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How long on lupron

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Posted 12/4/2019 5:01 AM (GMT 0)
Diagnosed with prostate cancer 11/2014, prostatectomy 12/2014 failed, radiation 6/2015 failed. Started Lupron hormone treatment10/2015. Still on Lupron 4 years later. PSA .02. Doctor wants me to end Lupron injections. Let the cancer grow/ spread so he can find it with pet scan and attack it with radiation or surgery. I feel it would be better to stay on Lupron as long as it is working. When cancer becomes castration resistant then attack cancer. Anyone's thoughts or experience would be appreciated.
Posted 12/4/2019 6:51 AM (GMT 0)
Good morning Nam Vet. Sounds like you've been steadily on lupron for 4+ years - never a break. Is that right? Also that you're handling side effects well enough to not be much interested in stopping. True?

Any consideration of intermittent lupron?

Sorry I've no advice - beyond my training & research.

Thanks for your service. Tough duty.

Best to you,
Wilderness
Posted 12/4/2019 12:15 PM (GMT 0)
Greetings.

I was on leuprolide (Lupron, Firmagon, Eligard etc) chemo for 2 & 1/2 years. When I went off it I got regular blood tests to observe my recovery from that. It took 2 & 1/2 years for my body to return to its new normal. That is why they do intermittent leuprolide chemo.

Some med professionals say that the average lifespan of a prostate cancer stem cell is about 3 years, so the theory is that if they keep you on leuprolide chems for that long, all of the cancer stem cells will die off and you will be cured. That didn't happen for me so my guess is that the 3 year thing is hooey.

Also - my 2 & 1/2 years of leuprolide chemo killed off both of my testicles. 1 never came back on line and the others' testosterone production dropped to 160 ng/dL before my current round of leuprolide. The longer you are on leuprolide chemo the greater the chances of killing off some vital organs (hypothalamus, pituitary) or inducing a serious medical condition (heart attack, type 2 diabetes etc).

I waited to get an axumin PET until my PSA was over 3.0 so there would be enough tumor mass to register on the scan so bear that in mind. It won't fire back up bigtime right away if you stop leuprolide chemo.

Further, some folks think that staying on leuprolide inhibits ONLY the hormone-sensitive cancer cells while allowing the more advanced 'castrate resistant' cells to outcompete them as they remain unaffected.

Just some stuff to consider. wink
Posted 12/4/2019 2:45 PM (GMT 0)
This might depend on the 0.02 PSA. Have you been undetectable until the 0.02? If so, this very low, but detectable PSA could be the sign that you are starting castration resistance. In that case you could add Zytiga or Xtandi. It's reasonable to expect another couple of years, or more, of remission.

I'm not so sure about intermittent ADT - if it ain't broke, don't fix it, is my view.

As far as surgery, that doesn't seem likely - you are systemic. It may be possible to spot radiate bone or LN mets visualized on a scan to slow down progression, but why not worry about that later?
Posted 12/4/2019 3:01 PM (GMT 0)
Just speaking from my experience so can't give any advice one way or another I was on Lupron for 2 yrs on a break right now will be watching psa every 3 months for a year. As far as surgery or radiation I would think that would depend entirely where the cancer is? For you guys that have been on long term Lupron my hat is off to you guys I got my last shot in April and I'm sitting here with sweat dripping off me and my joints in my hands on fire making it hard sometimes to type lots of mistakes. But I won't complain after reading Purgatory's post yesterday there is a true hero in my book! Larry
Posted 12/4/2019 4:04 PM (GMT 0)
I don't know about stopping for that purpose.
My Onco has put me on intermittent ADT.
When my PSA starts to get to a certain level he orders scans done to maybe see the spread.
Once scans are done, back on to ADT.
Posted 12/4/2019 5:11 PM (GMT 0)

mattam said...
This might depend on the 0.02 PSA. Have you been undetectable until the 0.02? If so, this very low, but detectable PSA could be the sign that you are starting castration resistance.

PSA of 0.02 may just be the lower threshold of the test. With or without the < sign 0.02 is the lower limit of the tests I get at Dana-Farber.

As for stopping the Lupron. It seems like a good idea to me, though not necessarily for the sake of waiting until you can see mets. But it does make sense to go on intermittent ADT and have a break from treatment. I stopped monthly Firmagon shots last May. As of a week ago my T is back to nearly normal range and my PSA was 0.08. I see no need to go back onto ADT until my PSA is much higher - back in whole numbers and rising, unless my MO has a convincing reason to do otherwise.
Jim
Posted 12/4/2019 5:59 PM (GMT 0)
A lot depends on what you mean by surgery & radiation "failed". If you look at the bottom of most posts you will see a treatment history in our "signature". If you can create one we would have a better idea of what you have gone through. Presumably your gleason score was not 9 or 10 because your Dr would probably have you on lifetime ADT. So if you can fill in some of the blanks you may get some more advice.
Posted 12/4/2019 6:05 PM (GMT 0)
I think the question for Nam Vet is has he been undetectable for four years, and now has he suddenly become detectable? We don't have enough information. If he has become recently detectable, and the PSA continues to increase, then he is CR. If this is in fact the scenario, then intermittent ADT no longer applies. If this is the case, I personally would want to add one of the second tier ADT medications - Zytiga, Xtandi, Erleada - in the hope of getting an extended remission, rather than letting the PSA increase for visualization and possible spot radiation. But that's just me. If he is CR, he could take an ADT break and then start Lupron + a second tier drug, but I'm not sure that makes sense.

If his PSA has historically been hovering at very low, but detectable levels, then intermittent ADT could be a reasonable option, as he may still be hormone sensitive despite having a detectable PSA.
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