One med or two??

[Granica4818]

Is it better to do the lupron shot alone? or is it better to take the lupron with xtandi? My husband's psa has been <0.01 for the past month after radiation to the spine. He was wondering if he could stay on lupron alone or if would it be better to take both. He is Gleason 9 with one bone met to the spine which was radiated a few months ago. Then one month ago he was given the lupron shot which he will get every three months. Now today he is supposed to start his xtandi. He had his Psa on Thursday which as I said was <0.01. Just wondered what the pros and cons are from just lupron or taking both. Thank you.

[MJCA]

You ONLY start a drug such as Xtandi, Erleada, Zytiga or Nubeqa once Lupron loses its effectiveness i.e. the patient is deemed castrate-sensitive or castrate-resistant. His PSA is basically 0. Why throw more meds into the mix when it appears Lupron is doing its job?

[Concerned-wife in reply to MJCA]

that advice is no longer standard of care. The clinical trials proved adding another drug has better outcomes.

[dhccpa in reply to Concerned-wife]

Only if they started both at the beginning, right? That was my recollection. I've been on Lupron 4.5 years and my MO resists adding another drug for that reason. I've gone a long with that so far.

[pakb in reply to MJCA]

Yes- newest studies show adding one of these with ADT (and chemo too) is the best for outcomes.

[GP24]

The standard of care is now to add e.g. Xtandi to Lupron when there were bone mets. It will result in a significantly increased period for new mets to appear and castration resistance to occur.

[tango65]

He has metastatic PC he should take both. He could consult about using Xtandi, Zytiga or Apalutamide.

[RyderLake2]

Hello,

The usual process is you start with a Lupron type drug and take it until it starts to fail. Your husband's PSA is undetectable so it is working. Xtandi (enzalutamide), Zytiga (abiraterone) and several of the other newer second tier drugs are added when your husband's PSA starts to rise. However, you stay on Lupron for the whole journey. This is the way it was explained to me by my medical oncologist. Think of your husband's battle with PCa as a train ride that he will be on for the rest of his life. Lupron is the locomotive. As your husband goes down the tracks he will add a few (and possibly subtract a few) cars from his train but he doesn't detach the locomotive. Good luck!

[Guber in reply to RyderLake2]

I agree, at least this is the plan I am on. In fact I am being scheduled for an orchiectomy to make sure my locomotive doesn't fall off the tracks.

[pakb in reply to RyderLake2]

This is no longer standard of care. Newest studies show its best to do these together. Many start with triplet therapy now due to current studies.

[gsun in reply to pakb]

Yes, triplet is slowly the new SOC. I wish I had that a few years ago. I started on Lupron + Abi right away. Why would you not? Why wait for Lupron to fail?

[pakb in reply to gsun]

Agree. My husband started on lupron and chemo- which was a new combo in 2017. I wish triplet was available then.

[Heykm01]

You’re getting conflicting advice here. Any close reading of todays best options for metastasis to the bones includes more than just Lupron. Tango and GP are correct here - adding xytiga, xtandi, apalutamide or darolutamide (not yet approved without docetaxel) has been proven to improve all outcomes - survival, time to progression, time to castration resistance.

In most cases the side effects of the additional ARSI is not much different than Lupron alone. There are certainly exceptions to this.

[anony2020 in reply to Heykm01]

Agreed. The clinical experience of the well known doctors seem to confirm that. It is counter intuitive but if you carry on until the disease gets stronger, the more 'powerful' drug may be less effective. Does that make sense? Dont know. I am just a layman, Dont mind me.😊

[Granica4818 in reply to anony2020]

Yes makes a lot of sense. Thank you.

[Hidden]

Both!

[Lettuce231]

I have Lupron, Zytiga and prednisone, its unlikely Lupron will do the trick on its own.

[Concerned-wife]

you can read the expert physician opinions about this on UroToday. And look at NCCN guidelines. Recommend the second drug based on clinical trial results.

[larry_dammit]

stage 4 here in 2016, on lupron (eligard) every month with Xtandi. Just over 6 years now since I was diagnosed. Doctor had originally gave me a 50/50 of 5 years. Wife and am happy with ho the Xtandi is working for me

[Granica4818 in reply to larry_dammit]

That is great news !!! And reassuring for us as we have decided to do both, Thank you.

[Hawk56]

Just a layman and fellow traveler, so, my thoughts.

I understand there are three sources of testosterone, the testicles, adrenal glands and the PCa cells themselves. The latter is what I am least confident in what I say. Perhaps it is the ability of the PCa cells to bind and use testosterone.

Anyway, Lupron only deals with one of the three.

Monotherapy seems to be fading as the standard of care and doublet or triplet therapy is emerging in clinical practice as the SOC based on data from various clinical trials. Gone are the days of linear and progressive treatment, each destined to fail and then an inevitable end. Today, we, the PCa members and our medical teams, seem to combine and bring treatments forward in the treatment of PCa, overwhelming it when it is in a stage where it can be. That may not bring the elusive cure but longer progression free survival, radiographic progression free survival though some debate about overall survival. Those 2nd and 3rd generation ADT agents deal with the 2nd and 3rd ways testosterone "fuels" PCa,

As to the additional SEs, well, there are some which is often why prednisone is added but from what I read, side affects are side affects when one's testosterone is castrate!

From my perspective, you may want to consider asking his medical team "how long" will he be on these treatments, do they envision stopping, if so, what are the clinical criteria and data for that, and what would be the plan for actively monitoring while he is off treatment n\and finally, criteria for going back on treatment (if they see stopping it in the first place, many argue don't...)

Anyway, my thoughts are the doublet therapy may be beneficial to your husband in treating his PCA.

Kevin

Clinical History

[Granica4818 in reply to Hawk56]

Thank you, That makes sense to me. We decided to do both and hope we made the right decision.

[Magnus1964]

If Lupron alone is keeping his PSA down then save xtandi for when Lupron fails. The more treatments you save in arsenal, the mor you will have for later.

Magnus

[gsun in reply to Magnus1964]

The different treatments are for different producers of testosterone. Why leave one producer active?

[Magnus1964 in reply to gsun]

If you have a comfortable life on one treatment why add another. Your trying to live with your cancer, not kill it.

Magnus

[Chadsdad]

I’m just gonna ditto Hawk56’s response to save all the typing.

[cancerfox]

Sounds clear as mud! 🦊

[Granica4818]

I think as the Dr explained to me, that since his cancer seems to be very aggressive Gleason 9, When his cancer returned in September his doubling time was less than 30 days three consecutive months in a row. Then with the Mets to the back and the pain being unbearable, and still having a psa after radiation in December, all those factors together the MO thought it would be best to start both. My husband too just wanted to do lupron alone until it stopped working, that's why I posted here to see what other people have done and what their outcomes were. I thank you all for sharing and helping us remember that there are many ways to treat PC. But after much consideration, we decided to do both. I hope we made the right decision. I will keep you all updated. Being on here has been a wonderful thing for us. You are all so appreciated. Thank you