Radiation with Hormone Therapy-Firmagon

RADIATION HOPEFUL said:

Common Symptoms
Vasco & Kongo are like having access to doctors ---VERY helpful in decscibing in layman terms answers to many of the posts on this site. I can't speak for everyone but> personally THANK both of them VERY much for sharing their knowledge & answering some difficult questions.
Keep up the excellent work --it is truly appreciated by many.
Thanks for enlightening me about the cranberry juice--I will keep drinking it ( I dilute it with a little water due to the bitter taste. I feel beter after reading these posts.

The urologist called back & is prescribing Procet for the burning. I'm going to try the Advil approach first.

Rad Hopeful

barbercheech said:

radiation treatment
Glad to hear that. i had the same type of radiation treatment.i had 44 treatments plus lupron shots and 2 years later PSA Is Still .005. Reading These Posts Make me Realize how many Guys Are Going Through This With A Lot of Hope And good Results

VascodaGama said:

PSA=1.09 is equal to the previous
RadHope
I enjoyed reading your post. PSA=1.09 is equal to the previous but it does not surprises me. You may see fluctuations and "plateaus" along the recovery period before it reaches nadir.
The physical exercises from loading those pellets will help in your recovery.

The best to you.
VG

VascodaGama said:

Your results demonstrate that the actual protocol is correct
RadHope

I am very pleased to read about your success. Another lower PSA result, and still more to come. I wonder if you have experienced with certain intensity any symptom in regards to HT. Something that you could relate to; Hot flashes, Fatigue, Decrease in the size of the testes, Dizziness, etc.

I say this because you are reluctant to change Firmagon to Eligard and I cannot understand why your doctor would suggest such a thing when your results demonstrate that the actual protocol is correct.
If your lipids or any other health marker is within the limits particularly the liver health, then I do not see a “clear picture” for the change.

Surely Eligard will also do the job, and its side effects are in fact similar if one compares the results from trials in shots of the same grade (1-month shot), however, medication is metabolized differently in different bodies and that leads to side effects being more acute in some guys than in others.
If you are doing ok with Firmagon I would suggest you to continue on that drug. But, if you cannot alter your doctor’s opinion then try to get the 1-month shot of Eligard which seems to be the one with lesser side effects.
Have a look in this site;
http://www.drugs.com/sfx/firmagon-side-effects.html

The worse side effects actually are due to the low testosterone in our body which both drugs cause equally. The drug itself also have reactions directly affecting our pituitary function such as “pituitary apoplexy”, but that usually is reported from cases using the drug continuously in long periods of time over 4 to 5 years.
You can read about the symptoms here; http://www.medscape.com/viewarticle/518323_6

Your case as I recall, it is for a short period of one to two years, or less if your PSA demonstrates a continuous low plateau.
The only justification logic that your doctor may be thinking is to change due to a practical use of a 6-month shot (like mine) that would avoid your monthly visit to the clinic to have a shot as well as avoid the shot reaction in the skin.

I hope my insight is of help to your decision.
Wishing you the best.
VGama

VascodaGama said:

Expect your PSA to go still much father down
RadHope

Firmagon in the stomach? You mean that she “perforated” the skin and stomach and injected the medicine inside the stomach? Do you really mean that or abdomen?

What an experience you had with that “lady”. I hope the PA has taken notice of the problem and that you get a clear response from them on Monday about the matter. If your doctor is not available then see another one but do not leave the matter unchecked.
I know that agonists should avoid to be injected in veins due to bad reaction.

In my last shot the nurse was new to hormonal depots. She did not know that the two syringes (A with atrigel and B with leuprolide) should be mixed connecting the two syringes and actionating the plunger back and forth about 60 times. I had to instruct her in all the steps. I also had it done in the abdomen without any pain.

I did not know that your protocol is for 3 years. Many guys with similar treatments as yours have HT for periods of 6 to 18 months, and some of them stop HT earlier once the PSA stabilizes. Your doctor may want to have you on a longer period because of your diagnosis prior to treatment. Nevertheless, you have not reached nadir yet.

It is logic that a monthly injection is bothersome if one could avail it of a longer span. Eligard 4-month depot is also friendly when looking into its side effects and you could try with an initial 1-month shot, moving up latter.
If you get nasty symptoms you can go back to the Firmagon again. The medication intent is to keep your testicles “out of service” for a low testosterone level in your body.
The drug has no effect on the cancer itself.

The major side effects for Eligard 4-month shot are described as; hot flashes, fatigue, nausea, joint pain, itching and urinary frequency. Eligard has been friendly to me, being fatigue the most annoying. You can read about it here;
http://www.eligard.com/side-effects/eligard-side-effects.aspx

The point of “Remission” is difficult to define. In another forum I wrote like this:

“Keep a close eye and be prudent in your decisions” may be the best translation for Remission. A number is just another “marker” which does not reflect the whole spectrum of one guys’ status. Remission could be taken with the meaning as absence of symptoms which indicates a successful treatment”.

That said, you are in remission but the success of your treatment can only be certified when your PSA plateaus (stabilizes) and stays there for a long period.

In regards to “Nadir”, you have to be patient and wait for that to come. In my case it occurred 13 months after ending IMRT. I am different than you because I have no prostate, so the curve declines quicker.
In your case under HT after IMRT with a prostate, you will also get a nadir. The difference will be that yours may take longer time to reach. HT can also affect the PSA level (lower PSA) but the number is REAL. A PSA under the influence of HT is not a “faked” value. The important is that the PSA stays continuously low, once the treatment effectiveness ends.
Expect your PSA to go still much father down than 0.78 ng/ml.

I hope you could understand my layman’s explanation.

VGama

VascodaGama said:

I believe that your nadir will be in the 0.0 range
RadHope

Yes, I believe that your nadir will be in the 0.0 range.
My understanding is that guys on HT only (with the prostate and no other treatment) get to levels of 0.07 to 0.1 when they use an LHRH agonist. If they add an anti-agonist (ADT2) such as Casodex then the PSA goes futher lower to the 0.02 to 0.08 bracket. Guys on ADT3 (triple blockade) with added 5-ARI such as finasteride still go futher to the bracket of <0.01.

Nevertheless you have a challenging case with an initial high PSA on the 53th and Gleason score 9 which may give you a different outcome.
The important is that your PSA keeps stable in a level between 0.05 to 0.15.
You could start a new thread to inquire on the experience of other survivors with similar treatment (IMRT + adjuvant HT), in regards to their nadir PSA and the time it took from the end of IMRT.
Have a look on this guy's story. His PSA went down to 0.01 (http://www.yananow.org/Mentors/AlanJ.htm)

Wishing you the best.
VGama</p>

VascodaGama said:

Maybe Bounce PSA
RadHope

Do not be upset for the slight increase of PSA. As you commented the cause could have been due to the inappropriate way of the injection but it also could be due to “bounce” which is typical in cases post radiation treatment.
The problematic shot of last month could cause the rise because the quantity of Eligard injected into your belly was not the full dose (your writing; “…Much of the serum ran down my stomach…”). You can check about it with a testosterone test. An increase of PSA in a Low Testosterone status could have a different meaning.
Nevertheless, the increase is not much and you can draw your conclusions in your next PSA checkup.
Just google “PSA Bounce” to read about details of its meaning in the contest of your RT treatment.

I recommend you to check your testosterone levels too, to have it as base data in future.

Regards.
VGama