A website to provide support for people who have or have had any type of cancer, for their caregivers and for their family members.
Page 1 of 2 12 LastLast
Results 1 to 10 of 13

Thread: Lupron and on and on?

  1. #1
    Newbie New User
    Join Date
    Jan 2019
    Posts
    2

    Lupron and on and on?

    Greetings fellow travelers.

    So a "routine" PSA (9.49) in June began the process, which has involved an MRI, biopsy (Gleason 4+3), procedural delays, and my first Lupron shot in November. I am now about a third of the way through a course of 26 high-intensity IMRT treatments, having selected that as my primary therapy. (I still have a prostate, sporting three calypso beacons, although it is slowly being fried.)

    Here's my question: I know that my urologist is going to want to keep me on Lupron for a while. Why? I know there is "some data" that shows people who continue ADT after radiation live longer, but I am skeptical. What is the theory of action? No one says Lupron kills the cancer. My radiation oncologist is highly confident that his ray gun is going to destroy any cancer in the prostate bed. He also characterized the information supporting the value of continued ADT as highly uncertain.

    This may be a situation where I prioritize near term quality of life over some dubious promise of a longer life. Foolish move?

  2. #2
    Regular User
    Join Date
    Aug 2018
    Posts
    15
    I think radiation oncologists try to avoid mentioning adjuvant ADT because they are afraid they may loose patients if they tell them that this is required. The guidelines recommend ADT and that is standard of care. You can get away with 18 months of ADT according to this study:
    Nabid 2018-Duration of Androgen Deprivation Therapy

  3. #3
    Hello Srcoffee: Welcome to the forum. Not knowing all your stats, and what exactly u are dealing with, it might be hard to give u the best advice. Going on what u wrote, I can make the following comments. I believe the synergies of combining the RT and the ADT can be much more effective than either one alone. There is a wide range of opinion as to what is the proper length of time. In my high risk case, standard of care is what u see in my signature. I asked my doctor if the ADT kills stray cells that may be floating around ( when I first began SRT). He said they think it might, but he could not give me a conclusive yes. I would at least continue the ADT after radiation for 6 months....I would liken it to being on antibiotics, and deciding to not finish the prescribed amount. You have the "unhappy G7" with a dominant pattern 4. You may have something worse...just hard to tell. Not trying to scare u, but we each must make a decision as to how hard we want to go at it. Again, if u could fill out the signature forms, I'm sure some of the smarter forum brothers will be along to chime in. Best to u, MM
    DOB:Feb 1958
    PSA: 9/15: 5.9 PC/Father
    DRE: Negative
    Biopsy: 10/1/15. Second Opinion University of Chicago. 9 of 12 cores positive. G6: 5 cores, G7 ( 4+3) 4 cores
    10/12/15: Ct scan/bone scan- Negative
    Clinical Staging: 10/28/15 T2c
    ( RALP) University of Chicago 12/29/15

    Final Pathology Report; Jan. 6 2016

    15 lymph nodes; no tumor present
    gleason upgraded to 9 ( 4+5)
    +EPE
    +LVI
    Right SV Positive
    Left SV and vasa deferentia, no tumor present
    PI present
    PM
    pT3bNO
    uPSA 2/9/16 0.05
    uPSA 3/23/16 0.11
    Casodex 4/1/16-8/5/16
    Lupron 4/15/16-5/15/18
    SRT 6/14/16...8/5/16 38Tx
    uPSA 8/10/16---2/14/19 <0.05
    Feb. 2017 Loyola Chicago
    11/15/2018 AUS 800 Implanted
    12/18/18...T Levels...Free T 42.8...Total T...262

  4. #4
    Senior User
    Join Date
    Jun 2016
    Posts
    181
    Like you are having, I started on Eligard (same stuff as Lupron, just different manufacturer) two months before 38 IMRT treatments. Yes, the Lupron does increase the effectiveness of radiation treatments. Lupron suppresses testosterone growth, the hormone which fuels the growth of prostate cancer cells. It does not kill Pca cells, but puts them into hibernation, so they don't replicate, and with time will die off like all other cells do. It is also thought that the lack of testosterone weakens the pca cells, so radiation therapy is more effective. Lupron/Eligard is continued for as long as 2-3 years, hoping the lack of testosterone will find pca cells that may be elsewhere in the body, and help them die off with out replicating during the 2-3 year period. I completed 19 months of Eligard. The side effects were not pleasant, but do-able. Quality of life was not that much disrupted. I think it has been well worthwhile treatment. I have an 80% chance of a cure, lower then that without Eligard.

    If your cancer has not spread outside the prostate gland, then your time on Lupron will be much less then mine.

  5. #5
    Moderator Top User HighlanderCFH's Avatar
    Join Date
    Nov 2011
    Posts
    7,071
    Good luck, srcoffee.

    When you have a chance, please consider posting all of your PC stats on your signature so we can have a better idea of your case. You will find instructions in one of the sticky threads near the top of the forum.

    Take care,
    Chuck
    July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA 9/ 2011 = 5.7.
    Local uro DRE revealed significant BPH, no lumps.
    PCa Dx Aug. 2011 age of 61.
    Biopsy DXd adenocarcinoma in 3/20 cores (one 5%, two 20%). T2C.
    Gleason 3+3=6. CT abdomen, bone scan negative.
    DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
    Surgeon was Dr. Matthew Tollefson, who I highly recommend.
    Final pathology shows tumor confined to prostate.
    5 lymph nodes, seminal vesicules, extraprostatic soft tissue all negative.
    1.0 x 0.6 x 0.6 cm mass involving right posterior inferior, right posterior apex & left
    mid posterior prostate. Right posterior apex margin involved by tumor over 0.2 cm length,
    doctor says this is insignificant.
    Prostate 98 grams, tumor 2 grams.
    Catheter out in 7 days. No incontinence, minor dripping for a few weeks.
    Seven annual post-op exams 2012 through 2018: PSA <0.1
    Semi-firm erections without "training wheels," usable erections with 100mg Sildenafil.
    NOTE: ED caused by BPH, not the surgery.

  6. #6
    Top User
    Join Date
    Aug 2016
    Posts
    1,340
    A side bar to the above encouragement. The way your brain works matters with this disease. You can't out think this. Those who try squander their opportunity. The brain is wired to avoid (shows up as denial) or delay.

    Early detection, early treatment is the key to staying ahead of this disease at every stage. The treatment protocols work if they are used. Shifting the brain from avoidance to treatment makes a difference with cancer.

    Some doctors, mostly men, share this same disfunction. Pairing up with a doctor who doesn't take this disease seriously may be more of the same for many men.

    To support this fact of professional denial, only 17% of internists and GPs screen for prostate cancer. Unexplainable and bad medicine, but still, it is a fact.

    The cancer doesn't have a brain. It is a mechanism. ADT disrupts the mechanism. You want a new drug. There isn't one. It's all we got. That and an overwhelming will to live. Use your will to shift your head in this matter.
    Last edited by Another; 01-12-2019 at 03:27 PM.

  7. #7
    Top User garyi's Avatar
    Join Date
    Apr 2017
    Posts
    1,106
    Quote Originally Posted by Another View Post
    ...Early detection, early treatment is the key to staying ahead of this disease at every stage.

    Some doctors, mostly men, share this same dysfunction.

    Use your will to shift your head in this matter.
    Excellent observations and advise!
    72...LUTS for the past 7 years
    TURP 2/16,
    G3+4 discovered
    3T MRI 5/16
    MRI fusion guided biopsy 6/16
    14 cores; four G 3+3, one G3+4,
    CIPRO antibiotic = C. Diff infection 7/16
    Cured with Vanco for 14 days
    Second 3T MRI 1/17
    Worsened bulging of posterior capsule
    Oncotype DX GPS 3/17, LFP risk 63%, Likelihood of Low
    Grade Disease 81%, Likelihood of Organ Confined 80%
    RALP 7/13/17 Dr. Gonzaglo @ Univ of Miami
    G3+4 Confirmed, Organ confined
    pT2c pNO pMn/a Grade 2
    PSA 0.32 to .54 over 3 months
    DCFPyl PET & ercMRI Scans - 11/17
    A one inch tumor remains in prostate bed = failed surgery
    All met scans clear
    SRT, 2ADT, IMGT 70.2 Gys @1.8 per, completed 5/18
    PSA <.006 9/18, .054 11/18, .070 12/18, .067 2/19
    We'll see....what is not known dwarfs what is thought to be fact

  8. #8
    Another: Your above post is some of the best advice that I have ever read. Well done!
    DOB:Feb 1958
    PSA: 9/15: 5.9 PC/Father
    DRE: Negative
    Biopsy: 10/1/15. Second Opinion University of Chicago. 9 of 12 cores positive. G6: 5 cores, G7 ( 4+3) 4 cores
    10/12/15: Ct scan/bone scan- Negative
    Clinical Staging: 10/28/15 T2c
    ( RALP) University of Chicago 12/29/15

    Final Pathology Report; Jan. 6 2016

    15 lymph nodes; no tumor present
    gleason upgraded to 9 ( 4+5)
    +EPE
    +LVI
    Right SV Positive
    Left SV and vasa deferentia, no tumor present
    PI present
    PM
    pT3bNO
    uPSA 2/9/16 0.05
    uPSA 3/23/16 0.11
    Casodex 4/1/16-8/5/16
    Lupron 4/15/16-5/15/18
    SRT 6/14/16...8/5/16 38Tx
    uPSA 8/10/16---2/14/19 <0.05
    Feb. 2017 Loyola Chicago
    11/15/2018 AUS 800 Implanted
    12/18/18...T Levels...Free T 42.8...Total T...262

  9. #9
    Newbie New User
    Join Date
    Jan 2019
    Posts
    2
    I appreciate all the responses and will endeavor to complete my profile, although I’m not sure what to add to what I already reported.

    I especially appreciate Another’s recommendation not to try to “outthink” prostate cancer. While I am clearly guilty of that, I would submit that that is really all we mere humans have. I can leave the thinking to the doctors and medical researchers or I can be an active participant. So here comes more denial:

    Doing my own review of the literature, I find the research that I believe drives current guidelines. The logic is all based on five-year survival rates. Patients with high-risk PCa who are on ADT for 2 years have a higher 5-year survival rate than those on ADT for six months. Well duh! They have had less time for the cancer to rebound.

    The way I understand it, ADT is just a timeout. It stops the clock in the progression of the disease—until it doesn’t. According to the research, it doesn’t seem to matter whether you use your timeout all at once or intermittently. (EAU Guidelines) In other words, I can endure the side effects of ADT now or later—it doesn’t seem to matter.

    Furthermore, the studies driving the guidelines are necessarily based on data from older treatment regimens. Some feel that new RT regimes change the equation: “Adding ADT to modern dose-escalated RT was not associated with improved survival for patients with favorable intermediate-risk prostate cancer.” https://www.ncbi.nlm.nih.gov/pubmed/27191936 Add to the equation the negative effects on quality of life, the increased risk of diabetes, osteoporosis, and maybe heart disease from ADT, and the analysis seems to tip the other way.

    Here’s the nub. (literally) One of the benefits of radiation over surgery (at least at my risk level) is that radiation spares your erection—but only for a while. After six months, so I read, it starts going south. Do I really want to decline my last shot at a sex life for a dubious promise of a few more months on the back end of my life?

  10. #10
    Top User garyi's Avatar
    Join Date
    Apr 2017
    Posts
    1,106
    Suggest you still have a lot more research to do srcoffee, before earning your Google MD, that all studies should be taken with a grain of salt, and that there are no absolutes answers or guarantees with this maddening disease.

    Welcome to the club and best of luck on your journey.
    72...LUTS for the past 7 years
    TURP 2/16,
    G3+4 discovered
    3T MRI 5/16
    MRI fusion guided biopsy 6/16
    14 cores; four G 3+3, one G3+4,
    CIPRO antibiotic = C. Diff infection 7/16
    Cured with Vanco for 14 days
    Second 3T MRI 1/17
    Worsened bulging of posterior capsule
    Oncotype DX GPS 3/17, LFP risk 63%, Likelihood of Low
    Grade Disease 81%, Likelihood of Organ Confined 80%
    RALP 7/13/17 Dr. Gonzaglo @ Univ of Miami
    G3+4 Confirmed, Organ confined
    pT2c pNO pMn/a Grade 2
    PSA 0.32 to .54 over 3 months
    DCFPyl PET & ercMRI Scans - 11/17
    A one inch tumor remains in prostate bed = failed surgery
    All met scans clear
    SRT, 2ADT, IMGT 70.2 Gys @1.8 per, completed 5/18
    PSA <.006 9/18, .054 11/18, .070 12/18, .067 2/19
    We'll see....what is not known dwarfs what is thought to be fact

 

Similar Threads

  1. Lupron, Eligard, Lupron Depot, and Viadur
    By hms03049 in forum Prostate Cancer Forum
    Replies: 1
    Last Post: 04-03-2015, 04:30 PM
  2. Price check: Cost for Lupron and related drugs....
    By mkane09 in forum Prostate Cancer Forum
    Replies: 4
    Last Post: 02-02-2012, 05:56 PM
  3. Replies: 6
    Last Post: 09-23-2011, 01:47 PM
  4. PSA and Cancer Spreading?? Lupron??
    By msds in forum Prostate Cancer Forum
    Replies: 7
    Last Post: 01-30-2011, 03:03 AM
  5. Question. HRPCa new treatment Lupron and Casodex?
    By BonnieD in forum Prostate Cancer Forum
    Replies: 0
    Last Post: 04-29-2010, 04:17 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •