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Questions regarding T level while on HT

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Posted 2/29/2012 1:07 PM (GMT 0)
Hi folks,

I just got my latest lab report in the mail. No discussion with the Dr. yet. My latest T level is 40. Last October it was 26. My last Lupron shot was on 11/1/11 .. a 6 month depot version. I have been on Lupron for 15+ months now. 40 seems higher than desirable for HT. A few random thought questions:

1. I just started taking Casodex in addition to Lupron, will that lower my T level?

2. Should I consider going back to shorter interval Lupron injections such as 3 months?

3. Should I consider a competing product like Zoladex?

4. Is all this exercise pushing up my T level? (Not that I am going to stop.)

5. With my last Lupron injection, my rear was very sore for about 5 days. Does that have anything to do with its effectiveness?

6. Any other thoughts on pushing it down to a lower number?

Thanks for any feedback.

Posted 2/29/2012 3:15 PM (GMT 0)
My understanding is that you want T to be under 20 to be most effective. Part of T comes from DHT that is not affected by Lupron or casodex. DHT is produced from the adrenal glands and is many times more powerful than T from the testes. DHT is stopped by the 5-alpha reductase inhibitors Avodart and Proscar. There are two chanels of the DHT production and Proscar is effective in one and Avodart is effective with both.

Many of the oncologists we read about routinely include either Proscar or Avodart in their ADT protocol. Myers usually keeps patients on even after the Lupron, Casodex, etc are stopped.

Another concern is the Lupron mix. If it isn't proper then it won't lower the T effectively. I have read that there is no effectiveness difference between the doses. I have been on Eligard as it was available in 6-month doses. Recently Lupron became available in a 6-month dose and my Urologist indicated he will likely use ot for the next shot in April. Check with your doc about the T being >20 and your concern and talk to him about Proscar/Avodart. Personally I am on Jalyn, which combines Avodart and Flomax. I am on Jalyn and Eligard for 16 months and my latest T was <3.
Posted 2/29/2012 4:20 PM (GMT 0)

Southern Comfort said...
Hi folks,
I just got my latest lab report in the mail. No discussion with the Dr. yet. My latest T level is 40. Last October it was 26. My last Lupron shot was on 11/1/11 .. a 6 month depot version. I have been on Lupron for 15+ months now. 40 seems higher than desirable for HT. A few random thought questions:

1. I just started taking Casodex in addition to Lupron, will that lower my T level?

2. Should I consider going back to shorter interval Lupron injections such as 3 months?

3. Should I consider a competing product like Zoladex?

4. Is all this exercise pushing up my T level? (Not that I am going to stop.)

5. With my last Lupron injection, my rear was very sore for about 5 days. Does that have anything to do with its effectiveness?

6. Any other thoughts on pushing it down to a lower number?



Thanks for any feedback.

I'm surprised your Dr wasn't concerned about the level of your T.....is your Dr an OCO or a URO?
Posted 2/29/2012 5:23 PM (GMT 0)
Hi SC,
All LHRH agonists (Lupron, Zoladex, Trelstar etc) are designed to lower testosterone to castrate level (identified as 50 ng/dL). In that respect your T is within the defined level.
Some experts prefer a lower level of 20 ng/dL, but not one of the manufacturers have changed their specifications.

Adding Casodex to the mix blocks the androgen receptor (AR). Many tissues express AR and therefore by blocking the receptors, testosterone or its metabolite DHT is unable to link with the receptor. The result can be an increase serum testosterone since it can’t go anywhere.

Switching to a lower interval LHRH might help. Some switch to a different LHRH with improved results.

Resistance exercises tend to increase testosterone while endurance exercises tends to lower it. A combination might help.

I don’t think that pain at the injection site is related to efficacy.

A shorter interval or different LHRH might help. I have seen that happen in several patients. That said, your PSA is the red flag that tells things are working at this level of testosterone. There are things that can be added to lower testosterone, Estradiol or ketoconazole would do it. Adding these can have related side effects without proven benefit.

RalphV
Posted 2/29/2012 7:36 PM (GMT 0)
Thanks for the feedback. Talked to the med onc this morning. Since I just started Casodex she wanted to wait and see what the T looks like in 3-6 weeks and then discuss prior to the 4/18  next-injection due date. She mentioned she has seen studies where degarelix worked when Lupron had a tough time bringing the testosterone down.
Posted 2/29/2012 8:07 PM (GMT 0)
SC:

I'd like to reply to your item 5. - Pain at injection site.

 

It seems that a small percentage of us have this reaction to Lupron and so far no Doc has been able to give me an answer.

 

We are not talking here about the usual "morning after sore butt", but rather bigtime pain issues.

 

My problem goes like this: Shot time - Just another shot in the butt. 200 mile drive home - No prob. Rest of day - No prob. Morning after - Hurts so bad I am unable to get out of bed.

 

Day 2 - Can hobble around at pain level 5/6

 

Day 3 - Back to work. Barely.

 

Any nurse will tell you to make sure that the glute is relaxed prior to the shot. This is not the problem here though with me at least as I make sure to relax the muscle.

 

3 Mo or 4mo shots - No difference.

 

If any member out there can give any insight on this, I would like to hear it.

 

Carry on SC, we will prevail.

 

Don K.

Posted 2/29/2012 8:10 PM (GMT 0)

Hey R.

Can't answer most of your questions. Just not that experienced yet with all this. I guess one good thing for us,  was that after 2 months of a 4 month Lupron, my T was .24 and any DHT was undetectable. My rear also hurt for a few days. The amazing thing

to me was that I felt nothing getting the injection. I guess the nurse had very good aim.

We were wondering what yur decision making process was in getting chemo. Even our newest well known M ONC is talking about nothing but Lupron for now. We have plenty of questions for him on our visit on March 8th. We also want to see that PSA down much further this time. We are now at the completion of 4 months.

I, like you ,will keep exercising. It makes me feel fully alive, just like I want to stay for a few more decades!

Jim and Marie

Champaign

Posted 2/29/2012 8:28 PM (GMT 0)

Don K. said...
SC:I'd like to reply to your item 5. - Pain at injection site.

It seems that a small percentage of us have this reaction to Lupron and so far no Doc has been able to give me an answer.

We are not talking here about the usual "morning after sore butt", but rather bigtime pain issues.

My problem goes like this: Shot time - Just another shot in the butt. 200 mile drive home - No prob. Rest of day - No prob. Morning after - Hurts so bad I am unable to get out of bed.

Day 2 - Can hobble around at pain level 5/6

Day 3 - Back to work. Barely.

Any nurse will tell you to make sure that the glute is relaxed prior to the shot. This is not the problem here though with me at least as I make sure to relax the muscle.

It must depend on how/where it's administered.....my first 2 were a breeze, but my last 2(given by my FD) were painful for a few days.

3 Mo or 4mo shots - No difference.

If any member out there can give any insight on this, I would like to hear it.

Carry on SC, we will prevail.

Don K.

Posted 2/29/2012 10:46 PM (GMT 0)
Don,

My last injection was not as bad as your experience. I had 6-7 pain if I sat on that side or rolled over on it in bed. But, otherwise I could do any activity and went on with plans as long as I avoided that one side of my rear. Like others mentioned, I felt no pain during that actual injection. I relaxed my glut, etc. This has generally been my experience every time, although, the last time seemed especially intense.

One of my upcoming decisions is whether to continue getting these (assuming I do not change drugs) through my uro or switch to the med onc. I may very well switch. The uro office tells me they are giving me the injections at their cost so they do not care from a financial perspective.

Posted 3/1/2012 3:05 AM (GMT 0)
I'm on Eligard 6 month shots..My first "T" test was 8.. My last one was 18 but I'm due for another shot..No issues at all with pain at the injection site..I think Eligard is just another name for Lupron..

Southern, have you ever tried "The Triple Blockade" to achieve maximum benefit? In some men, the drugs simply don't work as well as advertized.. They have a solution for that too...
Posted 3/1/2012 5:08 AM (GMT 0)
Fairwind,

I just added the double blockade part of the triple. Dr. wants to see how that goes before making any more changes.

Robert

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