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Feedback On Lupron Shots?


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Old 11-01-2016, 07:09 PM   #1
Phillip F
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Feedback On Lupron Shots?

Iím hoping to hear from a few people who are taking Lupron shots, or have taken them in the past.

My father, who is 87, got his prostate gland removed in 1992, at the age of 63. He didn't need chemothearpy or radiation as the tumor was slow growing and had no signs of metastasis.

Everything was fine until about 5-6 years ago, when his PSA started rising again. He started taking Casodex about two years ago, which slowed down the PSA, but unfortunately, it has started going up again. His PSA was in the 30's about 6-8 months ago, and is now in the 60's. There are no symptoms of metastasis yet, and he is tolerating the Casodex fairly well. His doctor has recommended Lupron shots, but my father is very reluctant because of what heís reading about it online.

Unfortunately, most patient-discussion-boards regarding Lupron shots are lukewarm at best, but I suspect for every guy sharing a grumble, there is probably another guy who is quietly tolerating it? Any feedback in this regard would greatly benefit my father. Iím guessing the one-month dosages of Lupron will bring his PSA back down again. His doctor seems to think so, despite his other health issues, which are high blood pressure and a small aortic aneurism.

Thanks in advance for your comments,

Phillip F

 
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Old 11-03-2016, 01:13 PM   #2
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Re: Feedback On Lupron Shots?

Hi Phillip,

It's impressive that your dad had about twenty years of cancer control due to surgery. Now let's try to give him some tactics to get that control back.

I dearly hope you get some other responses in addition to mine, especially because side effects from Lupron vary quite a bit so it is good to tap a range of experience, and Iíve heard doctors who are experts in androgen deprivation therapy (ADT, also called hormonal therapy) say that drugs in the Lupron class often have a higher burden of side effects for men in their 80s, like your father. On the other hand, such drugs are often highly effective in controlling the cancer.

I have had long experience with the drug but at a younger age than your father. I was on it intermittently for four cycles starting in late 1999 when I was 56 years old: first cycle Ė 31 months; second cycle Ė 19 months; third cycle Ė 19 months; fourth cycle in support of a curative attempt with radiation in 2013 that has apparently worked Ė 18 months. Lupron was my sole treatment for a life-threatening case (baseline, first ever PSA of 113) for the first few months, after which Casodex (bicalutamide) was added. In the fall of 2000 Proscar (finasteride) was added, along with Fosamax (alendronate) to protect bone density from the effects of Lupron. Thatís the short story.

Iím not surprised your father has read some discouraging accounts on the web. One key point to keep in mind is that there are countermeasures that, at least to some extent and often to a great extent, alleviate side effects. I was fortunate in learning about these countermeasures fairly early, but it still puzzles me that so many patients on ADT have never heard of these countermeasures, and it seems their doctors are often equally ignorant. Another important point is that the specific side effects encountered by a patient, their mildness or severity, and the extent to which they can be prevented and controlled vary among patients. In other words, it is likely that your father would only have some of the common side effects, that only some he encounters would be a problem, and that some or all of the problem side effects could be managed so they would go away or be quite tolerable. In fact, while the hot flashes I experienced were quite tolerable, on winter mornings I would wait for a flash and then go outside to pick up the newspaper. (Also, the drug Proscar helped me grow more scalp hair, but more about that below.)

Here are some of the common side effects and my own experience:

Hot flashes and sweats Ė quite common, but varying a lot in intensity among patients. Consumption of soy protein and use of fans, especially aimed at the open neck, seemed to minimize this issue for me (and for many of us). There are medications (such as shots) that completely eliminate flashes and sweats for almost all patients, but I never felt the need for them.

Loss of libido and decrease in erectile function Ė While about 10% of patients do not have these side effects (nor the others), these effects are quite common. Most likely these are not a concern to your father because of his age. There are some countermeasures that help.

A decrease in bone mineral density (BMD) Ė This is quite common and a potentially serious issue because of fractures. Because Lupron type drugs almost completely eliminate production of testosterone, the estrogen, which men make from testosterone and is needed to protect BMD, is sharply reduced, and that can lead to thinning of bones. Fortunately, there are a number of medications that are excellent at preserving BMD. They are typically used with calcium and vitamin D3 supplements; the supplements alone are not adequate to protect BMD for someone on drugs like Lupron.

Bone and joint pain Ė I experienced a bit of this discomfort but at the level of minor nuisance, and my recollection is that it would go away after several months on Lupron. Most of us do not experience this. Pain relievers can help, if needed.

Weight gain, decrease in muscle mass, weakness, depression, high blood pressure and fatigue Ė Iíve lumped these different issues together because exercise is a key countermeasure, with good diet also important. Both aerobic and strength exercise are quite important here. While exercise might be a challenge for a man in his 80s, the effort is worth it. Iím a huge believer in the importance of exercise for someone on ADT. (Of course, exercises and stretches involving balance, flexibility and agility also have benefits.) I was amazed that I was able to get my weight that did increase under ADT under excellent control and actually build muscle while on ADT; building muscle was difficult and my results were modest, but I was really pleased to do it at all with almost zero testosterone. As I was fit at diagnosis and kept up exercise, I never experienced weakness or significant fatigue due to ADT, and never experienced depression other than feeling low for some weeks after diagnosis. (Diabetes and cholesterol control also benefit from exercise and diet.) Iím not sure about how your fatherís aneurism would play in all of this, but I have a hunch it would not be affected by ADT; I just did a quick check of ďprostate cancer AND ADT AND aneurismĒ on www.pubmed.gov and got no hits, which reinforces my hunch that it is not an issue. (PubMed is outstanding for presenting research on all kinds of medical topics. It is run by the US government and captures the vast majority of medical research published in reputable journals from all over the world.)

Anemia Ė not that common, and there are drugs that can be used.

Diabetes Ė fairly uncommon I believe, especially if good diet and exercise are employed as countermeasures. The diabetes drug metformin Ė dirt cheap and with a very long track record Ė helps against diabetes and apparently also against prostate and a number of other cancers.

Cholesterol control Ė If a statin drug is well tolerated, it will help control cholesterol and also help against the cancer itself. Researchers believe it is good to get the LDL to within the desirable range, or possibly lower. If a statin is not well-tolerated, other drugs, such as Zetia, which works by a different mechanism, probably will control cholesterol without side effects.

Gynecomastia Ė This is more an issue with Casodex than Lupron. In fact, my impression from research is that a Lupron/Casodex combo seems to be associated with less gynecomastia issues than with Casodex alone. Therefore, if this has not been a problem with your dad while on Casodex, I doubt it would be a problem with Lupron added.

Iíve mentioned diet several times. Having seen who does well and who has died from the disease, I believe that diet is very important. My own choice is the Mediterranean diet, which I find enjoyable and nutritious. It appears that eliminating red meat, including lamb and pork, is a good idea for combatting prostate cancer. A lot of fish or other seafood, and fish oil supplements, seems advisable, and limiting milk fat also looks wise, based on research. A lot of plant-based food in the diet is considered wise. Olive oil has a good reputation for prostate cancer patients, but flaxseed or canola oils (contrasted with ground flaxseed) appear to be risky choices. (Women tolerate them well.)

A tangent Ė has your dadís DHT been measured? DHT, which is far more potent as a fuel for cancer than testosterone, can ruin an ADT program if not controlled. An excellent control can be achieved by the drug Avodart/dutasteride, which is the more potent of the two, or Proscar/finasteride. Some men do not respond to Avodart because of their genes, but they do respond to Proscar. For all but the first eight months or so, I was always on Lupron, a Casodex type drug (antiandrogen), and Proscar or Avodart in combination (as well as supporting medications like Fosamax, Boniva, later estradiol patches and simvastatin).

This is getting long so I will stop here for now. But feel free to ask about further detail or sources of information if you need them. Again, I really hope that several others of us will share their experiences.

Good luck to you and your dad.

 
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Old 11-04-2016, 10:18 AM   #3
ralphh
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Re: Feedback On Lupron Shots?

phillip,

I went on firmagon followed by Lupron shots in advance of radiation treatment by EBRT and seeds two years ago. Came off Lupron after 8 months against Drs. recommendation to stay on at least two years. I didn't like the hot flashes and wanted to lose impotence. My PSA's were always low, but the disease spread rapidly in my case so I went back on Lupron along with chemo. It is tolerable, hot flashes less frequent now, but still impotent at 67.

 
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Old 11-29-2016, 07:34 PM   #4
Phillip F
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Re: Feedback On Lupron Shots?

I just wanted to thank everyone for responding. My father has never had his DHT tested, so that would definitely be a good next step. Also, Iím pretty sure he already has a prescription for Proscar, and he could start taking it (in addition to the Casadex) whenever he wants.

We also have some family & friends who work in the medical field, and their opinions are somehwat varied on his best course of action, but I still think he needs the Lupron shots. Maybe not at the higher dosages his doctor wants, but just enough to keep the PSA from doubling every 6-12 months.

Phil

 
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Old 11-13-2017, 02:03 PM   #5
REDFIELDT
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Re: Feedback On Lupron Shots?

Lupron has kept my PSA down or maybe the radiation. Gained 10 LB. Hot flashed aren't bad, especially if I keep off the sugar. Have hip bursitis. Radiation or lupron?

 
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