fall) yet a scan from groin to heart last fall showed now sign of anything amiss.
I truly consider it a modified form of watchful waiting, and fortunately, I have a doctor now who's in total agreement with me. Last summer when after no treatment for 3 months PSA climbed to over 7, he just suggested doing a scan (first in 2 years) and waiting till cool weather in the fall to do an injection.
Hi Nalakrats,
Doesn’t the Vantas implant treat only the symptoms of PCa and not the cancer itself? Thinking about the different SEs vs. Lupron.
Thanks, Billy
Contrary to what TA says above, effective Lupron dosing profiles are not the same for 1- and 3-month Lupron versions . I looked into this during my 18-mo Lupron tx, and chose to take the 1-month cycle because the initial peak serum level and steady state level is significantly lower. Also the T-flare after the initial shot is lower for the one-month version. Also, I decided to time-space the one-month shot every five weeks because I found that the American dose is 2x the recommended European dose, and found this worked to keep my T < 12.
Here's the data on the mean plasma concentrations for the 1-, and 3-month cycles (ng/ml).
Serum levels at 4-hours: 20.0 versus 48.9
Steady state serum levels: 0.36@4wks versus 0.67@12wks
So the one month dose actually gives a smoother dose profile with a lower peak at 4-hours and lower steady-state level at the end of the cycle.
Interesting post. The data for Eligard is similar but somewhat higher for 1 and 3 month injections
If I was retired I might elect the 1 month injections but working full time I'm comfortable doing the 3 mo injections of Eligard
My personal observation that I record and write about in a published book is that the 1 month shot is nore effective. Even my rad onco agrees. Only reason for 3, 4, 6 month shot is to see you less often.Same logic for quarterly psa test vs monthly.
In my case after the 6 month eligard my two month later psa, that I did not post in my previous messages reached 2.18. This was three times the low before the 6 month shot.
Also was less than quarterly.
Tripple and less than three months!
We are NOT all the same and if I had followed SOP my psa might have been 4.0 or worse.
What harm is there in monthly testing? None.
But it should be the patients choice.
Can understand the monthly protocol for the single digit psa.In my case, the 3 mo psa test is adequate given my < 0.1 test results for 14 months now. My Oct was <0.01, so it's plausible I've been that low for 14 months. Different psa tests have different lower range of sensitivity and I normally get the <0.1 psa vs <0.01 psa.
It is interesting that everyone wants the cost of care to come down but not the rate of using care. Every test and Dr visit adds cost to the system but is there a real return on that cost or is it done for psychological reasons?
Not a shot at you but putting that out there for consumption
I agree on your reasoning about costs. My thoughts are low consistent psa on a few monthly warrent going three months or possibly more. Also no need to see the doc unless numbers require. Six month or more would seem to be good.
However if the numbers are rising, even slowly, more often seems warrented.
As to the psychological reasons? Of course that enters into the mix. My lowest, NADR, was 0.16 and recent before getting the one month shot was 2.18 and that was after a 1.16 the month before. So following the offer of quarterly would have been no good. I have had one PET Scan and it found some spots in my pelvic lymph nodes. Biopsy found no cancer but was radiated for best practice.
I fully understand the No Shot at me and did not take it that way nor is this anything other than offering more data.
I offer my numbers and experience openly because we are all different in our pathway with this Cancer. Have just last visit taken a blood test for the Genetic test.
Everyone - Keep posting and offering where you are with this and how you are doing. It helps to see the different paths.
Hi,
Would an urologist or RO be more willing to prescribe this. Neither of them have mentioned this.
Thanks
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