Abiraterone, Prednisone, Zometa – Without Lupron?

[SKKALH528]

Hi everyone,

Is anyone here on Abiraterone and Prednisone with Zometa infusions but without Lupron? My dad's oncologist recently mentioned that he "doesn't need Lupron," which I don’t fully understand. He received his first Lupron shot in July and was scheduled for another in October until his oncologist abruptly canceled it, saying it wasnt necessary. For context, my dad was diagnosed with Gleason 9 prostate cancer with bone metastases in a few areas (more details in my profile). I’m concerned because I haven’t heard of this approach before. I’m encouraging my dad to get a second opinion at Mayo, but in the meantime, I’d appreciate hearing your thoughts.

[Tall_Allen]

His testosterone may be at castration level without Lupron?

[SKKALH528 in reply to Tall_Allen]

That's what I'm worried about, it seems risky to eliminate it at this point. He was just diagnosed in April and his cancer was advanced (Gleason 9, PSA 151). I can't figure out why they're choosing this route.

[Tall_Allen in reply to SKKALH528]

I asked a question (badly phrased)- what is his testosterone level?

[SKKALH528 in reply to Tall_Allen]

Tall_Allen The last time they measured his testosterone was on July 15 and he was at 581

[Tall_Allen in reply to SKKALH528]

In the SPARE trial of abiraterone mono-therapy vs abiraterone+ADT, adding ADT increased radiographic progression-free survival, but the result was not statistically significant at the small sample size (n=67)

urotoday.com/conference-hig...

IMO, if abi alone brings his testosterone down to castration level, he can skip ADT and its side effects that are unique to it. I think it's important to monitor T closely. But the SOC is still abi+ADT, so it should be his decision after acknowledging the risks.

[GP24]

Abiraterone lowers testosterone better than Lupron, so you can take it without Lupron. However, the approval for Abiraterone is in combination with Lupron. There are trials which determined that the added benefit of Lupron is small.

Ask the oncologist if you can omit Zometa too and start with it after maybe two years of hormone therapy. I would try to avoid the side effects of Zometa and not start with it at the same time as the hormone therapy. It does not fight against cancer, it just helps against the bone loss caused by a long hormone therapy.

[maley2711 in reply to GP24]

Maybe I misunderstand what I just read, but my understanding is that standard ADT impact the primary producer of T, which is the testes? No? Abiraterone acts to reduce T produced adrenally or by the cancer itself. NO? Thus, standard ADT would have a bigger impact on T?

[GP24 in reply to maley2711]

No, Abiraterone also reduces the T produced by the testes. In addition to that it reduces the T produced adrenally or by the cancer itself.

[Grandpa4 in reply to maley2711]

Abiraterone blocks testosterone synthesis everywhere. I have alway wondered why both drugs are used but since I don’t have many side effects I have gone with the flow.

[maley2711 in reply to Grandpa4]

I guess because the combo produces better overall survival results?

[dhccpa in reply to maley2711]

As TA mentioned, slightly but not statistically significant compared to AAP alone.

[Concerned-wife]

he needs T measurement. I think they try for under 20 now. And , although you didn’t ask about it, a DEXA scan regarding whether the Zometa is needed.

Interesting experience…unusual from most men’s experience, SOC is with the Lupron.

[ctflatlander]

get another opinion

[Apisdorsata]

I was on abiraterone + prednisone only for six months. It brought my testosterone done to castration levels and my PSA to undetectable. I had all the usual side effects of hot flashes, fatigue and weakness but much less than with Lupron so I was happy with it. I've been off all treatment since early April, 2024, and enjoyed a fine summer with energy. But my PSA is back up to 2.17 and as soon as I can get a PSMA scan to see where the tumor is I will go back on treatment. Hopefully abiraterone + prednisone alone. I will get monthly PSA and testosterone levels to be sure the medication is still working.

[rainlessman]

I did six months abiraterone and prednisone with no ADT ending June, 2024. The side effects were not too bad, noticeably less than those from Lupron or Orgovyx. My PSA was undetectable and T was down to 2. Now after 3 months holiday, my PSA is 0.54, my testosterone is 1454. I'm going for PSMA PET scan in 2 weeks. If I have to go back on abiraterone, I hope it's without ADT. I'm a patient at Mayo.

[Derf4223]

@rainlessman Please put case details etc in your bio. Its bad kharma if you don't.