Question about Lupron!

I wonder if any MRI or PET exam has been done to locate metastases in tissues other than bone. In any case, metastases in bone are typically treated with hormonal manipulations (ADT). Spot radiation is kept to alleviate pain or directed to areas that may be in risk of collapsing (cause of paralyzes).

Your dad's cancer seems to be hormonal (Lupron) dependent which can be assumed from the low PSA. ADT may also be behind the improvement at affected areas but it is the radiation (RT) that has given the bigger blow. The protocol is solid. The only problem is that the RT cannot be repeated at the same spot twice so that if the cancer recurs one needs to consider an attack with chemotherapy. ADT is palliative and got many drugs in its arsenal that can be exchanged or combined in the treatment before refractory is considered. A concern with hormonal therapies is that these weakens the bone so that many doctors add to the protocol bisphosphanates (Prolia, Fosamax, etc) to prevent deterioration of bone. I would recommend you to research details on the matter and get your dad tested (DEXA scan) to check bone health. Testosterone is also a marker to be included in the follow up of his treatment.

https://www.pcf.org/c/side-effects-of-hormone-therapy/

https://www.prostatecanceruk.org/prostate-information/treatments/bisphosphonates

I wonder his age. Older patients with other health issues (existent or expected to occur) should involve medical oncologists in the team of physicians to control possible interaction of drugs/medications. I believe that quality of living is important so that one should balance the extent of treatment against symptoms.

Welcome to the board.

Best wishes for successful outcome in the therapy.

VGama

Sometimes the doc will start a patient on a shorter duration of Lupron in case he has an allergic reaction, but usually that would be a one month injection.  If they start with six months and the patient has an adverse reaction then there isn't much they can do about it.  But starting with three months and then moving to six months would probably indicate something else.

Your doc may have started you with a three month shot just to see whether or not it would be effective. Some PCa's are not sensitive to hormone deprivation, and in some worst cases the cancer becomes "castrate resistant"... in other words, the HT doesn't work.  As I recall in your case the Lupron did lower your PSA from hundreds to 50 or so, but now it looks like it's not working so well anymore. There's other stuff that may work but it sounds like you've already been on just about everything.

Kid,

Survivors at this forum are ready to help you understanding facts. Please share more details about your dad's case.

What is his PSA histology?
Did he get a positive diagnosis on a third biopsy or was it done on bone alone? What was found?
What is the Gleason score provided by the pathologist?
What king of image studies did the doctor execute?

His doctors surely are doing their best but the patient should be acquainted with the procedures, its consequences and outcomes. Doctors treat according to guidelines. We can always inquire or discuss on something we wish to have or would not like to happen, so that the doctor will take such into consideration. The fact of having a DEXA scan can serve as an example in your dad's case. A simple bone scan does not tell everything.

Pain after Lupron shot is typical occurrence in patients with metastases at the spine if injected before treating with an antiandrogen (what was your dad's case?). Lupron causes "flare" (a condition represented by a surge in testosterone fabrication) which will directly augment the action of the cancer affecting the tissues where it is set. In critical cases it may compress the spinal chord leading to paralyzes. To avoid such occurrences doctors start by administering an antiandrogen in the initial two weeks before the Lupron shot so that the flare doesn't occur. ADT therefore doesn't cause pain. The typical cause of pain in metastases is due to inflammation of affected tissues were the cancer resides. In bone this is common so that doctors reserve radiation to treat these spots when it becomes unbearable.

The reality in extensive metastases cases is that these cannot be cured via a radical (surgery or radiation). Radiation therefore is spared for critical issues only. I wonder what was the clinical stage attributed to your father. Was it T4 N0M1 or T3b N0M1?

You need to know the details of his diagnosis to access any possibility in cure or on the way to extend life.

A side note to you and your brothers and sisters is that you are at 4 times in risk to contract prostate or breast hereditary cancer. You need to start screening on the matter once you get to 40 yo.

Best wishes and luck,

VGama

a note to VG, my testosterone is <2.5ng/dl in march.. they did not check testosterone the last two labs ,so i mill make sure they check that next lab.. seems like i should know if i'm refractory or not...  ;~} ---  KID welcome to the discussion boards, and good luck with your dad.. it always makes me sad when when that prostate cancer goes so far as to matasticise in to the bones and other parts of the body,, everything i read says that it is detectable so why does it some times get away from us.. 

Regulator said:

" . . .  so why does it some

" . . .  so why does it some times get away from us"?

Given my own experience, I think I can speak to this. I think its a matter of fear and delays on the part of the actual patient to move forward in some instances, and it can most definitely be caused by delays associated with the American medical system in getting patient's referred to the necessary facility or specialist(s). In my case, much to my regret, I put-off a number of key appointments with urologists and/or oncologists that probably would have led to earlier treatment, but at the same time, significant delays in treatment occurred as a direct result of referrals to other backlogged facilities or specialists, that sometimes took 6-8 weeks to fulfill. In other words, far too much time can pass between medical visits, sometimes caused by the patient themselves, and sometimes by (IMHO), an inferior (log-jammed) American medical system.  

You are correct in complaining about the American medical system... but other systems have similar or different drawbacks. The patients I have known of in some socialist medicine programs have a much harder time getting past their GP, then are discouraged from scheduling treatment with specialists to limit the drain on available funds for treatments. In other words, the government doesn't want to spend money on their treatments, even if it saves their life.

You should enquire with others here in your area if you are disatisfied with your care. That is the one advantage we have in America over a full on socialist medical system... if we dont like the professional we have , we can find a different one. I went through 5 different urologists... however, if your circumstsnces are extremely dire, you may not have that luxury.