Eligard - delay by 1-2 months?

[LDC2024]

Hi everyone,

I used to actively post questions here last year when my Dad was first diagnosed and found this forum to be a wealth of incredible insight, knowledge and support.

My 78-year Dad was diagnosed stage 4 prostate cancer (no symptoms!) in January 2024 with mets to lower lumbar spine. He did radiation to his prostate in June 2024 along with an Eligard shot every three months. His PSA has been undetectable since last summer and his oncologist considers him in remission.

Here is where it gets very murky. In a routine scan for his prostate cancer in August 2024, they found a mass on his pancreas that was determined to be pancreatic cancer. Awful. He tried two months of chemo and it didn’t help the growth, but it is still contained within the pancreas (we think). He is undergoing SBRT radiation right now to the pancreas. He is still feeling good and enjoying life! He’s a very “young” 78-year old. Radiation to pancreas has made him very fatigued however and he still has two more high dose treatments to go.

He is scheduled for his next Eligard shot in two weeks. Usually when he has his Eligard shot it wipes him out for a bit. Literally he had more side effects from Eligard than from his IV chemo (gemcitabine). Is there a big harm if we delay his Eligard shot a month or two while he recovers from radiation? Prostate cancer has taken a massive back seat from his pancreatic cancer which is obviously the focus for any treatment given the aggressiveness and prognosis of pancan.

We’ll ask his oncologist as well but wanted to check here if anyone has taken any breaks from ADT and how that went.

thanks for any insight!

[Slugger61]

I have taken a break from ADT and it went very well for me. About a 4 month break. But PSA has gone back up and it's time for ADT again. Discuss the possibility of taking ADT break with oncologist.

[LDC2024 in reply to Slugger61]

This is great to hear. Thank you so much!!

[Atdabeach]

Just my non-doctor's opinion, from personal experience: at 78, it's unlikely that his testosterone would rise appreciably in a couple of months. (I discontinued ADT a year ago, and have seen very little impact -- they told me it could be up to 18 months.) Since the whole point of the Eligard is to shut down production of testosterone, which feeds the prostate cancer, I think he'd be fine on that front. Focus on the pancreatic cancer -- it's a bear, but increasingly survivable these days. My wife's mother was an early survivor (with Whipple surgery) over 20 years ago. I understand that chemo has gotten much more effective since then.

[LDC2024 in reply to Atdabeach]

Thanks for sharing! Amazing to hear about your MIL. My Dad was a candidate for whipple, however decided against surgery due to his age and possibility of never recovering. Quality of life is what is most important for him. He also didn’t try the strongest chemo (folforinox) for his pancreatic cancer as it would have completely destroyed him. His treatment plan would be entirely different if he were 10+ years younger (he would have opted for surgery).

[petrig]

Of course you must ask it for your oncoligist or urologist. ADT hormone therapy(Eligard etc) is the treatment that keeps the cancer "sleeping"(if hormone sensitive stage) so it is very important drug.

Eligard is GnRH agonist so its "old school" drug.

Ask your doctor what he/she thinks to change agonist to antagonist hormone therapy like Orgovyx .Orgovyx is oral so its easy to take at home once a day.

[LDC2024 in reply to petrig]

Thank you! How do you find the side effects for Orgovyx? Have you noticed loss of muscle mass? We notice my dad loses some weight and muscle mass after each Eligard shot … but then side effects at least taper off after a few weeks.

[petrig in reply to LDC2024]

I took my first pill this morning.Its oral so much easier to take than injection based adts. In a large clinical trial, the drug, relugolix (Orgovyx), was shown to be more effective at reducing testosterone levels in men with advanced prostate cancer than another commonly used treatment, leuprolide .

In the clinical trial, relugolix was also much less likely than leuprolide to cause serious heart issues.That’s important because leuprolide and other ADT drugs have been linked with an increased risk of cardiac events, including heart attacks and heart failure.

In addition, men in the relugolix group also did substantially better on several other measures, including being able to return to normal testosterone levels within a few months of stopping therapy.

cancer.gov/news-events/canc...

[Mgtd]

I had to reread your post. You stated his oncologist said he is in remission. If that is true then why the need for HRT?

Something is off. If your dad is in remission you should be off the drugs and it should be a moot point.

Definitely challenge the Oncologist.

[LDC2024 in reply to Mgtd]

He said in remission but more like on his way to remission since his mets all shrank to nothing and his PSA has been undetectable. Just from radiation and ADT.

[LDC2024 in reply to Mgtd]

Also - many patients have ongoing treatment while in remission to reduce the risk of remaining cancer cells to start growing again.

[petrig in reply to Mgtd]

It is specifically the ADT that keeps the cancer in "remission" when hormone sensitive metastatic prostate cancer.Information and practise we have today you should take ADT rest of your life.Also when the cancer turns to castration resistance. I would not dare to stop my Orgovyx(adt).The cancer would get very agressive and spread aggressively.

[Tall_Allen]

I wish I could give you assurance that delaying Eligard won't hurt him, but I can't - no one can. For the two years after his radiation is the most critical time for hormone therapy. In fact, I'm surprised that his hormone therapy hasn't been intensified with an added second-generation hormonal. The standard of care for newly diagnosed patients like him is triplet therapy (Eligard + docetaxel + abiraterone/darolutamide).

In a way, the PCa was a blessing -- otherwise he would never have found the early pancreatic cancer as an incidental finding and possibly be cured of it.

[LDC2024 in reply to Tall_Allen]

Thanks Tall Allen! Appreciate the honesty. He denied chemo for his prostate cancer as he didn’t want to live miserably through intense chemo…he is 78 and is big on quality of life - but it ultimately was a good decision not to do chemo for his prostate cancer, despite the oncologist pushing it at the beginning, because radiation and ADT did the trick to knock it down and stop it in its tracks. PSA is untestable for last 8+ months. Who knows how the chemo for prostate cancer would have affected his mental outlook and physical strength he now requires to fight pancreatic cancer - a much larger beast. He won’t ever be cured as he isn’t going to have surgery but we’re hoping for a miracle of stability to get some more happy memories with him!

[Tall_Allen in reply to LDC2024]

"...stop it in its tracks. PSA is untestable for last 8+ months." Adding a second-generation hormonal stops it in its tracks for longer.

[AlmostnoHope]

Look onto the oral route like Orgovyx as it's more controlled by how and when you take it.

[LDC2024 in reply to AlmostnoHope]

Thanks for the insight! Do you know if Orgovyx has similar side effects to Eligard? We’re hesitant to add another daily drug to the mix if it can potentially add to his side effects. He is currently on Type 2 diabetes medications, along with heart meds (aortic valve replacement years ago). Eligard hits him hard but the side effects do taper off for him a couple weeks after the shot (every three months).

[SteveTheJ]

Make sure to read others' advice also. In my case, I temporarily stopped Lupron in July 2023, and have not continued to date. By Jan. 2024 my testosterone was 4 and has rebounded to about 150 since then.

This is just data, not advice. In my case testosterone dropped very slowly.