Cancer Survivors Network

Thanks Mike very much for your response.

I had a RD by Da Vinchi followed by radiation. My oncologist at MGH will probably start me on some type of treatment (HT) when he sees me in March. He only treats patients with prostate cancer so I'm hoping he will have the right approach to this.

Grey Ghost (Jim)

Welcome to the “Libido-less Wonder”. The world of castration.

You can find many past threads here dealing with Lupron (and the hormonal treatment or hormonal blockade). Taking Lupron is easy but the side effects of hypogonadism may put you down.

I have been on HT with Eligard shots (similar to Lupron) since November 2010. I have experienced numerous side effects being fatigue the most pronounced. My body accepted well the castration status and I managed to tackle the worse effects with a fitness physical program and diet.

Libido and pubic hair disappears and the loss of muscle mass makes us fell ten years older.

The nicest thing though is that it all returns to a normalcy once we stop taking the drug and the testosterone gets higher to the normal levels.

I wonder if your doctor has prescribed you an antiandrogen (such as Casodex) to be taken (two weeks) before the Lupron shot. I say that because agonists (like Lupron) cause a flare (of testosterone) initially and such may cause pain in patients with metastases at the bone.

There have been paralyzing cases in patients with spinal metastases because of compression of the spinal cord. That may not be your case, but as a precaution to have a dose of antiandrogens is proper.

The hormonal treatment principle is to block the testosterone from reaching the cancer. In the process many cells will die by starvation (PCa feeds on androgens like testosterone). To avoid the feeding, Lupron takes the lead by causing the testicles to stop the “production” of testosterone (hypogonadism). For extra blockade, HT protocols can include an antiandrogen to block the cancerous cells’ androgen receptors (AR) so that they do not absorb the testosterone (dying in the process). Still some doctors include in their HT protocol a third drug to block the production of dihydrotestosterone (DHT) which is a tenfold more powerful form of testosterone. These are 5-Alpha Reductase Inhibitors (5-ARI) such as Finasteride or Avodart.

Triple blockade is usually more effective in cases of PCa with bone metastases. In these cases a bisphosphonates like Zometa or Fosamax are also recommended to treat or avoid any bone loss.

Recently newer drugs have been reaching “the market” and they target the intratumoral effect of the cancer when it starts to produce its own androgens. Other target drugs avoid the cancer from resting at the places it most likes to spread (Xgeva helps to reconstruct the bone loss).

In your case with apparent bone metastases, a drug called Alpharadin may be proper. This is a newer “wonder drug” that kills PCa at bone with its radioactive substance. You may want to discuss with your doctor about any possibility of getting involved in a trial for this drug. Trials are safe and the best way to get “special” drugs that otherwise would not be available to the general folks.

Here is a link about the drug and the trial;

http://www.youtube.com/watch?v=NwPbMDktMWc

http://advancedprostatecancer.net/?cat=818

http://www.fiercebiotech.com/tags/alpharadin

I would recommend you to research the net about the side effects of hormonal treatment. You can also order from Amazon used copies of the fantastic very comprehensive book of Dr. Charles “Snuffy” Myers named;

“Beating Prostate Cancer: Hormonal Therapy & Diet” latest edition.

One important aspect of the hormonal manipulations is to monitor the drug’s effectiveness not only through tests of PSA but with periodical tests of testosterone and DHT (if on triple blockade).

Lipids and bone densitometry tests should also be included in the periodical monitoring.

Here is a link about diets for cancer;

http://www.cancer.gov/cancertopics/pdq/supportivecare/nutrition/Patient/page1#Keypoint5

Best wishes for a successful “ride on Lupron” and the treatment.

VGama