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Deciding on whether to do third Lupron injection?

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Posted 2/20/2017 3:29 PM (GMT 0)
Have an appointment to do my third three month Lupron injection on Wednesday, 2/22/17 -

Not sure if the potential benefit is worth the constant lack of energy and hot flashes I am currently experiencing?

I finished Radiation the middle of December so don't think radiation is still a cause.

Bobby Mac
Posted 2/20/2017 4:34 PM (GMT 0)
HT sure isn't fun, is it? How long were you initially scheduled to be on Lupron? Based on your question, was it nine months?

For my part, I'm not sure how to assess the benefit versus how you're feeling part of the equation. But if you only have three more months to go, I'd lean toward just powering through that.
Posted 2/20/2017 4:42 PM (GMT 0)
In a similar boat. There are studies just done that show longer survival for men with lymph node involvement staying on Lupron. If you are scheduled only for one more three month shot I would lean on getting it.

I have been on Lupron since last June. You are correct, the side effects suck. For me, the cancer sucks more.
Posted 2/20/2017 4:57 PM (GMT 0)
Yea, there are plenty of different answers -

Urologist who administers Lupron says keep on it - I said how the heck will I know if RT worked?

My RO says 6 months - which I am at now -

PhD RO on Miami said 3 three years -

Another opinion last week from Urologist do one more-

Studies that suggest two years are better -

Per Allen - study in progress - is six months as good as two years?

I was leaning toward another injection, but started thinking this AM - do I really want to go on feeling like this? Why not just take HT again if PSA goes up?

Bobby Mac

Really, no conclusive consensus -

Bobby Mac
Posted 2/20/2017 5:07 PM (GMT 0)
Only way to know that RT worked is keep testing PSA after HT is out of your system. Testing goes on forever. In my case I got my last hot flash 6 months after the final 3 month Lupron shot. After that PSA every 6 months seems to be the standard. In my case PSA scored "undetectable" for nearly 3 years, then back in the soup. But that is another story. Best wishes!

NewspaperLover
Posted 2/20/2017 5:49 PM (GMT 0)
They told me six months in the beginning but I was also given a third shot, making it nine months. I was angry about it. don't know if it helped but i'm in my seventh year of remission.

ed
Posted 2/20/2017 7:18 PM (GMT 0)

Bobbie Mac said...
Why not just take HT again if PSA goes up?

You can't do that and expect a cure. If you allow PSA to go up, you have given a chance for the more resistant cells to take over and multiply. It's the same reason we have to finish the full course of antibiotics and not stop early - it selects for resistant bacteria. No one can tell you if your short course has been effective or not. You've seen the study (GETUG AFU-16) that proved that 6 months is better than none. The UMich retrospective study (below) found that >12 months was better than <12 months, and that each additional month of ADT reduced biochemical failure, metastases, and death by 10%. Only you can decide if it's a risk you are willing to take.

www.redjournal.org/article/S0360-3016(13)01075-4/fulltext
Posted 2/20/2017 7:34 PM (GMT 0)
I was on it for 3 years. It sucks, and I don't want to do it again. But I will if it's appropriate. Mine's a G9 high risk, with about a 40% chance of lymph node involvement when diagnosed. So, even though I hated it I did what the "experts" were thinking to be appropriate.

Maybe 2 years would have been as good. Some studies seem to be indicating that, though nothing yet published categorically says so (like an actual randomized prospective controlled study saying 2 years is non-inferior to 3 years). Maybe there is by now, but I haven't seen it.

Point is, you're aiming at a cure here, and your first shot is your best shot. While the cells are reeling from radiation, using HT to further damage them and their little wandering colleagues is worth the side effects. Tough it out. Fatigue will persist, do light exercise regularly, and take naps. Hot flashes will persist. You can try Megace, or some suggest estrogen patches. Ask your doctor; there are some ways to help to some degree anyway.

Only you can really make the tradeoff between side effects and survival. I'm in favor of survival, but only time will tell.
Posted 2/20/2017 8:51 PM (GMT 0)
BOBBY MAC,

Have you thought of seeing a medical Oncol. who specializes in PCa?
My husband is also a G-7 and started Lupron 5 years ago. Our Oncol. switched him to Degarelix 3 years ago without those horrible side effects.

I'm not saying he doesn't experience some side effects, quite different from Lupron however, and much more manageable and not as severe as he had while on Lupron.
As you can see by his sig. he is doing O.K.

GOOD LUCK

BOOGEE
Posted 2/20/2017 10:28 PM (GMT 0)
I don't have the link or data in front of me right now but I though I read something posted here that 18 months was the number....after that there were no significant benefits. Could be wrong but my oncologist agreed when I mentioned this a year ago.
Posted 2/21/2017 12:05 PM (GMT 0)
You still have about 3 years to go before you really know what the radiation side effects are/were. Good luck!
Posted 2/21/2017 12:51 PM (GMT 0)
Thank you all for your input -

I have decided to have the Lupron injection tomorrow - play it by ear for future injections -

I would really be pissed off if I did Lupron for three years (not going to happen) and went through all those SE's for those years then found the cancer was still there. So I would say to myself that darn it should have stopped at six months it wouldn't have made any difference!

Bobby Mac
Posted 2/21/2017 7:41 PM (GMT 0)
Bobby Mac -- I hear you, and I believe you're doing the right thing!

ed
Posted 2/21/2017 9:37 PM (GMT 0)
I'm just starting my IMRT radiation treatments and HT has been mentioned but I don't want to go that way just yet. Can someone answer dose HT kill the cancer cells?? Not sure how it works..

Thanks
Jay
Posted 2/21/2017 10:33 PM (GMT 0)
Jay -

Studies have shown HT allows the RT to work better - HT is palliative and doesn't necessary kill any cancer cells, may weaken them to allow the radiation to work better. Taking HT 2-3 months prior to radiation may improve results and possibly radio-sensitizes the cancer cells allowing radiation to work better.

Tall Allen has a lot of information and studies about the above.

Bobby Mac
Posted 2/22/2017 6:35 PM (GMT 0)

Bobby Mac said...
Yea, there are plenty of different answers -

Urologist who administers Lupron says keep on it - I said how the heck will I know if RT worked?

My RO says 6 months - which I am at now -

PhD RO on Miami said 3 three years -

Another opinion last week from Urologist do one more-

Studies that suggest two years are better -

Per Allen - study in progress - is six months as good as two years?

I was leaning toward another injection, but started thinking this AM - do I really want to go on feeling like this? Why not just take HT again if PSA goes up?

Bobby Mac

Really, no conclusive consensus -

Bobby Mac

My URO suggested 3 years as well and I strongly protested after 6 months and long story short, my Brachy ONC convinced me to do 12 months at the very least to weaken the cells for the radioactive implants to kill.
Knowing what I know now, I'm still not sure I would make the same decision.....I may have gotten lucky!
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