lupron? And are side effects as bad as they sound?

Swingshiftworker said:

Good Reason For Concern

I believe you have good reason to be concerned about starting your father on Lupron at this stage of his life.

The reported side effects of Lupron and other HT medications are not good.  Your father is 83 and currently has a "good quality of life."  Is there any reason to disrupt his quality of life by starting to use Lupon (or other HT meds now)?

The questions that I'd ask myself if I were in his situation would be:

1) What would my longevity be, if I didn't have cancer? 

2) What is my likely longevity, with the cancer I have, if I do nothing? 

3) How much longer could I live if I start HT now and it's successful in reducing my PSA level?

Of course, there are no definitively answers to these questions but they need to be considered becuase your answers to them will determine whether the likely reduction in your father's quality of life caused by Lupon (or other HT drugs) is worth the estimated increase in his longevity using them.

On the other hand, since it is reversible, you could just try the medication and see what happens.  If the side effects are atrocious, just stop taking it.  If you think other HT medication would be less harmful than Lupon, suggest them to your father's physician and try them instead. 

Only you and your father can make the choice.  Good luck!

Swingshiftworker,

Thanks so much for your thoughtful response.  Your questions are very helpful in organizing my thoughts, especially after being overwhelmed by hours of research.  I am hopeful his oncologist and nephrologist can provide some guidance.

As far as HT, my understanding is that the side effects can last a long time after the HT is stopped and may be even permanent, especially in the elderly.

Ugh, I hate the thought of having this talk with my Dad.

You all have been incredibly helpful.  Old Salt, that is an excellent idea.  The doc described an initial injection to prevent the flare, then a three month Lupron injection.  I read the Dr Walsh book which encouraged immediate HT in cases like this but then Dr Snuffy Myers seems to precede more cautiously with maybe only the antiandrogen  in the elderly or reduced dose of Lupron.  Your suggestion might be a safe "compromise".  Trying to not dwell on the immediate horrible reactions such as stroke, cardiac arrest that I've read some have reported.

The two initial shots in the abdoman would apparently be Firmagon, then a month later starting Lupron. This was seconded by a urologist.  We also talked about waiting to start until he feels symptoms.  The urologist ordered a Ct scan after feeling a very enlarged prostate and the big hard tumor on one side during the dre.  If there is obstruction or worse it will be moot and ht will be started.

VascodaGama said:

Casodex+Avodart instead of Lupron?

Belle,

You did inquire about the subject in another post. My opinion on the subject is that you can try Casodex alone and stop it at first sign that another health aspect deteriorates. Casodex treatment consists of a daily pill (50mg). Its half-life is 7 days meaning that your dad can stop it and expect to recuperate from such side effect causing the problem/symptom.  In general it can be taken with other drugs, however, its side effects increase (become more accentuated) when the patient has hypogonadism (lack of testosterone and/or estrogens). The typical added risk is bone loss.
Avodart (dutasteride) is similar to Proscar (finasteride) already taken by your dad. Both are 5-alpha reductase inhibitors used to treat hyperplasia. Substituting finasteride by dutasteride may improve the efficacy in avoiding dihydrotestosterone manufacturing. The drug has the same side effects.

Casodex may affect the liver when at the begining of its administration so that one should follow up with proper tests. You need to be attentive to any anemia case. Gynecomastia is typical.

I think that you should consult a medical oncologist for help.

Best,

VG

Thank you VG.  Ends up, doctors feel that casodex and avodart would not be effective enough and of course still has side effects.

VascodaGama said:

All treatments for PCa involve risks and side effects

Bella

You are wonderful and your father is very fortunate for having you to look after his problem.

In your post above I think that you meant Xofigo when saying Xoinga. This is a kind of drug using an isotope of radium 233 (radiation) administered to tackle/kill cancer in bone. It is recommended when there is a wide spread of metastases making it impossible for spot radiation at certain areas of the body, done externally via convenient RT equipment (EBRT). Surely Xofigo as well as any other treatment for prostate cancer has risks and side effects that you need to consider when chosing. It is known that injected radio-isotopes can affect the bone marrow impairing the immune system. This weakens the body to fight other illnesses which in the case of your father could be inappropriate. You need to discuss with his doctor about the benefits but also the risks in case you consider such a treatment.

Swing above gave you the details and sets it well. What can be the best for your dad at his age, with a collection of medical health problems (just on paper) and his lovely quality of living?

Hormonal therapies are palliative but manage to provide control on the advancement of the cancer for long periods of time. These work by suppressing the cancer of its "food" (the androgens). Oncologists use several tactics for the accomplishment, blocking the path ways that feed the cancer or stopping the production of androgens (testosterone) in our body. Casodex is an antiandrogen common in PCa treatments. It is a pill taken daily and the effects are mostly related to the cause of the lack of androgens (stimulation) at affected body functions. It will cause lesser libido but it also can increase the risk for high blood sugar, prejudicing cardiovascular and diabetic patients. Lupron, also a common drug in PCa, is an agonist that leads to hypogonadism (low levels of testosterone in circulation) and therefore all the symptoms related to such a status, similar to menopause. It also adds similar risks to those of antiandrogen medications because of lack of testosterone (T) in circulation. Some guys seem to accept better the condition than others independent of their age. The experiences reported go equally to: very nasty to mild or unnoticed. Surely one must consider its implications on other health situations, requiring constant vigilance of lipids, etc. 

Your dad's case is very advanced due to the spread but he is symptom less (some guys are) and that is a plus. However the condition requires some kind of treatment to avoid more deterioration.
I notice that he has been taking Finasteride which is a drug used by oncologist to moderate cancer aggressivity. It prohibits the manufacturing of dihydrotestosterone, a sort of refined testosterone 10 times more potent that T, most wanted by the cancer for its druggy parties. His doctor may have recommended this drug to treat benign prostatic hyperplasia (BPH). However, oncologists know that Finasteride halves the PSA signifying that your dad's PSA of 2 1/2 years ago (at the age of 80) was in fact 14x2=28 ng/ml, and now it is 56x2 corresponding to PSA=112 ng/ml. This information provided in your first post indicates that your dad's doctor did not consider attacking the cancer at the time but trying controlling it with palliative intent. This is common practice in older patients for reserving their quality of life.
This time thinking on cure may be again unpractical. Probably trying to hold the cancer at its track with the lesser side effects is the best choice and that should be procured within the hormonal arsenal.

He can do it with chemical castration (Casodex+Lupron; Firmagon) intermittently (on/off drugs periods) or surgical castration (orchiectomy) permanent condition. Both have side effects being the worse fatigue. The choice depends in his wishes. You need to research details and discuss with him. He should be aware of his advanced status. Most probably his bones are weaker and in need of bisphosphanates. I would recommend you to consult a medical oncologist specialist in target medications for prostate cancer. Someone with the skills like Dr Charles Myers or Dr. Stephen Strum, that manage wonders in the treatment of advanced cases. Please see this video regarding the treatment of bone metastases in a similar case.

https://askdrmyers.wordpress.com/2013/05/10/disappearing-bone-mets/

Please note that I have no medical enrolment. I have a keen interest and enthusiasm in anything related to prostate cancer, which took me into researching and studying the matter since 2000 when I become a survivor and continuing patient.

Best wishes,

VGama

He saw an oncologist who was highly recommended but little to no discussion of options and downplayed side effects to hot flashes and a little muscle weakness.  Wanted to give the injection after the first few minutes but dad wanted to wait until warmer weather when he could be more active and better counteract muscle loss.  But again, that is without knowing about the bone involvement.  When I saw the PSA increase from 49 to 56 in one month I started to think sooner.

henryb said:

CHB

With the caveat that everyone's body is different, and reactions to disease/treatments differ, my experience:

I was diagnosed with PCa almost 23 years ago, when PSA testing was relatively new and surgery was "the gold standard," and radiation second. The C word is scary enough, particularly two decades ago when a lot less was known, and just reading about the potentially horrible effects of what was then major surgery, was equally or more frightening. With a PSA of 11 at age 58, indications were that the PCa was likely aggressive. Pretty much convinced I'd received a death sentence, I dithered, did nothing for a year or more. PSA rose to 16, which some specialists said was the range that the cancer could begin to spread from the gland to establish beacheads elsewhere. The dilemma then: go through the surgery only to find it had spread, and that trauma for naught. I saw a specialist at a major medical center and actually set a surgery date for a couple months later. As the time neared, I'd heard nothing from them. Contacted them and apparently my records had been "misplaced" -- which served as a sign that I didn't want to do it. Told 'em to forget the whole thing. A bit later, a notice in nearby big city of a seminar on PCa, which I attended. Struck up a conversation with the doc, and later made an appointment with him. Told him I didn't want to do surgery or radiation, and asked if he'd work with me on CHB, which I'd been reading about online (this in the days of mucho slow dial-up modem connection). He admitted only basic familiarity with it, but agreed to work with me. I had a Lupron injection (one month was all that was available in those days) and a drug, Eulexin, which caused horrible GI upset, and I had to discontinue it. Shortly, though, Casodex became available and there were no GI symptoms. I also took 5 mg Proscar twice daily (I don't think a generic was available then). PSA began dropping almost immediately and within 6 months was almost negligible. There were hot flashes, some breast enlargement, and minimal muscle diminishment. The hot flashes were tolerable and over time lessened in intensity. After a year and a half of this regimen, I began reading about intermittent CHB, discussed it with my physician, and although he had no experience with it, he agreed for me to give it a try. After two years, I stopped everything except Proscar, which I continued to take, but just once daily 5 mg. For more than three years, PSA remanined <1.0, then began slowly rising. When it reached 3.0 (6.0 because of the Proscar), I went back on Lupron (which then was available in a 3-month injection), 50 mg. Casodex once daily, and the 5 mg Proscar. After a year, PSA was back to negligible, and I discontinued all but the Proscar. Another three years-plus of stable PSA. In the last almost 23 years, I've been on this regimen three times, for a total of probably five years, and off 17 or so (one span of almost 7 years). In the last  year and a half, at now age 80-plus, PSA began rising. When it reached 6 (or 12 due to generic finasteride), urologist suggested Casodex alone. PSA dropped for about a year, then began rising again, and because it appeared resistance might be developing, we discontinued that and resumed Lupron alone (4-month injection). It may well be, at this point, that the piper must be paid and the Lupron won't do the job it has done in the past. We'll see. But for the last 23  years, the imminent death sentence I thought I had received didn't come to pass. Except for a day now and then for bone scans or other tests, I never missed a day of work because of the PCa, continued running 3 to 5 miles daily (now walk or bike), traveled widely, including internationally, and lived a reasonably "normal" life. There was always, in a musty corner of my mind, the nagging realization that cancer cells were lurking somewhere, possibly massing forces and waiting for a chance to pounce and show who's boss. Would things have gone differently had I opted for surgery or radiation? Who knows? My urologist who has worked with me all these years has since steered many of his patients to the intermittent CHB regimen, but I'm his patient with the longest experience. As I noted at the start, everyone is different, and my experience may well be atypical. What lies ahead, I haven't a clue. But we play the cards we're dealt and have chosen. (As a P.S., in my wandering-in-the-wilderness period following initial diagnosis, I spent a lot of dial-up modem time reading about the work of Dr. Stephen Strum, whose work with PCa and CHB has contributed much to the field, and struck up an online conversation with Dr. Bob Werman, a New Yorker who'd moved to Jerusalem and was an eminent neurology researcher at the university there. Himself a long-time PCa patient on the CHB regimen, Dr. Werman's e-mail exchanges over succeeding years were encouraging, sympathetic, and always leavened with wry humor. I was saddened when he died -- of heart complications, not PCa.)

Thank you, Henry, for your comment.  Very encouraging.  I wasn't familiar with the term CHB, I guess also known as Triple Hormone Blockade.  Dad started with firmagon (2 injections) one month ago and immediately felt very good.  Only side effects so far are increased blood sugar and a 7lb weight gain.  his prancing had been increased but meeting with the endocrinologist soon to discuss the Lupron-prancing interaction VG kindly alerted me to here. He had a one month Lupron injection (more about that experience below) a few days and so far continues to feel good.  Our priority continues to be living better if not longer.