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prostate cancer ADT injection
I’m 62 and will start Proton Therapy next week. My psa is 8, with a 3+4 Gleason 7. my doctor is suggestion ADT for 6months. I’m concern with the muscle loss and other adverse affects. Is the benefits worth the toll it will take on my body?
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@brianjarvis When I got my first of two 6 month shots of Lupron neither my urologist or RO mentioned anything about a testosterone flare. So when I came home to my wife after the shot and said something like, "Well, I just got my death by lethal injection shot. Wonder how long before I start feeling all the bad side effects."
And lo and behold, over the next few days my lifts went up and my desire for sex went up too! I was thinking that ADT isn't going to be bad at all. Maybe they gave me the wrong thing? Of course, as I dug into what was happening I did read about the testosterone flare and the testosterone boost did go away and my strength and libido started to drop as well.
But thinking back on the situation, would I have rather had some Casodex to eliminate the flare before the shot? Not really, the flare was fun! And I had a whole year of ADT to go so the little two week delay on the testosterone drop didn't really matter.
What ended up mattering was the long testosterone recovery after Lupron was supposed to expire. I thought it might take a month or two, but it was about 5 months before testosterone recovered to a normal level. I would highly recommend that a man use orgovyx instead for ADT so as to enjoy a much quicker testosterone recovery.
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2 Reactions@readandlearn
Zytiga Is a drug that acts like ADT since it further suppresses testosterone like ADT, But it is an ARPI as I’m sure you’ve found out. I was on it for 2 1/2 years and it was never easy. I was only undetectable for one month in 2 1/2 years. My PSA kept going up and down.. When I stopped it, I had to have a metastasis in my spine zapped because it just didn’t work well enough. It did give me high blood pressure, lots of hot flashes and four afib events. Not an easy drug to live with for many people.
The problem with stopping the drugs is that the metastasis are not always killed when you’re on them. They shrink in size and stop growing completely, but they may be there to come back again. It could be proton radiation could enable you to have that one on your lymph gland zapped, If it comes back, need to speak to a radiation oncologist that does proton.
If they have you get back on ADT Try to get them to prescribe Nubeqa. Unlike Zytiga, it has very few side effects, Most people don’t notice any. Zytiga did not stop my PSA from going up and down, I’ve been undetectable for 26 months on Nubeqa.
Hopefully your PSA stays undetectable for a long time.
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3 Reactions@wwsmith I suppose that a testosterone boost can be fun; but, if a tumor that flares happens to be near the spine (or some other critical anatomical structure), that boost/flare might not be such a good thing (which is why they use Casodex).
Though there are no hard and fast rules on this, guys that I’ve spoken to say that once the time on Eligard is set to expire, to expect about 50% more time for the ADT to leave the system, testosterone levels to bounce back, and side-effects to subside. (My 6-month Eligard experience lasted 3-1/2 months past the end of that 6-month period.)
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2 Reactions@jeffmarc When I first began studying prostate cancer, I would read about following the SOC (standard of care). I had always thought the SOC was some kind of unwritten typical treatment protocol for certain conditions. But now, if I am thinking correctly on this, following the SOC actually means following the most current NCCN Guidelines, right? And if that is correct, I am going to start mentioning that more in posts to new patients and even provide the link for the NCCN Guidelines https://www.nccn.org/guidelines/guidelines-detail
Like you have been doing, I think it is important for all patients to know what the Guidelines say for their condition so that they can compare what their doctors are recommending against the Guidelines. Deviations from the Guidelines are certainly ok if the doctors can make a good case for those deviations. But patients should always be involved in the process and be prepared to question and give their own input towards what is the best treatment for their particular case.
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3 Reactions@brianjarvis Here in Ontario, Orgovyx doesn't cost any more per month than Firmagon or Lupron, so there would be no financial incentive for government or private insurers to move you off Orgovyx once you're on it. However, there could be other reasons for preferring an injectable, e.g. concerns about a patient remembering to take the pill every day, or deciding to try something other than a GnRH.
@brianjarvis Yes, I can see how a flare could cause some harm. But this flare situation shows one more benefit of using Orgovyx in that it works so fast that Casodex is not needed before its use.