Lupron, A Fib, What to Do?

[gottodealwithit]

Robotic surgery Dec 2015, PSA 0.52 March 2016, PSA 0.64 June 2016. June 2016 first Lupron shot, 4 weeks later A Fib after 10 years without had cardio conversion. Salvage Radiation Oct 2016. Second Lupron shot Dec 2016 a few weeks later A Fib again and again cardio conversion. June 2017 Lupron shot and again within few weeks A Fib and cardio conversion. Aug 2017 Catheter Ablation but 2 weeks later went into A Fib, cardiologist says I'm in permanent persistent A Fib. Due for final Lupron shot. PSA now 0.008. Cardiologist says take Lupron only if benefit is really high. Oncologist dismisses the impact of Lupron on A Fib. I AM UNDECIDED AS TO HOW TO PROCEED BUT NEED TO DECIDE WITHIN A FEW DAYS. Any comments would be welcomed

[AlanMeyer Moderator]

I'm no expert but, for whatever a layman's opinion is worth, I tend to agree with your cardiologist. Here are some suggestions:

1. If you don't get the Lupron now, nothing terrible will happen. Your PSA will begin to slowly rise. If you take it later, it will go down again.

2. Look up the FDA drug label for Lupron on the web. They're available on a number of websites including, of course, the Food and Drug Administration FDA website. Check for "adverse effects". I seem to recall that cardiac problems are not uncommon.

3. If cardiac problems are a known effect of Lupron (and I think they are), then your oncologist isn't reading the labels of the drugs he's administering - which is not a good sign. You may want to change oncologists.

Ask around for recommendations for oncologists. Ask in this HealthUnlocked group and in the HealthUnlocked "Advanced Prostate Cancer" group. Tell us where you live so people who live in that area can make recommendations. You want a real specialist in prostate cancer, not just a general oncologist. Teaching and research hospitals are good places to look. If you're in the U.S., the National Cancer Institute has a list of top hospitals for all kinds of cancer. See: cancer.gov/research/nci-rol....

Your response to the Lupron was excellent. That means that your cancer is very hormone sensitive - which is a good thing. There are other hormone therapies besides Lupron. Some are like Lupron - Zoladex and Eligard. Some are different and more powerful, Firmagon, Zytiga, Xtandi. Some work in totally different ways, e.g., Casodex, Estradiol. All of those may put strain on the heart. I'm not sure. Maybe a very mild treatment like Avodart may be safe for you to take and might still be enough to do what you need.

I hope you can find an oncologist who understands these issues and can offer you the best treatment to fit your situation.

Please let us know what happens, and if you post again, please give us your age, which may be relevant for your overall situation.

Best of luck.

Alan

[gottodealwithit in reply to AlanMeyer]

Alan, thanks for the thoughtful response. I am 72 yrs old. Interestingly the oncologist is at Duke. I live in the Tri-Cities area of NE Tennessee and purposely sought an oncologist at a teaching hospital. I would have preferred Vanderbilt, however Blue Cross/Blue Shield and Vanderbilt ceased working together Jan 2016, and thus Vanderbilt is "out of network". So, I went to Duke as it is "in network".

[AlanMeyer Moderator in reply to gottodealwithit]

I would expect someone at Duke to be highly knowledgeable. Maybe if you found something in an FDA label and showed it to him he would take notice and rethink his prescription. Or perhaps there's another oncologist at Duke who could give you a second opinion.

Talking to doctors is always a difficult problem. They are like everyone else in that some are very easy to deal with but others can be very touchy, sure of themselves, and unwilling to listen. However, changing doctors is always a pain and there's no guarantee that the new guy will be better. I think you have to play these issues as best you can, sometimes relying on convenience or even on your intuitions about the best way to deal with the doctor.

I asked about your age because I was thinking about life expectancy. Very young men need very aggressive treatment because their disease will eventually kill them long before they would have otherwise died. Very old men might emphasize quality of life and look for less aggressive treatments that can still keep them alive, but without expecting or requiring many more years. I'm 71 myself and recently turned down an operation (not cancer related) because, so far at least, I've been able to live okay with my problem and I don't need a solution that will last forever.

Doctors may or may not understand all that. I think most doctors do understand it, but they are trained to cure your illness as best they can and they don't always see the big picture.

Best of luck.

Alan

[gottodealwithit in reply to AlanMeyer]

Thanks Alan. I have decided to forgo the 4th Lupron shot and monitor my PSA on a 6 month basis. The Onc at Duke has asked to be kept informed, so I will probably go to Duke in June for the PSA test and a consult with the onc. I will try to remember to show him the FDA info.

[Don1157]

First of all, I hated Lupron, still do. Within a year of beginning Lupron right after Diagnosis I had to have open heart surgery\bypass x3. My med onc decided to try intermittent Lupron after a chemical recurrence 7 years later to avoid more heart, diabetic, and other possible side effects. Alan had good thoughts. Good luck!

[gottodealwithit]

Thanks Don, are you saying your PSA was very low or undetectable for 7yrs and then began to be of concern so back onto Lupron on an intermittent basis? Is the intermittency 3 month intervals, 6 month intervals or ??

[rust]

My dad had same issue and had the ablation procedure performed at UAB finally. Conversion is temporary. A fib can be caused by low testosterone. I know I will probably get a fib when I start ADT and so trying to avoid. Thinking maybe orchiectomy but don't know if any better than Lupron for people prone to a fib.