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Back on Lupron???

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Posted 4/5/2014 9:27 PM (GMT 0)
Hi Gents,

I've been off Lupron, which was keeping my PSA in check at 0.0, since 7/2013, had a followup in 12/2013 and it was at 0.9 and most recently, 3/2014, at 3.2. I have a followup next week and if it's continuing to rise my Dr. wants to put me back on the Lupron, probably for the rest of my life, he says. I hate the side effects from this. Any ideas of other approaches to deal with this? Nothing I've researched has turned up what seem like good alternatives but this is why I'm reaching out to you all. Thanks much! Frizzle

Age 59 Mnpls
PSA 3/09 – 5.6, 2/11 – 10.5
DRE: nodule on left side of prostate
Biopsy: 6 of 12 cores positive, GS 3+4
Pre Op CT Scan & Bone Scan clean
Started HT, Lupron, 3/29/11
DaVinci 11/29/11, Rt. Side nerve sparing, Left apical margin positive
PSA 3/12 – 0.04, 6/12 .94, 7/12 1.5
Resumed HT, Lupron 7/13/12 for 1 year
SRT, 7/29 – 8/14/12
Clinical: T2aN0M0, Path: T3N0MX
Final GS 4+3
Finished 1 year of Lupron on 7/13
PSA on 12/13 – 0.9
PSA on 3/14 – 3.2
Posted 4/5/2014 9:49 PM (GMT 0)
Tough call.

I am also a G4+3.

I was on Lupron/Casodex for a year. Just started my HT vacation and will be doing my first post Ht vacation PSA test on Friday.

I think when my PSA starts to rise again, since I responded so well to the above regimen, I will be back on that for a year and then off it again.

I do HATE the SE

Mel

Posted 4/5/2014 9:54 PM (GMT 0)
Thanks Mel, Never thought of a "vacation", I'll have to run that by my Uro and look forward to it!

Frizzle
Posted 4/5/2014 10:58 PM (GMT 0)
Another thing that is not an option right now but may be in the future (if some currently-ongoing clinical trials work out) is "bipolar androgen therapy" (BAP). You can read about the trial here.

If it can be made to work it will go a long way towards lightening up the "life sentence" aspect of HT for metastatic disease.

I have an agreement in principle with my MO that if I ever recur we will launch our own n=1 trial to see how I do on a BAP protocol.
Posted 4/5/2014 11:37 PM (GMT 0)
frizzle,

Sorry to hear that news however my husband too was on Lupron for 1 year and then off for 1 year then his PSA started to rise. Read stats below. Our oncol. put him on Degaralix and so far after his 2nd shot he isn't yet having SE, as he did with Lupron.
The downside is it is injected every 28 days. His PSA is undectable after the first 28 days!

BOOGEE
Posted 4/6/2014 12:35 AM (GMT 0)
When your testosterone level is reduced to castrate levels, there are bound to be side effects..But since this is the most effective (and the cheapest) treatment when surgery and radiation have failed to deliver a cure, then hormone treatment is what you are going to get. like it or not...When the Lupron starts losing its effectiveness, they usually add Casodex to reenforce the Lupron, ADT-2. This approach has kept me going for the last 3 years...When this starts to fail, it's on to Provenge..
Posted 4/6/2014 2:43 AM (GMT 0)
Thanks folks! The feedback, ideas, and comments are encouraging and greatly appreciated. Bless you all, Frizzle
Posted 4/6/2014 2:45 AM (GMT 0)
I've been off Lupron for just at a year, but with the March PSA and doubling time, I'll be back in for another 6 month shot in June. just another detour.
Posted 4/6/2014 2:46 PM (GMT 0)
Hey Frizzle,
We were in the same situation as you. Jim went intermittent after a year on lupron. PSA started rising rather quickly. We decided to try the c11acetate scan to see if targeted radiation might work if lymph or bone mets could be located.
Scan was clear at .04 PSA.
We then pursued the Prostvac/enzalutamide trial at the National Institutes of health in Bethesda, MD. Jim was randomized to the arm that received both Enza and the immunotherapy!! Its been a wild ride with lots of trips to DC. But the 3 months of enza knocked the PSA to .01 and now we wait to see if the prostvac will keep the bugger's at bay.
Yes, lupron and adt3 could keep working for years but this opportunity to receive immunotherapy early in disease progression convinced us to try the trial.
If you're in MN I believe DR.Kwon at Mayo in doing a c11 choline scan.
I'd be happy to share additional info if you email. We have the 32 page consent form which makes great bedtime reading:-)

http://www.clinicaltrials.gov/ct2/show/NCT01875250
Marie and Jim
Posted 4/6/2014 5:44 PM (GMT 0)
You can discuss intermittent rather than continuous ADT. They seem to give equivalent outcomes, but intermittent gives you some breaks.

You can talk to your doctor about irradiating your chest to prevent gynecomastia and using an estrogen patch to get rid of most other SEs of ADT. There's a new drug called Capesaris (GTX-758) that avoids many of the SEs of LHRH agonists like Lupron or antagonists like Degarelix, but the clinical trial so far is only for mCRPC.

- Allen
Posted 4/6/2014 6:17 PM (GMT 0)
TallAllen,

Are you referring to the clinical trial for Enza and Prostvac? If so you are mistaken. There are two trials, one for hormone sensitive men, another for castrate resistate men.
Jim is in hormone sensitive trial, Arm B, both drug and vaccine. Adjust is in mcrpc trial also arm B. 49packard is mcrpc and in Arm A, enzalutamide only.
As of last Monday, 20 men are in the hormone sensitive group. 37 are needed. I noticed my link is not working in above post.
It has been a great experience for Jim. My gift from his last trip there was a Large coffee mug imprinted with " NIH. BIG PLACE, LOTS OF SMART PEOPLE" Hope that means patients as well as drs.
Marie
Posted 4/6/2014 6:20 PM (GMT 0)
Marie,

No, I was referring to the clinical trial for Capesaris.

- Allen
Posted 4/7/2014 2:57 AM (GMT 0)
Thanks Marie & Allen, I'll look at the clinical trial and ask my Uro about intermittent Rx, I like that idea :)
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