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Confused about HT after talking to Uro

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Posted 4/9/2012 9:49 AM (GMT 0)
Finally I met my dad´s urologist. He is an excellent surgeon but also had an extensive knowledge in treating advanced PC, so overall, I was impressed. Unfortunately, not all of the medication is covered by insurance in our country, so I can see us supporting pharma industry generously in the next few years. When I asked the doctor about the second-line hormonal therapy options, he told me that one of the options down the road was orchiectomy. I told him that I thought it was the same, or had the same effect as the Trelstar injection, he answered something like "Yeah, but sometimes we get a response from this procedure"

Have you ever heard of orchiectomy as a "second-line" defense? It completely surprised me.
Posted 4/9/2012 10:26 AM (GMT 0)
Speciallady

Thats a surprise to me also, surgical removal as a second line? Are you sure you heard that correctly?

On the medications - there maybe alternatives that would be covered or would be less cost.

As a example, taken from www.ustoo.org/Treatment_Options.asp

LHRH Therapy

The administration of an injectable luteinizing hormone-releasing hormone (LHRH) agonist or antagonist that causes a drop in testosterone levels in the body.
Currently available LHRH agonists:

Lupron® (leuprolide acetate)
Eligard® (leuprolide acetate)
Viadur® (leuprolide acetate implant)
Vantas® (histrelin implant)
Zoladex® (goserelin acetate)
Trelstar™ (triptorelin)
Plenaxis™ (abarelix)

I know the VA Hospital I goto uses Eligard and not Lupron as from what I recall the Eligard was/is less expensive. Now that could have been what the procurement process yielded and may not be accurate for a individual

Hugs!

Bud
Posted 4/9/2012 12:52 PM (GMT 0)
SpecialLady,

I don't think orchiectomy is "second line" in the typical use of that term. As long as the drugs, mentioned in Raddad's post, are administered properly, they are medically equivalent to an orchiectomy. So, an orchiectomy is more like "first line" HT. I think second line HT typically refers to DES, anti-androgens, steroids, Ketocanazole, etc.

Posted 4/9/2012 6:17 PM (GMT 0)
Bud, thanks, yes I heard that correctly, the Uro did not necessarily say "second-line", more like "down-the-line, in the future we have an option of orchiectomy."
Thanx for the list, dad was on Trelstar, taking a break currently.

Thanx Southern, I wish I had asked him to expand on that, he definitely knows something we don´t....
Posted 4/9/2012 10:21 PM (GMT 0)
Orchiectomy is inexpensive and is the most effective "hormone treatment" as it lowers testosterone to virtually zero. In some men, the drugs are not as effective as they need to be to suppress PC as much as possible..With your Dad, a "T" level check should be part of every PSA check to be sure the drugs are working as hoped..For many years, this procedure was the first line treatment against PC..The drugs relieved the psychological impact of castration and became a profit center for all involved with them. As you can imagine, they became very popular..
Posted 4/10/2012 12:26 AM (GMT 0)
perhaps our member, ralf, will chime in, as he had the performed years ago. good luck.

david
Posted 4/10/2012 11:40 AM (GMT 0)
thank you Fairwind, Purgatory, his T level was castrate level, although on the second measurement in January higher than first (border level).
Posted 4/24/2012 3:07 PM (GMT 0)
Hi SpecialLady,
An orchiectomy is irreversible. The effect on PCa is the same as castration by medicinal means. The only possible benefit is if the patient has to pay for the cost of the shots or if therapy is done in a patient with bone mets that could result in spinal compression. Why give up the possibility of intermittent therapy and benefits?

RalphV
Posted 4/24/2012 4:00 PM (GMT 0)
Thanks Ralph, so this is basically a cheap version of Zytiga, it seems. For now it is intermittent, but we´ll see down the road.
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