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Five Percent of Patients on Lupron Report Cardiac-Related Side Effects

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Prostate Cancer
How well did you manage the side effects of ADT with Lupron?
Very well. It had little effect on my daily life. - 12.5% - 1 votes
It was realtively easy with just a few side effects. - 12.5% - 1 votes
My side effects were moderate. - 25.0% - 2 votes
I encountered every known side effect. - 50.0% - 4 votes
Not well at all. No one warned me it would be like this! - 0.0% - 0 votes
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Posted 7/6/2011 6:18 PM (GMT 0)

Most who have been inducted into the Lupron League know that life without testosterone is a crazy and trying proposition. While not at all pleasant (except for the laughing fits...), I thought I had started to make peace with this drug and its hold on my day to day life. But, just as I was counting down the days to the one year down, two to go mark,  I started to feel them. Palpitations.

After the first few occurrences, I thought perhaps they were simply an aberration--something that would go away as simply and quietly as they had arrived. But they didn't. Their frequency and severity increased over a two week period. Soon they began to feel as if someone was grabbing my heart and trying to choke the miracle muscle mass. These sessions came more frequently in the afternoons and evenings. If they came at bedtime, it was difficult to fall asleep. They grew more distressing in a sleep position. There were no other indications to make me think that a more serious condition was looming. But, considering one percent of patients do experience cardiac arrest, I did monitor these episodes very closely.

 

To read more: http://mynewyorkminute.org/?p=1567

Posted 7/6/2011 6:27 PM (GMT 0)
Dan,
I also posted this at your site...
I was on Lupron for 28 months (more if you count how long it takes to restore testosterone levels to pre-treatment). The more I read about this side effect I can't help but wonder if a cardiologist might not be a prudent part of my care before and during treatment on these drugs. I am curious about your thoughts about it...If there are ways of detecting cardiac risk for these patients I would think it would be a good idea to be proactive about it...

Tony
Posted 7/6/2011 6:34 PM (GMT 0)
It's a sound tought and one that I will discuss with my oncologist next month. There should also be a referral to exercose groups to ensure patients are doing all they can to combat the side effects.

Thanks.

Dan
Posted 7/6/2011 6:45 PM (GMT 0)
I guess it's important to note that patients on Lupron (and all of the other LHRH or GnRH agonists ~ this should not be thought of as just a Lupron problem), but all of these patients should know about weight gain as a result of taking these drugs. I am not certain that all cardiovascular problems should attributed directly to the drugs but rather that some of the side effects such as fatigue, weight gain, and many other well known SE's, can also attribute to cardiovascular issues. I seriously think that all of these factors come into play and can be a great reason to include regular EKG's as part of the routine diagnostics while under this care.

What I don't know is that if when we stop taking these products that risk comes back to a more appropriate levels for men. We know the testosterone comes back but does heart health also realize the same effect?

I guess we need some new studies...

Tony
Posted 7/6/2011 9:00 PM (GMT 0)
Before I went on HT both a echo cardiogram and a bone density test was required. Unless you have a baseline how can you tell how HT is effecting you. I'm amazed at how many patients are on HT without even minimal monitoring.
JT
Posted 7/6/2011 9:22 PM (GMT 0)
I got most of the side effects but the weight gain did not hit me until the second year. Then "whoomp" 20 lbs. I could hear my pants ripping. I see a cardiologist once a year and have been doing for years. I asked about this effect and he noted that it could be countered if one kept up a good diet and exercise program. The Lupron causes what is know as metabolic syndrome and the heart effects are mostly due to that.

Otherwise my Luron soujourn was tolerable but I do not look forward to another round.

Don

Posted 7/6/2011 9:23 PM (GMT 0)
Picture this. When a man's cholesterol is high he is given a statin and his doctor checks his blood for cholesterol level periodically. The same happens to men with diabetes type 2. They get medication and a glucose meter. What happens when men are CASTRATED chemically? If you think that their testosterone is checked periodically you must be dreaming...and dead WRONG! It happens all the time...and those that are checked are the exception...$%#&*

RalphV
Posted 7/6/2011 9:29 PM (GMT 0)
I am in the 9th month of a 24 month regimen, and while I have tolerated it, it hasn't been fun. The hot flashes have been difficult and often hit hard during inconvenient times such as during meetings and at church. I have also gained 20 lbs. Most recently I have started having migraine like headaches that stop most activities.

Today I helped dig post holes and set a rather large home made BBQ pit at our church.. It was 95 F in the shade, and we worked our butts off for about three hours. I actually enjoyed both the work and the interaction with friends. After getting home about 1pm, showered and sat down to check the stock market, and shortly afterwards my daily migraine began.

Imitrex and Tylenol usually help, but that always gives me that "druggy" feeling for a few hours.

Hopefully, most of this will end when I'm finished with HT.

K
Posted 7/6/2011 10:41 PM (GMT 0)
John,
I would think every patient that had surgery, In fact I know they did, or radiation should have pretreatment scans to make sure they are healthy enough to move forward with therapy. I absolutely had EKG, MRI, CT and others (remember extra imaging was not a bad thing for my case). The thing is that many men do not go straight to HT. It can take months or years before they do and I would be curious how many redid these tests prior to starting HT.

Ralph,
Most men are not as young as I am when you start HT. And thus they likely have not had a recent EKG as they are considered too young for it in a standard physical. So a new one should be ordered. And when the objective is to treat with HT, it is absolutely necessary that they should get T levels before and during there tenure on the drugs. The only time I had issue was at DX. And when I started HT I never knew what my original T levels were. But they were there. My original PCP measured my T levels in a physical and I was slightly hypogonadic before I ever had therapy. We discovered that later when my T levels stopped climbing at 260 after HT. It has never risen above that and my doc is really reluctant to prescribe androgel to a seminal vesicle positive patient. But we had the data ~ I just never asked what my pretreatment levels were. I bet most men don't know that these things are being monitored. Sure there are some that don'y know how low their T levels were while on HT but I didn't have that problem. LOL I was very low and into shoe shopping...:-)

kbota,
Stop checking the stock markets. That has had the ability to give me migraines as well...Long before I started HT...

Tony
Posted 7/6/2011 11:01 PM (GMT 0)
"If you think that their testosterone is checked periodically you must be dreaming...and dead WRONG! It happens all the time...and those that are checked are the exception...$%#&*"

I'm wondering on what you base that statement?
Posted 7/6/2011 11:06 PM (GMT 0)
Les,
I know you are asking Ralph, but I know a few men in my UsTOO group that never knew to ask. And when a couple did they their first T level check from the oncologists administering the drugs. In my experience I have seen that most men are watching it but too many are not. You also have to remember that Ralph has been around a long time with this...er, but he's still a young man, cough, and I bet until recently the pendulum was in the other direction...

I hope you and Carol and doing well, my friend.

Tony
Posted 7/6/2011 11:57 PM (GMT 0)
Tony,
EKGs and chest Xrays are done pre surgery as a normal routine. An Echo Cardiogram (Doppler stress test) and Bone Density are completely different and not done in the normal course of any treatments that I know of except for those going on HT. I also agree that most do not have there "T" monitored. Strum uses a lot of other blood markers to insure that HT is working and also not affecting other things.
Posted 7/7/2011 1:46 AM (GMT 0)
Tony, I cannot blame today's headache on the market.......it was an up day.
Posted 7/7/2011 2:21 AM (GMT 0)
Does HT (Lupron) cause depression in any form? Or is it simply the knowledge of HT with the daily hot flash reminders, that cause depression?

It seems that it's a very difficult thing to get off my mind.

Honestly, I'm not even sure that it's really depression as much as just a sadness over the situation. Sometimes, I find myself just not wanting to do this anymore, but scared not to.

I actually do pretty good on a day to day basis, but I'm scared of the future.

Oh never mind.... this chit just sucks.

K
Posted 7/7/2011 3:00 AM (GMT 0)
Well a well qualified individual indicated this evening that Echo Cardiograms are for cardiologists diagnosing heart ailments that are already present and are completely unnecessary for qualification for HT. Dexa scans are questionable in the first year but should be done after HT. This one example leaves EKG's to the PCP but suggests that if your aren't getting them you should. He wasn't impressed with the data in the available studies on HT. He did say that dietary issues are discussed prior to starting HT and that these issues are far more dangerous than HT.

Just sharing.

Kbota,
Sorry you have them. I can get them from ED drugs but I never had the headaches with HT. I had the hot flashes, depression, and some weight gain (See my last paragraph). I was able to address all three with CAM's

Tony
Posted 7/7/2011 3:05 AM (GMT 0)
John just a side note I have Strums book "A Primer on Prostate Cancer" here next to me and I can't find mention of echo cardiograms. He does mention elektro cardiograms and only recommends them annually during physicals. Do you have something different to share from him?

Tony

Post Edited (TC-LasVegas) : 7/6/2011 10:23:47 PM (GMT-6)

Posted 7/7/2011 4:00 AM (GMT 0)
I'm sorry Tony, but what is CAMS?
Posted 7/7/2011 4:18 AM (GMT 0)
Complimentary and Alternative medicine. We all do conventional therapies but that's just treating the tumor. I have typed quite a bit about an integrative approach to therapies and I swear by them as they have helped me be a healthier me. Treating mind, body, and spirit is also included with treating tumors. For example I understand that acupuncture or meditation can help migraines and hot flashes in many men. It may help you and it may not, but the important concept is that you keep looking for what counters the side effect until you find something that makes the journey a bit easier...I have a website that will take days to get you through the presentations and reading.

www.integrativeoncology-essentials.com

The individual who made this site has done quite a bit of research on it while at Harvard University. i didn't buy it at first but it is good stuff. Many centers are now providing CAM's to go with their conventional medicine. I personally joined the Society of Integrative Oncology this year (www.sio.org) and the information is great to have.

Tony

Post Edited (TC-LasVegas) : 7/6/2011 10:21:31 PM (GMT-6)

Posted 7/7/2011 4:22 AM (GMT 0)
Tony,
I was referring to blood markers that Strum recommends not scans. In his P2P responses he lists a lot of markers that he routinely uses. I also know that Schotz recommends an echo cardiogram before HT to eliminate any cardiac issues that a patient may have that have been yet to be Dxed along with a bone density as a base line to identify any bone loss from HT. He says that the vast majority of his patients die from heart attacks and not from PC, and he would be remiss if he did not identify any cardiac issues a patient may have. An eco cardiogram may be overkill, but that's his recommendation.
Posted 7/7/2011 4:36 AM (GMT 0)
He doesn't mention it but I do have what might not me his latest rendition of his book. I wonder if any other oncologist does echo cardiograms prior to prescribing HT? I can see some logic to it. But as I said earlier it sounds like diet and overall health risk factors are higher risk factors than HT. I'll keep looking for more data on the benefits of cardiac diagnostics prior to HT. If you find any links please post them...I've been searching all night and all I can find from Strum is an EKG recommendation as part of routine health maintenance.

Tony
Posted 7/7/2011 2:49 PM (GMT 0)
Tony,

Strum refers to pg 64 in his book for other markers. I'm in Idaho so I don't have his book with me.

His quote:

CONCLUSIONS: MRI of axial skeleton enables precise

measurement and follow-up of bone metastases as it is for other

soft-tissue metastasis.

Pending the results of the above would then make treatment decisions

re ADT (androgen deprivation therapy) and how best to give.

If Combidex were still available would do after a normal MRI-A (MRI

axial skeleton) study. If MRI-A (MRI axial skeleton) could not be

done then I would opt for PET/CT using F18 but NOT FDG isotope.

I would also want baseline testosterone level as well as prolactin

level and given the uncertainty of the Gleason score would want

neuroendocrine (NE) markers that are more often seen with high

Gleason scores of 8-10 such as CGA (Chromogranin A), NSE (Neuron

Specific Enolase) and CEA (Carcinoembryonic Antigen). Read The

Primer on Prostate Cancer by Strum & Pogliano and see page 64

regarding markers in high GS situations.

Assuming all has been done, ADT should be at least ADT with 3 drugs

to include anti-androgen (AA) e.g. Casodex or Flutamide followed one

week later by an LHRH agonist like Lupron or Trelstar or Eligard. I

also use Avodart along with the anti-androgen (AA). I monitor the

CBC, ultrasensitive PSA, CMP (comprehensive metabolic panel) &

testosterone monthly until stable values. My goal in PSA is < 0.05 x

12 months and then off ADT but staying on Avodart.

Our published paper used finasteride (Proscar) but dutasteride

(Avodart) appears to be a more appropriate 5ARI (5-alpha reductase

inhibitor) for higher Gleason score PC

Posted 7/7/2011 3:37 PM (GMT 0)
John my fault. I understand the blood markers that Strum recommends and my page 64 is consistent with your page 64.

My reference is to the requirement for echocardiograms before HT as you stated above and I can find absolutely zero requirement from the drug manufacturers nor from Strum on doing these prior to HT. From what I found thus far it's unnecessary. Standard EKG's should be part of a 50+ yo man's annual physicals regardless of prostate health. Will this change in time? I dunno. They are not too expensive, and if the threat of heart attack is a concern I would think getting one is logical. Dan is pointing out that he is interested in whether his blip on his EKG radar is from the HT drugs as he has experienced some indicators of it. This has been a question here and in our UsTOO group before and I am looking for what other oncologists recommend or require before starting HT for my own education. Thus far I am only able to find references to EKG's, DEXA, and various blood panels and only sometimes on the EKG's. I didn't ask if this woulf be different for me when I started at age 44 versus a median aged 67yo man or older prior to starting HT. Logic says it might...

I have had a few EKG's during my prostate cancer journey. The first was for surgery as is required. The second was done prior to starting radiation but I should note that the EKG was done on the same day I started HT. Vogelzang indicated that wasn't for him it was for my scheduled radiation therapy. My third one was done after my blood pressure started to rise the summer following my radiation therapy. We think unrelated to the therapies and my family history with high blood pressure is present. Weight loss has lowered my BP which tells me that it was a contributor to any increases.

In an indirect way I can probably safely say that being on HT contributed to my weight gain, which contributed to my rise in BP ~ which can ultimately contribute to heart ailment...but that the drugs themselves would not have caused my rise in BP had I done a better job keeping the weight off...

Tony
Posted 7/7/2011 3:57 PM (GMT 0)
I guess for everybody following this thread, last year the FDA required the manufacturers of LHRH and GnRH agonists (HT drugs) to include the mention of risk of heart attack and diabetes on their labels. Here is a reference from the InfoLink on this topic:

prostatecancerinfolink.net/2010/10/21/fda-formalizes-warning-of-cardivascular-risks-for-lhrh-agonists/
prostatecancerinfolink.net/2010/05/03/us-fda-reviewing-the-safety-of-lhrh-agonists/

What I am unable to find is what preliminary cardiac diagnostics might be prudent prior to starting HT that might help determine risk as a result of taking these drugs. American Heart Association says that monitoring the cardiovascular system is recommended but they don't say how. Every indicator I can find is that while there is risks, they are very small. I also do not know if these risks go away once you stop taking the drugs.

If anyone has any information on this stuff I would like to pass it along to our UsTOO group...I get asked this question a lot but very little data exists...

Tony

Post Edited (TC-LasVegas) : 7/7/2011 10:00:47 AM (GMT-6)

Posted 7/7/2011 4:51 PM (GMT 0)

Gordy said...
"If you think that their testosterone is checked periodically you must be dreaming...and dead WRONG! It happens all the time...and those that are checked are the exception...$%#&*"

I'm wondering on what you base that statement?

Gordy,
Based on published data:

3.3.4. Determining the efficacy of androgen-deprivation therapy

ADT is the mainstay of therapy for advanced PCa. Given that the goal of ADT is to achieve castration serum levels of testosterone, it is somewhat surprising that testosterone measurement is not part of routine follow-up, with 26% of surveyed clinicians claiming never to utilise this assay Furthermore, EAU and American Urological Association guidelines recommend PSA testing as the principal mode of follow-up, supplemented by DRE and symptom evaluation , and . However, it is important to appreciate the different objectives of serum testosterone and PSA assays. As the target of therapy, serum testosterone is a direct measure of treatment efficacy, whereas PSA is a more general reflection of disease progression. Testosterone determination can therefore provide a direct ADT quality control indicator. Some authors have even advocated tailoring the ADT dosing interval to the individual patient on the basis of testosterone measurement [55].

For patients commencing ADT, the importance of testosterone monitoring is underscored by the observation that a percentage of patients fail to achieve castration levels with traditional luteinising hormone-releasing hormone (LHRH) agonists. A recent review found that up to 12.5% do not reach the 50 ng/dl (1.73 nmol/l) serum testosterone target, and up to 37.5% do not attain levels <20 ng/dl (0.69 nmol/l), which more closely reflects the outcome of surgical castration [56].

Source: tinyurl.com/42zvj9u

That evidence and talking to many, many men on ADT. Even men who had increasing PSA and their T was never checked while told they were androgen-independent. How is that?

Tony,
I am old, but I really try to stay up on current clinical practice
smilewinkgrin and sometimes it is just incredible! smhair
Posted 7/7/2011 4:56 PM (GMT 0)
Don't know what happened with all the bold type...apologies

RalphV
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