Question about 1 month vs. 3 month Lupron

[drjg]

Currently undergoing radiation treatment to the prostate bed following doubling time of PSA.

Have had 20 treatments of proposed 39. Most recent PSA was .3 in August of 2022. Had radical prostatectomy in Nov. of 2018 with 4 years of undetectable psa. Appx. 24 lymph nodes were removed with resulting current lymphedema on right side.

Just wanted to hear any thoughts on 1 month vs. 3 months lupron. Radiation oncologist said the recommendation for radiation was between 4-6 months.

Thanks for your thoughts,

Jerry

[Tall_Allen]

It seems inconvenient to get monthly shots.

[drjg in reply to Tall_Allen]

Sorry I failed to mention that the proposal was 4-6 months on Lupron and I already received a 3 month shot. Was wondering if I should get the second 3 month or 1 month shot of Lupron. Sorry for the confusion.

[Tall_Allen in reply to drjg]

OIC. You may want to end your cycle with one month of Orgovyx, since it allows testosterone to return quickly.

[timotur]

Despite the inconvenience, I did monthly shots and stretched them out to every 5 weeks to “time-dose” and keep the average serum level of Lupron lower. It worked and was able to keep T<12 ng/ml. The Lupron data sheet has the numbers, and I’ve posted here before, but the initial concentrations of a 3-month dose is about 2x in the first few days, then settles into a steady decay, close to, but still above the 1-month shot. By time dosing, I reduced the total number of shots to 15 over an 18-month treatment, three less than normal, and probably had fewer SE’s, so it was well worth the inconvenience.

[FlyJ]

The following is the dosing requirements from the spport trial: Dose definition

Short term androgen deprivation (STAD) will be administered to patients randomized to Arms 2

and 3, will begin from the start of LHRH agonist injection within 6 weeks after registration, and

will consist of total androgen deprivation, using a combination of antiandrogen and LHRH

agonist therapy for a total of 4-6 months. The antiandrogen will be either flutamide at 250 mg

p.o. TID or bicalutamide at 50 mg p.o. QD. Antiandrogen therapy should begin at approximately

the same time as LHRH agonist injection but may be started up to two weeks earlier. LHRH

agonist injection will consist of analogs approved by the FDA (or by Health Canada for

Canadian institutions), e.g., leuprolide, goserelin, buserelin, or triptorelin and may be given in

any possible combination, such that the total LHRH treatment time is 4-6 months. For example,

LHRH agonist injection(s) may be given as a single 4-month injection, a 4-month injection and

one to two 1-month injection(s), two 3-month injections, one to three 1-month and a 3-month

injection (4-6 months total), four to six 1-month injections, or a 6-month injection.

[maggiedrum]

I wish I had started with a 1-month dose of Lupron. I was given a 3-month dose at the beginning (my last Lupron). I was clinically depressed then and now. The Lupron gave me , by a couple of magnitudes (seemingly), worse depression. I discontinued it then but I suffered from the increase in depression for 11 months. Evidently, testosterone mediates my depression. This has been documented in a few studies. I wished I had had only the 1-month shot to find this out and that that would have lessened the side effect to less than 11 months. I could have ramped up to 3-month shots after that if the side effects been more tolerable. There are many therapies which required monthly and even more frequent shots for other illnesses. I would have not found having to go back one more time after one month to be overly inconvenient. Ask your MO about that if you have any concern. Most who get Lupron don't have as severe a reaction as I have so it may not make any difference in your situation. If you have any, at all, of a history of depression, you should start with a 1-month dose.

[RMontana]

drfg, I have three articles that I saw which dealt with ADT and its effectiveness. The time periods that your Dr is contemplating seem short, but who knows...shorter may be better. But, I attach the articles here for your review. I was on 6 months ADT Lupron prior to sRT (I had recurrent PSA of 0.13 at 6 weeks post RP), then I followed that with 15 months of ADT post sRT (my doctor wanted me to stay on ADT a full 24 months post sRT, but I cut if off)...looking back I would have done the same thing with one change regarding dealing with ED (see below). Here are the articles on ADT;

healthunlocked.com/active-s...

healthunlocked.com/active-s....

healthunlocked.com/active-s...

What I would have done differently is look for my erectile health sooner and moved on an implant right away. I know that back in the day this issue was not on my mind; it was the furthest thing I could think of; treatment and cure was #1, #2 and #3. But ADT does a number on your penile tissue and its side effects on ED are not explained to men who start this treatment (if your Dr has that is great)...think about this if you can...right now it many not be important. But you will live a long time with this disease and as you do ED becomes a larger issue. Here is my story;

healthunlocked.com/active-s...

PS in your case its not too late to move to a IPP post RT and not wait. The longer you wait the more atrophy you will have. Again, back in the day I did not care about this...now almost 3 years later I care alright...I should have moved earlier to perserve what I had prior to this disease...Rick