Just got my last Lupron shot (hopefully) ...

[fireandice123]

or at least a nice long vacation from it. I just had my appt with my MO. My PSA is 0.2 (still have a prostate). The plan was to come off of Lupron in October which is about 18 months after the end of my RT last year. My prostate and the bony mets in my pelvis were zapped. We decided to come off 1 month early and he gave me a 4 month shot. Fingers crossed. We'll now see how well it worked. The Lupron gave me a safety blanket that will be pulled away in 4 months. It'll be nice to be off of it but it's rather scary as well.

[6357axbz]

You say you “still have a prostate” but later say your prostate was zapped. Seems contradictory

[Tall_Allen in reply to 6357axbz]

Radiation doesn't get rid of the prostate.

[6357axbz in reply to Tall_Allen]

If the RT was successful isn't the prostate no longer a functioning organ, incapable of producing PSA?

[fireandice123 in reply to 6357axbz]

Good question. According to cancer.org

"After radiation therapy

Radiation therapy doesn’t kill all of the cells in the prostate gland, so it's not expected to cause the PSA to drop to an undetectable level. The remaining normal prostate cells will still make some PSA.

The pattern of the drop in PSA after radiation therapy is also different from after surgery. PSA levels after radiation tend to drop slowly, and might not reach their lowest level until 2 years or more after treatment."

[Hidden in reply to fireandice123]

That wasn’t the case with me. I did Lupron and tak 700 two months prior 8 weeks imrt . I went undetch immediately after Rt and have stayed here over five years . But who’s counting? I consider myself blessed and lucky to be here . There are exceptions to every rule . Good day brother .

[VHRguy in reply to Hidden]

To clarify for others reading this, Lulu700 per your post below you have had an orchiectomy, and also adrenal T suppression ("pill form ADT"). Hence you are on permanent ADT now.

That superb level of T suppression would keep your PSA down until your cancer becomes "castrate resistant", as it usually eventually does. Your low PSA is only partly from radiation, but mostly from your ADT. The comments about post-radiation PSA pattern apply to those without the accompanying ADT.

ADT given for a time after radiation therapy will mask what would otherwise be seen post-radiation. If and when the ADT is discontinued, the PSA may fairly quickly rise to the level it would have been without ADT.

Of course after an orchiectomy, without T supplementation you wouldn't ever expect to have much T again (adrenals only).

[Hidden in reply to VHRguy]

Who knows? It’s all a mystery land .

[Tall_Allen in reply to 6357axbz]

No. Radiation preferentially kills cancer because it cannot self-repair the DNA damage. Healthy tissue either self-repairs or is replaced by new cells.

[Tall_Allen]

I agree that it is risky to come off Lupron with bony metastases. There is no reliable data to reinforce that decision. You have destroyed only your most visible metastases, leaving all the others to thrive. The ones you've zapped are the ones producing PSA, so you will no longer be able to use PSA as an indicator that your cancer is growing.The other way to go is the opposite - Lupron + Zytiga to nearly finish off any micromets.

Of course, a temporary vacation from Lupron is very understandable if the side effects are onerous.

[fireandice123 in reply to Tall_Allen]

I get what you're saying about the big mets and prostate no longer producing PSA. Wouldn't any micromets also produce PSA?

[Tall_Allen in reply to fireandice123]

They don't. You have to understand what cancer PSA is, and what the test for PSA tests for. When cancer cells metastasize, they clump together. Their first job is to transform the tissue environment, usually lymph node or bone, to be a good home for bigger metastases. As the clumps grow, they form their own blood supply. But unlike the blood vessels that supply healthy cells, the ones that supply cancer cells are "leaky." Because of the leakage, their PSA leaks out into the serum where the PSA test detects it. Bigger metastases leak more PSA, smaller metastases leak almost none. You can read more about the way that "treating PSA" instead of treating the cancer can fool you:

prostatecancer.news/2020/07...

[Hidden in reply to Tall_Allen]

Dam

Leaky bastards!

[dhccpa in reply to Tall_Allen]

How does one determine that all mets are completely gone?

[Tall_Allen in reply to dhccpa]

They are never completely gone. You can use a PSMA PET scan to find the ones bigger than 5 mm. But there will always be thousands more that are smaller than that. Systemic therapy does a good job of getting rid of many of them.

[dhccpa in reply to Tall_Allen]

Thanks. Do you see anything at at all in the pipeline today that promises to get rid of all mets (and, I suppose, the tumor material in the prostate)?

[Tall_Allen in reply to dhccpa]

No. It's very much like HIV - controllable but not curable. But I heard there's a new HIV therapy, so who knows?

[Hidden in reply to Tall_Allen]

They can’t even get rid of herpes, let alone cancer

[Lettuce231 in reply to Tall_Allen]

That's a great explanation for the layman like me, thank you T.A.

Phil

[VHRguy in reply to Tall_Allen]

That is an outstanding write-up, Allen. You put a lot of time into that one! I missed that when you published it, and will spend a good deal of time studying through it. Thanks for assembling all of that!

[edgeh in reply to Tall_Allen]

Thank you for the education imparted by your posts. The science does appear to disclaim all supplements such as resveratrol and curcumin in affecting the cancer, thereby signaling their non-effectiveness. But the effect of statin usage is worrying in affecting a PSA score, statins are necessary for most people. We should therefore, never trust a PSA score but believe the number to be in actuality higher.

[Tall_Allen in reply to edgeh]

Maybe. It's suspected as interfering, but not definitive. I take statins for my heart too. My opinion is that if statins are having an effect, I hope the effect is constant, so over time, and looking at the pattern rather than the absolute value, it may not make a difference. But I very much agree that it is troubling that it may delay the original diagnosis. More studies are needed.

[Boywonder56 in reply to edgeh]

Dont get that started....just sayin...

[Turt713171 in reply to Tall_Allen]

Agree with metastatic disease you should hit it with as much as you can tolerate

Good luck

[treedown]

If all things remain the same I will be doing the same thing at the end of the year though I had nothing on my bone scan and LN's involved. Good luck if nothing else I hope you have a nice long vacation. Keep us posted.

[Hidden]

My last Lupron shot was 2017 after an

Orchioectomy. I’m

Still on

A pill form adt

Suppressing t from adrenal production. Good luck if you go on vacation . Live well!🕊🕊🕊no mo lupypron ! Yahoo.

[VHRguy in reply to Hidden]

For one going on permanent ADT, I think an orchiectomy is an excellent choice! One and done, no more ADT shots. Do you take any estrogen to offset the side effects?

[Hidden in reply to VHRguy]

No but , I’m thinking about it. ✌️

[fireandice123 in reply to Hidden]

Does having an orchiectomy reduce/eliminate the typical ADT side-effects. and does it bring it's own unique side-effects?

[Hidden in reply to fireandice123]

Side effects the same. No t is the culprit. I ve read less heart issues sin Lupron.

[MateoBeach]

Congrats on the last shot of your adjuvant ADT with the RT. Just know that the effects of it persist and recovery of testosterone, and hence feeling a sense of normalcy, typically can take over a year. So be patient. As for adding abiraterone to ADT after radiation to increase killing of remaining PC cells as T_A advises, I do not know. But it is worth considering and discussing with your MO/RO while you are still on the regimen.

[Spyder54]

Enjoy the journey! If you think about it, and aren’t too busy enjoying your newfound Manhood, maybe drop us a line as to your experience, and what we all hope to enjoy one day....for a very extended period of time🍀Mike K

[treedown]

I will be in the same or a similar boat come June, then off Zytiga in Oct should all things remain the same as they are at this time. My original bone scan was clear, CT showed LN involvement but was never confirmed by biopsy and an initial PSA of 156. So just hoping for a long vacation and with a T of <1 I may get it just because it will take T a long time to come back. Or not, my doc says as I am a high PSA producer if not cured it might just come roaring back. We'll see.

[fireandice123 in reply to treedown]

This will be my second holiday. My T level was back to approx 800 after about 3 months. Hopefully I have the same luck this time.

[treedown in reply to fireandice123]

Thats awesome, unfortunately mine wasn't that high to begin with. Enjoy.