Worsening symptoms after starting ADT therapy in setting of initial high PSA?

[micadoolittle]

My husband was recently found to have a PSA of 32, with subsequent prostate biopsy showing - T2cGG5 and ensuing PMSA showing prostate and nodal activity, stage IVA.

In the one month between initial PSA and starting leuprolide, PSA went from 32 to 41. Is this meaningful in any way?

More importantly, a week after starting leuprolide, his ability to urinate has gotten worse, and constipation has significantly increased. Is this consistent with a flare phenomenon? Or could this be disease progressing?

Thanks.

[pjd55d]

report these symptoms to the prescribing Dr and see what they have to offer as explanation and what they have to offer for meds and side effects relief

[Tall_Allen]

He wasn't given Bicalutamide for 2 weeks to prevent testosterone flare?

[Newtonmore]

I was given Bicalutimide for a number of weeks to stop testosterone spike; I also think it also aimed to reduce size of tumour prior to radiotherapy

[Justfor_]

I don't know much about lupron, but I do know that you can NOT fool Bicalutamide. If he was taking Bicalutamide your search should be re-directed towards some report error like a decimal point missing. My experience with Bicalutamide (alone-no Lupron) has been that after taking it for 10 days at the standard dosage (50 mg/day) my PSA declined by 50% (verified twice).

[Havanablues in reply to Justfor_]

Wow that much, I am close to my 14 th day on Bicalutamide, so I should expect to see same results or at least somewhat of a decline? Thank you.

[Justfor_ in reply to Havanablues]

There is fineprint underlying though. Frorm the initial paper back in 199x, the blood concentration of the drug varied more than 10:1 among 100+ patients at standard dosage. I have come to the conclusion that I belong to the high sensitivity group. Now, if this and how it can affect PSA decline this is another story. Simple reasoning leads to believe that more concentration can prove more effective, but I wouldn't bet on it, when a PSA test can serve us the answer on a plate.

[Havanablues in reply to Justfor_]

Thank you, I plan on taking PSA test by the end of week.

[Justfor_ in reply to Havanablues]

Excellent! Don't miss to post your numbers (from to in X days at standard dosage). Number cruncher is my middle name.

[micadoolittle]

Calling MD office this am. Yes, it is leuprolide without bicalutamide. Reviewed bicalutamide, and it is contraindicated with one of the other medications he is taking for polymyalgia rheumatica.

[j-o-h-n]

Greetings micadoolittle,

What was his Gleason score? Please update his bio. All info is voluntary but it will help him/you and help us too. Thank you!

(Note: See his doc asap).

Good Luck, Good Health and Good Humor.

j-o-h-n

[micadoolittle in reply to j-o-h-n]

Gleason 9/10 in all 12 biopsies, with intraductal component and perineural invasion. Grade 5.

[j-o-h-n in reply to micadoolittle]

Thank you for the update. (Great wife, less strife).

Good Luck, Good Health and Good Humor.

j-o-h-n

[EdBar]

I did not wait for a week week period for bicalutimide before getting a Lupron shot, I was stage 4 at dx and wanted to get treatment going. I had the initial flare which lasted less than a week, probably 3-4 days before subsiding. The flare caused a lot of bone pain but thankfully it didn’t last long and was managed with OTC pain relievers.

Ed

[Professorgary]

with no bicalutimide your results are not unusual. After the first lupron injection your T spiked causing tumor flare. Honestly, your doctor should have given you a heads up.

[Teacherdude76]

Fairly common and MO can help.