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..Lupon time line question..

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Posted 10/18/2013 11:10 AM (GMT 0)
..My question today is about Lupron and the six month schedule I am on suggested by my Radiation Oncologist that is administering my adjunctive treatment. The last few days I have read some posts here on HW about Lupron and the different time lines you fellow Lupron takers are on. Some three years, very few six months and all inbetween. Seems like a lot of room for discussion on this topic and which is better for who and why.
..I am on the six month plan for now. I know my treatment is adjunctive and not necessarily for failed surgery or reoccurrence. Should I stop in six months or should I investigate staying on Lupron for longer to archive the best results? You all know at the stage I am in there is only really this one chance to maybe beat it. I have three weeks of IMRT (cone down) left and I have done three months of Lupron thus far. When I see many of my PAc brother on different time lines and for many more months than me, I am compelled to ask questions?.
Posted 10/18/2013 12:02 PM (GMT 0)
There are quite a few studies about that, Tall Allen probably can give you a couple of good links.

For my high risk case's primary therapy, 2 years of ADT is a common term along with primary radiotherapy. There is quite a bit of discussion covering the spectrum from just a few months to 3 years, and possibly longer. With the higher doses possible now due to IGRT/IMRT, there's even some speculation on just how much good ADT even does. But at least with the earlier radiation methods of just a few years ago, high risk cases in particular did better with longer ADT.

Between the significant hot flashes, fatigue, and now trying to stave off weight gain, ADT is a real battle. I've always heard the term that someone was "battling cancer", and now I much more deeply understand it.

At 6 months into the campaign it's not fun, but I'm planning to stick out my full 2 years.
Posted 10/21/2013 3:11 PM (GMT 0)
Just as Redwing57 mentioned, there a studies that indicate that 18 months is just a good as 3 years of ADT. My original plan was for 36 months of lurpron taken every 4 months. During that time both my Radonc and medonc must have read the same study and asked if I wanted to stop at 18 months. For the entire 18 months my PSA was undetectable, so I went along with their suggestion. I actually feel much better now, no more hot flashes, my energy level is back to pre lurpron days.
It's been 4 months now and I'm due for a PSA test next month. Really not looking forward to this one. My anxiety level is through the roof and I want so bad to get good news. I don’t want to go back on the hormones, but I will I’m dealt that hand.
Good luck on whatever decision you make.
bertb
Posted 10/21/2013 3:47 PM (GMT 0)
I am doing 24 months of ADT3. I saw that study and pointed it out to my medical oncologist, hoping he would shorten my sentence. He told me the study was interested but a bit underpowered and not enough to convince him that the extra six months weren't going to improve my odds. From time to time I think about balking at my last shot (which would be next April) but I will probably finish out my two years. I've already told my wife that she can expect me to be grouchy and useless for at least the next year and a half.

I think I'd ask the questions if I were you. Six months of ADT seems a bit short for a lymph positive G9 in my untutored, non-medical opinion.
Posted 10/21/2013 3:53 PM (GMT 0)
I was a G7 and I received adjuvant HT for nine months. I got the last 3-month shot about a week after I finished IGRT.  I think in your case nine months is not long enough, but that's just my opinion based on being here a few years.

good luck to you!

ed

 

Posted 10/21/2013 4:32 PM (GMT 0)
As you are finding, using HT as an adjunct to RT is a relatively new treatment development and there is a lot of disagreement as to the optimal time period...Because the side-effects from HT are so severe and profound, most doctors try to limit it's use as much as possible..Also, another issue seldom mentioned, is becoming hormone refractory as a result of early hormone treatment...If you prescribe a 3 year adjunct HT treatment, it's fairly likely, should HT be needed down the road, that it won't be effective for very long..

This is what I did...I stayed on HT for one year..PSA was undetectable..I stopped the HT and closely monitored my PSA which, unfortunately, reappeared..Had I stayed on HT for another year as originally prescribed, would that have made any difference?? I'll never know for sure but I don't think so..

YOU will have to decide whether enduring the HT side-effects is worth any possible benefit, and that "benefit" is still being debated and studied...Best of luck to you...
Posted 10/23/2013 12:34 AM (GMT 0)
..Thank you for the great comments, it real does help to read all your responses. I appreciate your efforts in answering from the heart.. Thank You..

..Strength & Honor........Appleseed.........
Posted 10/23/2013 1:44 AM (GMT 0)
If it were me, I'd want 18 months because of the high risk of recurrence and the adverse features. There seems to be diminishing marginal returns beyond 18 months. Six months may be OK for Intermediate Risk, but more than 6 months seems to improve outcomes for High Risk. Here are some references:

Duration of Androgen Deprivation Therapy Influences Outcomes for Patients Receiving Radiation Therapy Following Radical Prostatectomy

High-risk prostate cancer treated with pelvic radiotherapy and 36 versus 18 months of androgen blockade: Results of a phase III randomized study.

- Allen
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