How long will Lupron work before prostate cancer becomes resistant?

I'm in a similar situation (mPSPC) and been on a different ADT (Firmagon first, now Orgolyx), and it's kept my PSA below 0.01 for 2½ years. I'm using it in combination with Erleada, an androgen-reception inhibitor. Given how well I'm responding, my onco team has started talking about many years, up from the original forecast of 5–7.

With these new treatments, everything's in flux.

Thank you for your reply. Did you have radiation before the ADT?

During. They started ADT and Erleada/Apalutamide immediately after the emergency debulking surgery on my spinal lesion (which had compressed my spinal cord) — my PSA was 67 when I was admitted to hospital with difficulty walking.

I had 20 gy radiation to the spine one month after surgery, and 60 gy radiation to the prostate six months after surgery (but at that point, my PSA had already been undetectable for several months just from the meds).

Note that the 5–7 years I mentioned earlier was life expectancy; they told me the cancer would likely become castrate-resistant within a couple of years (which it hasn't).

Now they've extended both numbers indefinitely. The head of my onco team says there's a possibility of 10+ years before the ADT becomes ineffective.

With all the new treatments — androgen-reception inhibitors (check out the big TITAN study), treating oligometastatic cancer with curative rather than palliative intent, more-accurate imaging, etc etc — the truth is that they just don't know our long-term outlook yet because there aren't enough years of new data.

Like a lot of people here, I'm in the IRONMAN registry/study (called TruNTH up here in Canada), which will eventually set new baselines for what we can expect.

Much of what you read about overall survival for metastatic prostate cancer, even recent papers from credible scientific journals, will be based on data collected 8+ years ago when our prognosis would have been much grimmer.

But long story short. when I was diagnosed with oligometastatic prostate cancer in 2021 at age 56, they told me I probably wouldn't make it to 65.

Now I'm back to planning for retirement, and they've resumed monitoring the usual longer-term health issues, like routine colonoscopies, avoiding type-2 diabetes, heart health, etc etc. It has changed that fast, and while I know I'll always be only one blood test or scan away from devastating news, I'm grateful every day.

You have been very helpful and I thank you for it. I’m desperate for information. I’m 65 and also dealing with anti seizure medication from a major seizure 10-4-23. Looking for a path I can get behind to make sure when I die it won’t be from my prostate cancer!

Thank you! 😊

Hubby was on Eligard injections for 18 months plus Abiraterone/prednisone. Then he had a heart attack, so can no longer take Abiraterone or anything like it. So of course we are scared PSA will start to rise. He will get shots for another 18 months. 72, Gleason 8, stage 3b and treated with radiation at mayo.

I also dealt with comorbidities, so I know how tricky that kind of balancing act is. Major nerve damage from the spinal lesion left me paraplegic for over 9 months, and the two months after my surgery felt like a series of dominoes falling: prolonged ileus, catheter, UTIs, stomach intubation, IV feeding, steroid-induced diabetes, DVT from not being able to move my legs, severe weight loss (40 lb in a month and a bit), pneumonia, etc etc.

But with patience and persistence we got those under control one at a time, and now I'm on a much-reduced list of prescription meds and just routine monitoring, living an almost-normal life (something I barely dared to hope for back then).

You'll get there too, but expect some turbulence along the flight path.

Short and quick answer, nobody knows...

Think statistics and Bell Curve. Done are one, two or three standard deviations to the right (longer time to castrate resistance), others to the left.

Based on the clinical data you proved your post, does not seem you are a strong candidate for intermittent ADT.

However, you have options that may enable you to manage this as a "chronic" disease and die with it, not of it.

To start, you could switch to Orgovyx which has a lower side effect profile than Lupron. Note I did not say the side effects are different, but flashes, fatigue, mucked and joint stiffness...switching may be a function of insurance and any financial toxicity.

There are a dizzying array of options for both hormone sensitive and castrate resistant PCa, ARIs, PARP Inhibiters, Radio Isotopes, Chemotherapy...,

One thing to consider is have genomic testing done, the results may serve to guide future treatment decisions.

Heck, future radiation is not ruled out. When mine came back this time my radiologist said we could do SBRT to that PLN though we had done WPLN in 2017.

When you're bored, grab your favorite drink(s), mine is a Manhattan or Old Fashioned, and start reading the guidelines from organizations such as NCCN, AUA and patient handbooks such as the PCF has. It will be time well spent to inform and guide your discussions with your medical team.

Kevin