I've never understood why MO's continue to prescribe Lupron ADT (or equivalent ) for men who are castrate-resistant (CRPC). Isn't that the definition of CRPC, namely, that ADT is no longer working for those men?
Why continue to prescribe a drug that no longer works and that causes such suffering from bad side effects?
Could it be that MO's are simply trying to cover their liability?
Appreciate your thoughts...
Bob
Janebob99,
Lupron is the med that keeps on providing a huge revenue stream for MO practices because it requires a patient visit to be administered and is not reimbursed by insurers as only a med, but instead it is reimbursed primarily as a procedure. I’m sure that there is an underlying medical justification for the drug’s use beyond the obvious financial rewards for its continued use, but the resistance of the MO community to discontinuing its use or switching to an orally administered hormone to maintain low testosterone is understandable when you understand what the MOs would lose in reimbursement revenue if Lupron use was minimized.
I have experienced no resistance from the MO community to Orgovyx. Quite the opposite.
Good for you. I hope your situation continues.
I asked the "Master Conspirator" ChatGPT:
"What is the cost in the USA for a three months Lupron shot compared to 3 months of Orgovyx ?"
ChatGPT's answer follows:
"As of my last update, Lupron Depot, a common brand of leuprolide acetate used for conditions like prostate cancer and endometriosis, typically costs around $1,000 to $2,000 for a three-month injection.
Orgovyx (relugolix) is a newer medication primarily used for advanced prostate cancer. Pricing for Orgovyx may vary depending on factors like insurance coverage and discounts offered by the manufacturer. Generally, it is in the range of $10,000 to $12,000 for a three-month supply.
It's important to note that these prices are approximate and can vary based on factors like location, pharmacy, insurance coverage, and any available discounts or assistance programs. Always consult with a healthcare provider or pharmacist for the most accurate and up-to-date pricing information."
Are you apt in elementary Maths? If yes, which case can provide a higher margin for kickbacks to the intermediator: 1000-2000 USD or 10000-12000 USD ?
Just wondering, but someone here thinks I am a "whack job", so, don't taking me seriously is ok with me.
That is a fable.
My understanding is that even if a man becomes castrate resistant, his stopping ADT will only result in faster tumor growth with the resumption of testosterone production.
For the simple reason that the crpca will grow uncontrollably if you stopped ADT. It's the foundation of BAT protocol....the crpca has developed many more ARs in order to survive in a low T environment. If a man is given t shots that drive the T to a supra level, the crpca chokes on the abundance of T and dies. This happens in about 30% of men.
There is no conspiracy theory here, basic cell biology.
Agree completely.
When a man becomes castration-resistant, there are several things that occur genotypically. One of the modes is that the androgen receptors (ARs) get amplified on each cancer cell. This means that there are many more copies of the AR on the cell surface waiting for even the slightest trace of testosterone to start the replication process. So, it becomes more important than ever for the patient to eliminate even the slightest amount of testosterone.
You and other conspiracy theorists always amaze me. Do you really believe a worldwide conspiracy to keep men taking testosterone prevention has gone on for 80 years with no one spilling the beans? Do you really believe all oncologists lack empathy over what patients are going through and only are motivated by covering their asses?
It would seem unlikely that all the cancer suddenly turns castrate resistant, either.
Some are, but certainly some remain behind. I have never heard of any mechanism that would cause the old line of cancer cells to die?
Is that so?
I was going to say something similar to what you said in your last paragraph. When I hear that physicians are doing procedures/surgeries/office visits just to generate income I just shake my head. That is a fallacy. Similar to stories I have heard that oncologists know certain "natural" remedies work against cancer but keep the truth from the public so they can continue prescribing money making drugs (that actually work). If there was a cure for cancer that was known by the medical profession it would become public knowledge and spread like wildfire within hours/days.
Agree… Physicians also get cancers, and have relatives and friends who do. To think at all that they are ignoring or withholding any curative cancer treatments is pure foolishness.
Nice one TA
Thank You Tall_Allen for speaking truth !!!
Thanks T A!
Castrate resistance is not all or none. You are said to be castrate resistant when your PSA and or radiographic evidence supports progression in spite of low testosterone. Not all cancer cells develop castrate resistance at once. If stopping ADT does not increase progression then you are likely mostly (or entirely) castrate resistant. If it does increase progression then at least some of your cancer cells still depend on testosterone.
I am not entirely sure why but when my PSA and radiographic evidence showed progression in spite of low testosterone(very very low something like .1 ng per decilitre) it was decided that aberaterone was no longer necessary. I had been castrated so that was not reversible easily 
My testosterone is still as low after stopping aberaterone and my PSA is climbing.
You really have to have a medical team that you trust because this is so complicated and different for every individual and there are so many treatment options.
It’s likely that not all the dormant cancer in your body is castrate resistant so continuing Lupron keeps those tumors still affected by it suppressed. Case in point, a couple of years ago after being undetectable for several years my PSA began to rise despite being on Lupron and Xtandi. A PSMA scan showed a tumor on one of my ribs, after SBRT my PSA fell back to nearly undetectable. That one spot seems responsible for the PSA rise, the same thing happened again about a year later on a different rib, same treatment same result.
Ed
Good to know that whack-a-mole can still work down the line.
The drug DOES work. The purpose of the drug is to reduce testosterone production from the testes. Reducing psa and tumors is a secondary effect. As said by several above, removing ADT drugs in order for testosterone to recover will drive any tumors, maybe all tumors, even more.
At first I thought this was a silly question to ask but on reflection I am glad it has been presented. The poster and perhaps others will learn a few details of treatment which would have otherwise have eluded them. There are no dumb questions, as long as someone is willing to learn and accept the truth.
Is this a purely hypothetical question?
Tall_Allen - The conspiracy thoughts and beliefs that SO many people have are based upon ignorance. It's shocking, sad and dangerous how many people think that way. Thanks for speaking the truth and trying to educate people. I hope your words have some success in enlightening those who lack basic knowledge, understanding and the ability to think critically and to think based upon facts, as opposed to fiction.
I'm in Canada and on Lupron 10 years. The oncologist never suggested I go to his office for the injection once every 4 months. My family doctor does it but my wife, a retired nurse, said she could do it if necessary. Fortunately, Lupron costs me $6 Canadian as it covered by a provincial drug plan for seniors paid out of taxes.
Wondering if there a point where testosterone has been suppressed for so long that the testes are no longer functional. I’ve been on ADT for about 6 years with only short vacations and am now castrate resistant. I still have a prostate and my PSA has been about 0.065 even without any ADT. Am I, in effect, chemically castrate?
I think there is such a thing as testicular atrophy.
How long has it been since you stopped ADT?
I'm curious why you say you are "castrate resistant". Is your PSA rising now? I guess I'm confused...
I am not castrate resistant but I can confirm that my testicules had shrunk to almost half their original size while I was on ADT for 2 1/2 years. They are recovered a little over the past year (treatments ended on May 2 2023) but I don't think they will grow back to what they used to be. My testosterone is only roughly 50% back from pre-treatments.
If your PSA has been stable for 6 months or so, have you consider supplementing T?
I wish it was stable but my PSA has been rising since August. In May 2023 it was at <0.01, or undetectable by my hospital.
Aug 18 2023: PSA is 0.09, Testosterone is 3.3 nmol/l (95.2 ng/dL), Testosterone FREE is 52 pmol/l, Testosterone BIO is 1.26 nmol/l
Oct 6 2023: PSA is 0.14, Testosterone is 11.3 nmol/l (326.0 ng/dL), Testosterone FREE is 138 pmol/l, Testosterone BIO is 3.49 nmol/l
Dec 5 2023: PSA is 0.22, Testosterone is 10 nmol/l (288.5 ng/dL), Testosterone FREE is 129 pmol/l, Testosterone BIO is 3.34 nmol/l
Feb 6 2023: PSA is 0.39, Testosterone is 9.6 nmol/l (277.0 ng/dL), Testosterone FREE is 141 pmol/l, Testosterone BIO is 3.65 nmol/l
Apr 16 2024: PSA is 0.90, Testosterone is 10.2 nmol/l (294 ng/dL), Testosterone FREE is 110 pmol/l, Testosterone BIO is 2.85 nmol/l
I had a CT scan in early April, which showed nothing. My next step is a bone scan on May 10. It too will show nothing but the only way for the hospital to approve a Pet PSMA scan, is to have a rising PSA with a negative bone scan and a negative CT scan. I don't see how this saves them money since they end up doing 3 scans instead of just the Pet PSMA. But it feels like I am getting lots of radiation from 2 useless scans just because of bureaucracy.
Damn! Sorry to read about your PSA increase.
I'm still hoping mine stabilises having stopped ADT in June 2022. But last 2 results were PSA increases.
Final Lupron Injection (Completed 24 months) June 2022
October 2022 PSA <0.01 Testosterone 0.5 nmol/L
March 2023 PSA <0.1 Testosterone 8.8 nmol/L
Sept. 2023 PSA 0.08 Testosterone 18 mol/L
March 2024 PSA 0.12 Testosterone 18 mol/L
I asked for 3 monthly Tests but they said they still consider my PSA as stable so will remain on 6 monthly tests. Despite the last two increases I'm hoping against hope it really does stabilise.
Though you are showing an increase, at least the growth is not as fast as it is for me so 6 months is still safe for now with the psa. As janebob99 mentioned it is also possible to pay out of pocket in a lab. I did it for my first year with tests every month. It was $65 each time though I guess pricing may vary.
you may find this interesting and why there could be mistrust
maybe this has an effect - Lupron in Dr office is Medicare part B, Orgovyx is under prescription meds. so, Lupron will cost much less out of pocket for those under medicare both original and part C
CRPC - causes and prevention of 
Is this pointing to cancer becoming castrate resistant?
Rapidly decreasing level of PSA during ADT is a risk factor for early progression to CRPC.
