Tough Decision - Whether to Resume Lupron Injections

Bob:

Although my MO recommended Lupron, I refused it when it was time for me to start treatment of my recurrence six years after RP because of the terrible side effects. I knew I wanted SRT and I immediately sought second opinions from other MO's and RO's as to the combined treatment.

Ultimately, one of the RO's recommended Casodex and Avodart for four months along with whole pelvic SRT. I followed his advice and stayed on the Casodex for a total of six months, two months before, during and after whole pelvic SRT. I am now a year out from SRT and still have an undetectable PSA. However, my case is much different than yours.

I have heard of other guys opting for Casodex after their second recurrence and having some success. However, it may work for you and it may not. If your MO is insisting you resume ADT/Lupron, I would seek second opinions from other MO's on the different ADT available to you. It cannot hurt to ask before you make your decision.

Best of luck to you.

Rick

Solid advice from Fairwind. We could have a 2 hour roundtable discussion of things "you can do". Imagine your question 2 years ago-the answer would have been a different standard of care treatment than today. I suspect (and hope) the answer will be different in 1 and/or 2 years from now. By the way I am a zero b/c of ADT. I am grateful to be alive and will enjoy life even if every week or so I have an ADT bad day. So enjoy the zero & l'chaim!

Hi Bob656! The advice given above is very good. I may soon have to begin to answer your question for myself. Note in my profile that I just last week had an ultrasensitive PSA go from undetectable to 0.11 . For now all I am doing is worrying about it but trying not to worry, haha. My plan is to get a repeat PSA in one month and then re-evaluate.
My personal bias is to get right back on Lupron if the PSA then is above 0.2 which is the level often used to define biochemical recurrence. My reasoning is that since prostate cancer cells eventually stop responding to Lupron, presumably by a cell or cells developing a mutation or some gene duplication, it makes sense to keep the number of cancer cells as low as possible for as long as possible. This is just my opinion and I am aware that actually there is evidence that early Lupron treatment in this sort of case is not better than delayed. I just am skeptical of these studies and wish there were a very large study with enough patients of all initial grades and stages in it to really be sure. And certainly if my PSA continues to head up I will get at least two medical oncologist opinions, one locally here in my little town and one at Mayo.
Hopefully neither of us will ever have to make this decision or if we do it will be a long time in the future when much more knowledge has accrued and better treatments are available. Best wishes and good luck.

garyi said...
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Both worry and anxiety fuel inflammation, which in turn can aggravate PCa. Please suppress it as best you can.

Best way is humor. Try some Stooges.