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Posted 5/14/2021 4:30 PM (GMT 0)
So, after prostatectomy in 2013 and SRT in 2015, my psa continues to climb. The last 6 month rise was from 0.82 to 1.80. A bone scan found no mets; an abdominal/pelvic CT scan showed "some small lymph nodes are noted in the right iliac chain measuring up to 10-11 mm", the size of the nodes being suspicious, but no bone mets. A follow-up Aximum scan showed uptake in some obturator nodes. I had a visit last week with an MO who suggested Lupron plus one of the following to be decided based on my blood tests: Zytiga, Xtandi, or Erleada. I will start with Lupron on Tuesday. This Monday I will also consult an RO to determine if radiation is an option; I will also get him to pin down the number and exact lymph node group (iliac or obturator) from the original scans. Several of these drugs have some negative impact on blood pressure (which I have) and the heart. I'm seeing a cardiologist and doing a stress test next week to rule out any heart problems. Have any of you had any blood pressure/heart issues taking any of these meds? I'm wondering if any have less negative side effects than others? Are there any questions I should ask the MO or RO? Thanks for any help!!
Posted 5/14/2021 7:18 PM (GMT 0)
Edwardo, i finished a 6 month course of Lupron 2 years ago, and i have Coronary Artery Disease. The effect of Lupron on my Triglycerides , which have always been pronouncedly high, were severe, going from about 200 before treatment, to over 500 after. The number has since come down, with the help of meds (Vascepa).

There is a new hormone block treatment on the market called Org ovyx, which is a pill form, that i believe have a less deleterious effect on heart disease. There is also Firmagon, which is a shot, that according to my RO is less likely to cause cardiac issues. I started on Firmagon, but had severe reaction at the injection site so i was switched to Lupron.
Posted 5/14/2021 8:01 PM (GMT 0)
I have been on ADT (see my sig) for just about one year now.... I have had two stents. My BP is normal with meds. Also what I am on is working.....
Posted 5/14/2021 8:26 PM (GMT 0)
Edwardo:
Your cardiologist should be able to answer your (very) valid question more definitively...
Posted 5/14/2021 8:35 PM (GMT 0)
If by chance you are told that you have a choice (i.e., more than one of them are safe for you), ask your docs about the results of trials on the optimal sequencing. Some orders may be better to try than others.

Djin
Posted 5/14/2021 11:14 PM (GMT 0)
Edwardo,
It's good that you are getting Lupron plus one of the second line ADT medications simultaneously, which has proven more successful than adding a second line medication at castration resistance to Lupron. Judging by forum members, Zytiga seems to be prescribed most often, followed by Xtandi, and then Erleada. Lupron doesn't quite get rid of all of the Testosterone from your system. I'm not an expert on these medications but my understanding is that Zytiga "squeezes" a little more T from your system by reducing production of T from the adrenal glands. Xtandi and Erleada are similar medications that bind to the T receptor, which blocks the remaining T in your system from binding to the receptor. None of these medications work perfectly. My MO gave me the choice of either Zytiga or Xtandi. I chose Xtandi because I like the idea of blocking any T left in the system that Lupron doesn't "remove." I'm thinking that any of the three medications works about as well as the other though.

My MO said that patients report worse side-effects for Xtandi than for Zytiga. Because of their similarities I suppose Xtandi and Erleada may have similar side-effects. I have been on Lupron and Xtandi for two years and I haven't experienced extraordinarily bad side-effects.

Good luck on your path ahead!
Posted 5/15/2021 1:30 AM (GMT 0)
It is good that you are consulting your cardiologist. I am on Lupron and Zytiga. After about a year I had a complete cardiac workup which was fine. Best of luck in your treatment.
Posted 5/19/2021 9:41 PM (GMT 0)
I saw my MO and RO this week and here is the plan: 1. Meds will be Lupron and Zytiga (plus prednisone) and 2. radiation therapy to all pelvic nodes. I got my first injection of Lupron yesterday; a 90-day dose. So far no side effects except the injection site was pretty painful last night. How long till onset of any side effects? For those who have used Zytiga, what was your out-of-pocket cost? Apparently, the MO is trying to get approval from the insurance company; United Healthcare -Medicare. Radiation will start in about a month whenever they can fit me into their schedule. I will have a total of 25 treatments.
Posted 5/19/2021 11:36 PM (GMT 0)
Edwardo, everyone is different but for me, it was about 4-6 weeks out before I started to feel side effects of ADT. I was on Firmagon at first, which crashes T levels much faster than Lupron.
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