Intermittent lupron therapy - Advanced Prostate...

Advanced Prostate Cancer

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Intermittent lupron therapy

Irwin profile image
40 Replies

while undergoing intermittent lupron therapy what should the psa not get above before going for your next lupron injection.

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Irwin profile image
Irwin
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40 Replies
Magnus1964 profile image
Magnus1964

What is the timing of your Lupron injections? Are taking any other drugs?

Irwin profile image
Irwin in reply to Magnus1964

Have been getting lupron about every 7 months. It used to take me down to .06 then more recently to .19 I usually go back for lupron injection when it gets above 1.0 this last time on March 5 this year after 6 months off lupron it was .25 then on may 20 a little more than 2 months later it jumped to 2.71 which was the highest psa ever during the 4 years on intermittent lupron therapy and I am concerned don’t know if I should be? Thanks magnus1964 for your interest,Irwin

Irwin profile image
Irwin in reply to Irwin

Not on any other drugs for Prostate cancer

Magnus1964 profile image
Magnus1964 in reply to Irwin

I think it might be time to add a second ADT drug, i.e. Zytiga or casodex.

Irwin profile image
Irwin in reply to Magnus1964

Getting my lupron injection tomorrow. Will see if it will go back down to .19 which was my last best psa after my last lupron. Thank you,Irwin

Irwin profile image
Irwin

Thank you Nalakrats. First time using this site. How do I find Adaptive Theory Principle. Irwin

6357axbz profile image
6357axbz

Good work Nal!

Irwin profile image
Irwin

Thank you very much for your good advice. It makes sense to me. Stay well,Irwin

Tall_Allen profile image
Tall_Allen

There are no rules. Some use 2, some use 4, some use 10, some use PSADT, some use time with normal T, some use time.

Irwin profile image
Irwin in reply to Tall_Allen

In the past I would wait until my psa was around 1.0 but this time unlike in the past in 2 months it went from .25 to 2.71 an unexpected jump in a very short time. I am getting my lupron tomorrow so I will follow it more closely hoping to catch it before such a large jump up. For the last 4 years it has gone up slower and I was able to catch it around 1.0 I might not be so lucky in the future. Are you using intermittent lupron and if so for how long have you using it. Appreciate your info,Irwin

Balsam01 profile image
Balsam01 in reply to Irwin

I have been on IADT for around 4 years. Nine months on Eligard (3 month shots) , hit undetectable, then off for a year. PSA started rising and got to 2.0 very quickly. My doc at Johns Hopkins said go back on so i did for another nine months, back to undetectable. Went off and have been less that .01 ever since but i am keeping my fingers crossed. There is an excellent thread on this site about the theory of Intermittent where the sensitive cells start building up again during the Intermittent phase and crowd out the bad cells.

Irwin profile image
Irwin in reply to Balsam01

Sounds like you are doing well. Did your onc say to continue going back on when your psa goes to 2. Thanks, Irwin

Balsam01 profile image
Balsam01 in reply to Irwin

Basically yes although he was concerned with the speed with which it reached 2.0.

dhccpa profile image
dhccpa in reply to Irwin

Let us know how your PSA does going forward.

Deadstick profile image
Deadstick in reply to Tall_Allen

TA,

Thank you...that's what my medonc says too about IADT intervals...it depends on the individual case.

lewicki profile image
lewicki

Nal, would Orgovyx be a better choice to Lupron?

lewicki profile image
lewicki

you do not use both at the same time do you? Thanks

Karmaji profile image
Karmaji

Very interesting NAL...I am having <0.03 for 2 years.

My RO says I can try vacation from 3 months ADT. My Onco and URO say yes and no.

But he says my PSA will go to 2...normal as my good cells in prostate are active.

Then you go on ADT.

I believe in adaptive therapy..... But reading you, I am confused.

Should I go back to ADT when I reach 0.06 ...

I was using 3 months every 5 months....

Thanks

Thank you Nal, so very much… We wanted to have monthly lupron, exactly your words.. why would you want that, it just bogs up the system!! Also I felt my husband should have monthly blood work. Why would any man not want to monitor his PSA level monthly. Nal I am new to this, both of us so healthy, no drugs at all, always aware of our bodies. Just not use to these doctors, things just don’t add up, or make sense any more.

Karmaji profile image
Karmaji

Thanks...I had radiation of prostate

but my RO says that PSA will increase to 2 when on vacation as normal cells are there, though not all....He says normal cells do not all die.

Moreover, I have been doing strange IADT...sine 18 months

.Having 3 months dose every 5 month....PSA stayed < 0.03

I may try 3 month dose every 6, 9, 12 month....Does it look stupid ?

Or one may say why not go on vacation till PSA 2.

If it stays below 2, all is well .....

I ask how one knows if one is free from PC ?

Any marker ?

Always respectful of your opinion....

Gouri

SteveTheJ profile image
SteveTheJ

Define "intermittent lupron therapy"

Karmaji profile image
Karmaji

RO was saying When you radiate...Cancer cells stay damaged but normal cells recover from one day to other...since they do not absorb as much.

Then 2 days off in a week normal cells come back to life slowly....

Radiation absorption is highest in tumours due to density...or the cell which divide most....

What to say ? I thought radiation kills all cells....but no according to RO.

Thanks

Nusch profile image
Nusch in reply to Karmaji

Tumor cells die, when they divide.

Scout4answers profile image
Scout4answers

Hi Nal could you tell us how you arrived at 18 months as optimum for the first Vacation?

NecessarilySo profile image
NecessarilySo

This question drives me crazy. My RO used 10. My first MO left it up to me. My current MO has me on continuous Lupron therapy with injection every three months. My PSA chart shows my 14 year PSA history. The basic idea is just don't allow growth of tumors to a size that can show on a scan.

My PSA history chart
john4803 profile image
john4803

I had RP, EBT & started Lupron for 2.5 yrs. Maintained <0.1 PSA. Went off Lupron & after 1.5 yrs. rose to 0.4. Axumin Scan showed lesion, only on T-ll. Had it CyberKniffed. 3 mons. later PSA shot to 7.3, mets through out skeleton. Went back on Lupron & added Apalutamide. After 1 mon. PSA 0.7, T 42. Be very cautious, would be my advice!

lewicki profile image
lewicki

Doing PSA and T tomorrow. No ADT for 19 months. PSA steady at <0.04. T was 10 a month ago. Up some.Concerned that this length of time T seems to be rising and may twigger PSA to rise. If so I now do high T injections or go safe route with lupron or Orgovyx and Casodex. Bring it back down, then do high T. Seem like a good plan?

mangeycritter profile image
mangeycritter

With my usual caveat that just about every poster here is more informed than I, I'll reply to Irwin by briefly describing my treatment history. RP Jan 2012, BCR Jan 2016. PSA rising continuously through May 2020, reaching 5.70 (five point seven oh). Initial ADT begun May, 2020. June, 2020 PSA undetectable, T 7. 3 month measures thereafter undetectable. Vacation begun May 2021. July & Oct 2021 undetectable. Jan, Apr 2022 undetectable. May 2022 PSA<0.01, T=393, free T=0.2451nmol/L. My intention here is simply to confirm what TA has stated and with which Deadstick has concurred: that there seems to be no golden rule in treating PCa or timing the onset or duration of IADT. Very early in my course a local MO wanted to start ADT at the time my PSA was 0.46. I declined. Subsequently I was told by an MO at MSK that I "made the right decision." I continue under the care of a local MO, but also with MO's at three of the leading cancer centers in the eastern US, each of whom independently recommended I start a vacation after my first year of ADT. I asked the lead treatment MO at what point would he recommend restarting ADT. His reply was "when your PSA gets back to about where it was at the first ADT", viz., 5.70 (again, the decimal is in the correct location). He went on to say that the more important item to track will be PSADT. Incidentally, and again independently, in a phone consult with NIH the MO there said that, while on vacation, to ignore PSADT's until PSA reaches 0.50. It's clear that this treatment plan, which waits for much higher PSA measures, and defers restarting ADT, is at variance with most of the opinions here as well as in many other posts. Should I look elsewhere, seek second, third, fourth, or nth opinions? I answer myself in the negative. These are my working hypotheses:

Most MO's (at least the males) probably have egos, and don't relish being wrong, and most likely don't like to lose patients. If motivated primarily by money, they probably would have chosen some other medical specialty. While the SOC is impugned often in many posts, there exits the possibility that it has not been arrived at capriciously or in the absence of empirical evidence; it's possible it may be the best available treatment protocol. The MO's specializing in prostate cancer at major centers are likely to have more clinical experience than the lay posters here. (That said, the posts contained here represent the collective input of many MO's, relayed by their patients, and therefore constitute an important source of data). What evidence is there that would suggest any of us should discount an opinion offered in good conscience by one who labors daily in trying to defeat prostate cancer? So while I will continue to respect the many opinions offered here, I will continue to rely upon and trust the collective input from my MO's at Memorial Sloan Kettering, Duke, and Johns Hopkins. They may be right, and they likely will gain nothing by my death from prostate cancer.

In short, Irwin, the correct answer to your question about PSA levels is what you get if you cross an elephant with a rhino:

ELIFINO!

Irwin profile image
Irwin in reply to mangeycritter

A lot of food for thought. Thank you mangeycritter

j-o-h-n profile image
j-o-h-n

Greetings Irwin, Here comes the routine:Would you please be kind enough to tell us your bio. Age? Location? When Treatment(s)? Treatment center(s)? Scores Psa/Gleason? Medications? Doctor's name(s)?

ALL INFO IS VOLUNTARY, but it helps us help you and helps us too. When you respond, you might want to copy and paste it in your home page for your use and for other members’ reference.

Note: Answers are for your benefit, not mine.

THANK YOU AND KEEP POSTING!!!

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 05/24/ 2022 10:50 PM DST

treedown profile image
treedown

Would you still be using these same reaction points, i.e. .03 to .06 if you had done RT instead of RP?

Karmaji profile image
Karmaji

By reading thru some works..I understand all good cells not get knocked... Mainly cancer and highly multiplying guys....Good cells have some capacity to repair themselves... Your contacts may help us to be free being floored...My RO has still out of box thinking...

He was giving graph of good cells knocked during one session, and they recover some before next session but cancer cells have no capacity...

Good cells wiggle like a saw tooth, but cancer cells just get more and more damaged...And in the weekend good cells can breathe... That is why we have radiation spanned over weeks and vacation on weekend...

Seems medicine does not follow 1+1= 2 logic sometimes it becomes Zero or 11....

treedown profile image
treedown

Thanks. So is your "starting point" the same as your nadir? I agree about what oncs and no doubt insurance companies "want". My MO talked me out of a monthly test recently and I let him, though, not without concern. Your response is food for thought and I'll get my next PSA test in a couple weeks.

lewicki profile image
lewicki

On a PSMA in July 2020 and an Axumin scan October 2021 showing a spot in the prostate and one in the lymph node and still have a PSA of < 0.04 ( no ADT for 19 months ) does this mean a problem. Actually the Axumin scan showed some schrinage to the PSMA that was done fifteen months earlier. Concern doing high T may wake up the cancer or the High T will destroy it for good. Thanks for your reply.

lewicki profile image
lewicki

Diagnosed in July 1999. PSA was 6.2 and a 3+4 (not sure could have been 4+3 ).

lewicki profile image
lewicki in reply to lewicki

I still have an untreated gland.

lewicki profile image
lewicki

Also, I still have an untreated gland except for transurethral hyperthermia in germany.

lewicki profile image
lewicki

I will see Uro's office today to find that out. Thanks.

lewicki profile image
lewicki

Yes going to review this. Thanks

treedown profile image
treedown

I hear you and appreciate your time to respond. So is this blood test list comprehensive or do you do more monthly? CMP

CBC

PSA

DHT

Full T workup, Free, SHBG, etc

E2

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