It looks like Lupron time...

Ted, your history is surprisingly close to mine, but regarding the failed SRT, I am behind you rather than ahead, so aside from commiserating with you, I cannot offer any advice. I am hoping my PSA stays low as long as possible, because my doc plans to treat it with Lupron just like yours when it rises enough. I asked him how high it would be before he started treating it, and he mentioned it had more to do with PSA velocity than value.

I wish you the very best, and a minimum of symptoms.
Jeff

Ted, I could tell you the side effects, but why spoil the surprise? Besides, you undoubtedly know most of them and are just here for company and support. The side effects are real and they suck... but, for some of them there are drugs, treatments and strategies for managing them.

Exercise is a big deal. Ask your back surgeon what you will be able to do when.

Good luck with the back surgery. Keep us posted.

Thank you for the responses. I guess I will just have to experience this to understand then....

Tedgard
For a Gleason six you have very aggressive PCa. What was your pathology report post RP? I'm surprised you didn't have Lupron before and during RT but there are different opinions on that I know. If you look at my signature you'll see the SEs I experienced but I did not mix Lupron with anything else. I found that the SEs are worse a few weeks after the shot then subside but exercise is vital to keep your strength up as your testosterone declines. I sleep a couple hours every afternoon as I'm dead tired. My last T test was 3! Man cannot live very comfortably with the T level so low but at least my PSA is zero now! Good luck!
Bob

Jeff, The whole idea of deferring ADT is to maintain QOL as long as possible. It doesn't mean that the guy will never go on ADT, it just means that he will only go on ADT when symptoms, like painful mets, demand it. If there is no survival advantage to beginning ADT earlier, then its only purpose is palliative. There's no point in palliation when the man is feeling fine - it would be given later when it is needed to keep him feeling fine.

I'm sure curative-intent treatment of oligometastatic disease has been discussed many times in this forum. Just put "oligometastatic" in the search bar to read more about it. There have been about a dozen small studies with up to 3 years median follow-up. Here's a meta-analysis that found that 17%-55% of men were progression free with up to 3 years of follow up, with no significant toxicities:

Advances in local and ablative treatment of oligometastasis in prostate cancer.

A new study showed that recurrences following oligometastatic radiation therapy can be similarly re-treated (some call this "whack-a-mole" therapy) to prolong progression-free survival. about a third of the men had no relapse, and among the re-treated men, which was able to delay ADT for a median 2 years. Results were much better among men with slower PSADT.

Repeated stereotactic body radiotherapy for oligometastatic prostate cancer recurrence

All of the studies on oligometastatic PC require longer follow up to see whether the short term freedom from progression translates into longer PC-specific survival, or even true cures in some cases. However, since the toxicity is very low, what is the downside?

- Allen

Intermittent ADT puts you on a roller-coaster ride..You must keep a sharp eye out as your testosterone climbs after the 6 month shot wears off...Your PSA can take off quickly and be difficult to get back under control...Also, your "T" level must be monitored closely..Different men respond differently to Lupron and its clones..With some, the "T" levels climb slowly as the shot wears off..With others, "T" level can skyrocket quickly..Another drug, Bicalutamide (Casodex) can be used to block the action of testosterone but not reduce it's level in your blood...Many Oncologists like to "save" this one for later as it can extend the period of time that HT is effective...

Another unwelcome side-effect to look forward to, slowly increasing blood pressure, probably part of the weight gain package...It takes a lot of effort to get enough exercise to keep these things under control....Once you move past the 38" waistband, you really have to get serious about exercise...

I had my first Lupron shot today.....

I will try to follow up as to the side effects as they occur.

As of today, I had the shot at about 9:30 AM. It is now about 10:30 PM. I have a small amount of pain in my injection site, but only slight. It is almost like a slight muscular bruising in the butt cheek where they did the injection.

I have been feeling a slight tingle at times throughout the day in my head. It is kind of like a slight buzz or something. I am only conjecturing that it is related in that it is out of the ordinary.

My understanding is that the side effects may increase over the next several weeks and/or months as the Lupron results in reduced testosterone. As the level of testosterone drops below 50 is when I understand that the side effects may be more sever (lethargy, heat flashes, cold sweets, etc.).

My Dr is using a 6 month term to gauge the impacts and effectiveness. The hope is that it may take as long as a year or more before I have to have another Lupron shot. As the reaction is different for each individual, it is unpredictable how I will react. My Dr said that many times the testosterone levels can recover much sooner then the PSA rises, therefore there may be a long time of improved quality of life before getting the next shot. I can only hope that is my case.

I will wait and see.