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Lupron strategy?

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Posted 1/25/2017 9:09 PM (GMT 0)
I have a 65 y/o buddy---who has a rising psa now getting to a doubling time issue and he has questions about peoples Lupron experience.
DX in 3-12
RP in 4-12 with good patho
7-12 psa .06
10-12 .08
4-13 .22
RADS in 7-13
9-13 psa .02 and for the next 3 years around .02
6-16 psa .15
10-16 psa .25
1-17 psa .39

seems like a 6 month doubling time???

All scans neg for any mets

So--- now he's thinking, does he try for an immune therapy study although he appears not sick enuf to qualify.
Does he start Lupron now at this early stage or will starting so early be counterproductive.
Provange appears to be about 90k and is not insurance covered he thinks until he is much sicker....

Aaaaaaaaanyway---- anyone have experience in this spot where my buddy finds himself.....????? (also he is a viet agent orange guy if that's relevant at all)

Thanks guys--- Craig
Posted 1/25/2017 9:50 PM (GMT 0)
Craig-

I can tell you my Lupron SE's are pretty annoying - hot flashes, muscle pain and stiffness, and I feel like I have aged about ten years.

I think your friend needs to see a medical oncologist, who specializes in prostate cancer.

Bobby Mac
Posted 1/25/2017 9:56 PM (GMT 0)
Do you know what his original Gleason score was? Also, next step might be a short bout of Lupron and then radiation. Or wait, maybe that's what you meant by "RADS 7/13"?
Posted 1/25/2017 10:00 PM (GMT 0)

Bobby Mac said...

I can tell you my Lupron SE's are pretty annoying - hot flashes, muscle pain and stiffness, and I feel like I have aged about ten years.

Yeah, Lupron is not something anyone would do for fun. Don't forget the mental fogginess. With that said if it puts the cancer in check it's worth doing.

I don't know what the standard of care is about starting it but agree a prostate cancer MO is the prudent at this point.

Jon
Posted 1/25/2017 10:29 PM (GMT 0)
The TOAD study indicated benefit to earlier rather than later implementation of ADT when "cure" is no longer an option. There was quite some controversy on our humble forum about it a couple months ago. People ultimately agreed to disagree it seems. There is a clear benefit to early starting, but also clearly side effects.

Risk/benefit is something each person must consider. The side effects of ADT are unpleasant. Not unbearable, but definitely unpleasant.
Posted 1/25/2017 11:50 PM (GMT 0)
There is now a thought that early use of ADT may lead to longer survival. This is as a consequence of the TOAD study carried out in Australia - see http://www.cancervic.org.au/about/media-releases/2015-media-releases/june-2015/prostate-cancer-trial-shows-longer-survival-with-immediate-hormone-treatment.html[url]

Unfortunately the study doesn't actually mention a specific level of PSA to be used as a trigger point, but the general impression seems to be "the sooner the better". Not everyone is convinced by this study.

This is an issue I am also facing and was about to re start ADT a few weeks ago, but allowed myself to be convinced that a short delay of 3 months would not have much impact, and would allow me to get over the Australian summer before the hot flushes start.

Chas
Posted 1/26/2017 4:38 PM (GMT 0)
My situation is similar. PSA became detectable againin January 2015, nearly three years after a round of Radiation and ADT. Have opted in consult with my Medical Oncologist to not start treatment yet, weighing the deleterious effects of ADT against potential life extending benefit. Even accounting for the TOAD study, not clear to me what the tradeoff should be. I said to my MO at our last meeting that "I preferred to feel like me for as long as possible." He was willing to take my wishes into account. I agree with other posters that your friend would benefit from discussions with an MO. Best wishes.

NewspaperLover
Age 73
Gleason 8
2009 surgery upstate NY. Failure in 18 months.
2011 moved my case management to MSK in NYC.
2011-12 Radiation + ADT
2012 thru 2014. PSA undetectable.
2015 PSA emerged again at .08.
June 2016. Bone and CAT scans negative.
Dec 2016 PSA .46
Next PSA March 2017
Next set of scans Mayb2017
Posted 1/26/2017 7:02 PM (GMT 0)
My surgical onc. said he likes to wait until PSA is 10, merely for the QOL issue. Well it hit 14 when he saw me last June. Then went to 19 in December. So we started casodex and Lupron and threw in some Taxotere.
The Adt is not too bad. All things considered (I always was a little addle brained). Taxotere is no fun at all.

The Casodex and Lupron brought my PSA from 19 to 3.97 in just a little over a month.

Post Edited (mr bill) : 1/26/2017 12:06:12 PM (GMT-7)

Posted 1/27/2017 3:57 PM (GMT 0)
Thanks for all of that info my friends-- useful--- I will pass it on--- he is seeing a med oncologist now. His Gleason was 3 plus 4 and had all good patho post rp
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