I just finished 38 rounds of radiation to the pelvic bed and abdominal lymph nodes. My last Lupron shot will be out of my system in December, and I am taking Xtandi. My last PSA was 0, and testosterone was 7. Side effects include extreme fatigue and sciatica pain.
I am scheduled to see my urologist again in December to receive a second Lupron injection. I would like to see if the radiation was effective and take a break from the medication. Is there any reason not to take a break and restart Lupron and Xtandi if my numbers start going back up? Suggestions ?
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GJ65
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Yes, there is a reason and it is huge. You are trying to get a curative therapy with limited-term adjuvant hormonal therapy to assist the radiation therapy you had. The last thing you want to do is stop and restart the hormonal therapy just so you can see what happens. You wouldn't like what happens.
It would be similar to stopping and restarting antibiotics for a bacterial infection. It would guarantee failure by allowing the most resistant bacteria to survive and multiply.
Similarly, the most vulnerable cancer cells are killed off first by radiation and hormone therapy, while the most resistant cancer cells are killed off only with continuous long-term use of hormonal therapy. Stop the hormonal therapy too soon and you allow the most resistant cells to take over.
Lymph node metastases may be cured by 2-3 years of adjuvant hormonal treatment. Maybe you can get away with just 2 years because you are adding Xtandi. Abdominal lymph nodes are at the verge of escaping systemically - now is not the time to cut back on treatment.
What an amazingly great explanation by Tall_Allen. I am so impressed with those rare individuals who can take very complex situations and make them easily understandable. Love the analogy with antibiotics for a bacterial infection. GJ, sounds like you need to bite the bullet, stay with the Lupron and go for the cure!
"GnRH agonist depot formulations have evolved to offer treatment intervals of 1, 3, 4, and 6 months, all of which offer similarly acceptable safety and efficacy profiles."
I was diagnosed as “unfavorable intermediate risk” so my doctor put me on 6 months of Lupron depot as well as radiation. Several radiation oncologists thought I should be more correctly designated as “favorable intermediate risk” because there was no evidence of cancer outside of my prostate and my PSA and Gleason put me in the favorable category. Of course the difference between these two classifications is one gets ADT and the other does not. Despite the differences of opinions by these doctors, my oncologist recommended being very conservative with 6 months of Lupron. My side effects were pretty bad so it was good that I had the 6 month depot shot. Otherwise, I may have elected to stop the ADT midstream or try some other ADT besides Lupron. I did get sciatica, muscle and joint pain and there were days when I could hardly walk. Now since I am off the drug and am recovering slowly and most of my side effects are a distant nightmare, I can say I was glad That I took the full treatment of 6 months Lupron. So far (and I know it is early) I am still hoping for a cure. My T level is almost 500 and my muscles are coming back with a lot of help from continued weight training. My last PSA was 0.07 If it stays that low, I will credit it to electing to take ADT even though I had many days of misery on that drug. However, if my PSA goes up I am hoping by that time research efforts will come up with something better than Lupron.
I totally agree with TA, as tough as it is, staying the course is what's important. You said you were going to to see your Uro, don't you have a medical oncologist who is driving your care? When my journey started, it was highly advised by everyone, including my Uro to have an oncologist as the main person as cancer is their specialty.
1. You never fully kill the prostate cancers off totally.
The theoretical mathematical research tells us if you are fighting a mutating epidemic or a mutating cancer... you do best by allocating all your resources in punctuated "shock and awe" attacks. That leaves a smaller population to grow back and start mutating.
The clinical trials research backs this up. Sequential escalation of treatments is now out of date and earlier use of multiple concurrent treatments are what the centers of excellence are doing.
You won a battle. To win the war you need to kill as many of those deadender prostate cancer cells. It makes them takes longer to come back and develop mutation workarounds to your treatment.
2. When you do lupron shots, 1 month shots are better 3 month shots, and 3 month shots are better 6 month shots.
Don't let the doc talk you into 6 month shots.
3. My doc only kept me going for an additional 18 months. In retrospect I think 3 years would have been better.
But I would specifically as Tall_Allen how long you should keep it up.
And I think it would even make sense to add something to the cocktail.
Sorry to interrupt- I usually don't, but I had to correct all this misinformation that you are stating as fact rather than your personal (ill-informed) opinions. 1 and 2 have no basis in fact. 1. Many are cured by exactly the kind of treatment the OP is getting. 2. This is just incorrect.
But if possible, I sure would value seeing hard data on this subject: Difference in the Performance Envelopes of 1 Month, 3 Month and 6 Month Lupron Shots.
My recollection of my original source, was someone on this forum said he had an informal discussion with an employee of the manufacturer of Lupron. That employee said that the short term shots were better able to maintain stable serum levels.
There must exist serum level performance envelopes comparing the serum level performance before and after the end date of 1 month, 3 month, and 6 month shots.
Pretty much all prostate cancer patients end up taking Lupron (or equivalent shots).
So I think this is an important subject to most of us.
Have you ever seen or heard of hard data on this subject that is publicly available?
My apologies for cutting in here to asked Tall_Allen a question, my husband suffers from sever plaque psoriasis, dx 07/01/2022…he just started Firmagon 07/06/2022 and Zytiga with Prednisone 07/20/2022
He was offered Lupron last appointment 9/13/2022
Lupron in studies, is shown to cause sever plague psoriasis flares and studies have shown this issue, plus there are other issues with the use of Lupron.
His glucose levels were high especially during and after the 10 days after his first chemotherapy docetaxel infusion, and had an epic head to toe, severe psoriasis plaque flare
We assume from the docetaxel chemotherapy
His MO was surprised
His mother is a diabetic
He has brca that blm bloom
Metformin has been shown to be used and prescribed with prostate cancer and also new studies have shown to treat sever psoriasis
Do you have any knowledge on this?
FYI
He was on Tremfya for three years, which is trials caused prostate and breast cancer, he is Not on any pills or injections for psoriasis because they are immune suppressants…
Ceces, I looked into the difference between monthly and 3/6-month shots, and there is data that shows the serum level of Lupron is much higher initially and at 4 weeks with the longer term shots. So if you are looking for lower SE's monthly shots may be better., eg the monthly shot has less than half the serum level at 4 hours and 4 weeks as shown below, but there aren't any RCT's that would support one dose is superior ovr another.
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Absorption
LUPRON DEPOT 7.5 mg for 1-Month Administration
Following a single injection of LUPRON DEPOT 7.5 mg for 1-month administration to patients, mean plasma measured concentrations were 20 ng/mL at 4 hours and 0.36 ng/mL at 4 weeks. However, intact leuprolide and an inactive major metabolite could not be distinguished by the assay which was employed in the study.
LUPRON DEPOT 22.5 mg for 3-Month Administration
Following a single injection of LUPRON DEPOT 22.5 mg for 3-month administration in patients, mean peak plasma concentrations were 48.9 ng/mL at 4 hours and then declined to 0.67 ng/mL at 12 weeks. Leuprolide appeared to be released at a constant rate following the onset of steady-state concentrations during the third week after dosing, providing steady plasma concentrations through the 12-week dosing interval. However, intact leuprolide and an inactive major metabolite could not be distinguished by the assay which was employed in the study. The initial burst, followed by a decline to a steady-state concentration, was similar to the release pattern seen with the monthly formulation.
LUPRON DEPOT 30 mg for 4-Month Administration
Following a single injection of LUPRON DEPOT 30 mg for 4-month administration in sixteen orchiectomized prostate cancer patients, mean plasma concentrations were 59.3 ng/mL at 4 hours and then declined to 0.30 ng/mL at 16 weeks. Mean plasma concentrations from weeks 3.5 to 16 was 0.44 ± 0.20 ng/mL (range: 0.20-1.06). Leuprolide appeared to be released at a constant rate following the onset of steady-state concentrations during the fourth week after dosing, providing steady plasma concentrations throughout the 16-week dosing interval. However, intact leuprolide and an inactive major metabolite could not be distinguished by the assay which was employed in the study. The initial burst, followed by a decline to a steady-state concentration, was similar to the release pattern seen with the other depot formulations.
LUPRON DEPOT 45 mg for 6-Month Administration
Following a single injection of LUPRON DEPOT 45 mg for 6-month administration in 26 prostate cancer patients, mean peak plasma concentration of 6.7 ng/mL was observed at 2 hours and then declined to 0.07 ng/mL at 24 weeks. Leuprolide appeared to be released continuously following the onset of steady-state concentrations during the third week after dosing providing steady plasma concentrations through the 24-week dosing interval. The initial burst, followed by a decline to a steady-state concentration, was similar to the release pattern seen with the other depot formulations. In this study, mean plasma concentration-time profiles were similar after the first and second dose
As my personal experience shows, TA is so correct. I was inconvenienced by 3 1/2 years of Lupron, and now almost 7 years out from diagnosis with T 300-350 and PSA at .03. Don't know what would've happened if I'd bounced around in ADT -- but only can say I'm happy where I am -- albeit 7 years older. Stick it out!
I’d say yes! There is a reason not to bow out early of Lupron or adt . It could extend your life? You are so young . I was 53 and did 8 weeks imrt with Lupron and another adt test drug . Test failed and was terminated .I kept on it until a few months ago . I went clear with no Psa and 3T right after imrt . At two years I chopped the boys and dropped the lupron. I just stopped taking the test drug 4 months ago . My point is that I was told “shots for life .”! But never ever did any mo tell me to stop adt .. .. I got sarcopenia and osteopenia no strength endurance or stamina . But , I don’t have have pc chomping me down presently like I did over 7 yrs ago …. “ Cancer free “ is an oxymoron after a #4 pc dx.. nuttin free about it . Read Magnus 64 here , over two decades fighting it! We pay the piper if we survive this at all . This shadow can lurk within us for years.. not a pleasant thought . Some men think they’re going to recapture the old me ,you know? Get the t back and feel good again . The best that we can hope for is to stay under the radar for as long as possible . I reckon it to being in the eye of this storm .. Good luck young man . I’m now 61 myself . Being so young you could see a cure.. ? Hang in there .
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