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PSA - 17.1, are Lupron injections necessary?

Prostate Cancer | Last Active: Apr 11 7:23am | Replies (84)
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@kujhawk1978

My grandfather is 79, his PSA level is 17.1, he is NOT on any treatment currently. He is generally healthy and is not taking ANY medication.

To best help this group, may be useful as others have said to add any clinical data on his diagnosis.

Has he had a biopsy, if so, what are the results?
Has he had any imaging, if so...?
Has he had any prior PSA tests, if so...?

You say generally healthy, the MSKCC has a life expectancy calculator - https://www.mskcc.org/nomograms/prostate

These pieces of clinical data can inform any treatment decision. For example, the Gleason Score, PSA doubling and velocity times, whether the prostate cancer is confined to the prostate or has spread outside it and where.

Generally healthy, does he have any cardiovascular issue, weight and BMI, diabetes...

Depending on the clinical data, this group can better respond.

As to the side affects of Lupron, well that can vary, depending on various things. If you've had any statistics training, think Bell Curve, most men will fall inside the Bell Curve in terms of side affects, hot flashes, fatigue, muscle and joint stiffness, cardio vascular and metabolic, genital shrinkage, loss of libido... Some will experience fairly severe side affects, others very mild. There are mitigating strategies, particularly diet and exercise.

There are some studies which may lead to a conclusion that it may be 8-10 years before your father shows any evidence of metastasis, so, no reason to treat until they do. That does not mean come back in 8-10 years, rather, he must actively monitor though labs and consults during that time.

Kevin

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Replies to "My grandfather is 79, his PSA level is 17.1, he is NOT on any treatment currently...."
drj | @drj | May 1, 2023

I had not seen the Memorial Sloan Kettering life expectancy nomogram. Thanks for passing it on. This is helpful in that it sets some baseline expectations for men with "untreated' (for a cure) prostate cancer. As a next step, it would be helpful to see "treated" data to compare to these "untreated" as I think that is what most are interested in. However, that interest may be greater in the radiation treatment group. I assume the data exists in medical journals somewhere.

One caveat: this site seems to focus on radical prostatectomy, which is definitely an "attempt to cure". So, this makes me ask whether my radiation treatment is also "an attempt to cure", or is it largely an attempt to treat and shift the Bell curve? I've been assuming it is the former. Perhaps radiation is favored for higher risk PCa patients who are less likely to receive the benefit of a cure from a radical. I'll have to ask my RO.

Finally, as to Lupron. I have experienced most of the debilitating effects you noted here. My RO has offered no mitigating strategies. I wonder if anyone has published such helpful advice. More importantly, I've been asking for clinical data comparing Lupron treatment versus no treatment. It must be out there. One person (web265) reports his doctor said there is a 5-7% improvement in outcomes with Lupron. If his doc's claim is true, I would like to see the data justifying the misery Lupron is putting me through. Perhaps the real value in Lupron is in slowing the cancer thereby shifting the Bell curve to the right so it appears to help because shifting it to the right leads to more people dying of age related issues before PCa.

These questions are above my pay grade

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yuliyalt | @yuliyalt | May 1, 2023

Thank you for your additional questions. I used them to make a list to gather all the data we know. Here is it:
- Grandpa got diagnosed with prostate cancer in 2014, he is 79 now
- He had Brachytherapy that same year, 2014 (internal radiation)
- Cancer currently is NOT spread/non-metastatic (yey!)
-His Gleason grade/score is 6 (my understanding is that Gleason scores range from 6 to 10, with 6 being the lowest grade cancer, so that's good for us but I am NOT SURE what to do with this information...?)
-His PSA has been slowly raising and the latest test showed 16.9
-He does whole body bone scan every 6 months and all is well on the scans
-He is in good general health (Weight, BMI, heart, blood pressure, etc.) and is not on ANY medication (he is strong and amazing, we love him so much)
-His doctor is recommending Lupron injections as treatment
My question - does generally healthy 79 year old with low Gleason grade and slow rising PSA, with non-metastatic prostate cancer need Lupron injections (which has a whole slew of side effects and will make him weaker, amongst other things)? My preliminary research, revealed that Lupron injections are used for more aggressive, metastatic cancer. Trying to weigh in pros and cons of this treatment for my grandfather.
If not, Lupron injections, should any other treatment be considered in his case or continue with no treatment at all?

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