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PSA - 17.1, are Lupron injections necessary?

Posted by yuliyalt @yuliyalt, Apr 27, 2023

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. Should he be doing Lupron injections or with this level PSA not yet? I read the side effects and not sure the benefits outweigh the risk, in his case…
If not Lupron, are there any other treatment he should be on to ensure his PSA is not climbing up?
- concerned granddaughter

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bens1 | @bens1 | Apr 30, 2023

Yuliyalt: if your grandfather/dr rules out an infection, he may want to get a prostate mri to see if anything shows up. If something does, then a biopsy makes sense. If he does do the biopsy, get the genetic testing done from the material. This can affect others in the family and serves as a second or third opinion regarding genes and aggressiveness, and is used by DR’s for additional analysis.

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remington | @remington | Apr 30, 2023

I was 67 when I was diagnosed with my Gleason 8 cancer and because of other problems radiation and Lupron were my only options. I am not handling Lupron well. While I was somewhat arthritic before I am now one step short of totally immobile and I have no energy at all. If I were 79yo I wouldn't use Lupron and just ride it out. While my PSA is undetectable my quality of life has greatly deteriorated. I probably won't take my last scheduled injection in June.
Yet, many older men haven't had big problems using Lupron as they were probably in better overall health to begin with. Grandpa needs to really discuss this with his doctor and weigh his options.

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3 replies
hbp | @hbp | Apr 30, 2023

Perhaps your doctor can adjust the dosage

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melcanada | @melcanada | May 1, 2023
In reply to @kujhawk1978 "My grandfather is 79, his PSA level is 17.1, he is NOT on any treatment currently...." + (show)
@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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https://seer.cancer.gov/statistics-network/explorer/application.html?site=66&data_type=1&graph_type=2&compareBy=stage&chk_stage_106=106&hdn_rate_type=1&hdn_sex=2&race=1&age_range=166&advopt_precision=1&advopt_show_ci=on&hdn_view=0&advopt_show_apc=on&advopt_display=2#resultsRegion0
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melcanada | @melcanada | May 1, 2023
In reply to @remington "I was 67 when I was diagnosed with my Gleason 8 cancer and because of other..." + (show)
@remington

I was 67 when I was diagnosed with my Gleason 8 cancer and because of other problems radiation and Lupron were my only options. I am not handling Lupron well. While I was somewhat arthritic before I am now one step short of totally immobile and I have no energy at all. If I were 79yo I wouldn't use Lupron and just ride it out. While my PSA is undetectable my quality of life has greatly deteriorated. I probably won't take my last scheduled injection in June.
Yet, many older men haven't had big problems using Lupron as they were probably in better overall health to begin with. Grandpa needs to really discuss this with his doctor and weigh his options.

Jump to this post

At 78 Zolodex injections no issues Just added Xtandi and now Xgeva all fro spinal pc met in L2 and L1

Check them out

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1 reply
lorenbk | @lorenbk | May 1, 2023

I was diagnosed with metastatic prostate cancer, Gleason 9, a year ago. A PSMA Pet scan. Showed the lesions in my spine, scapula, pelvis, and lymph nodes. Lupron and Erleada were prescribed (along with XGeva to help preserve bone calcium). The side effects were terrible for about six months and much better after. I had a second scan six months later and not only had a cancer not spread, the existing lesions were smaller. ADT is not fun but it’s definitely worth it to extend your life expectancy!

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drj | @drj | May 1, 2023
In reply to @kujhawk1978 "My grandfather is 79, his PSA level is 17.1, he is NOT on any treatment currently...." + (show)
@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

Jump to this post

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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kchris5174 | @kchris5174 | May 1, 2023
In reply to @hbp "Treatment for a low risk Prostate cancer, Gleason score 6 or 7 or less, is usually..." + (show)
@hbp

Treatment for a low risk Prostate cancer, Gleason score 6 or 7 or less, is usually to monitor and test, that is much different than treatment for an aggressive high Gleason score cancer. You and I both have an aggressive Gleason score 9 cancer. I had a year of ADT plus Erleada and RP. It appears that my cancer is presently sleeping and I will do all that my doctors tell me to do to keep my cancer sleeping. I think that getting aggressive treatment for my aggressive cancer was the right thing to do and I am thankful that I got it and hopeful for the long future.

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Similar situation here, 82 years old. Family history of aggressive PC (Dad's PSA was 1050 but he lived to 90). Younger brother just finished a two year course so I'm advising my son and grandsons to get the PSA checked on a regular basis. Mine has metastasized to multiple locations and I believe that it stared spreading even before the PSA took a sudden jump (to 13.5). So, I question the sensitivity of the PSA screening but it may be the best that's available. Mine is also in dormancy but I also recently read that 90% of cancer deaths occur with cancers that were previously dormant. I'm on Eligard and generic Zytiga and the latest PSA number is .008.

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kchris5174 | @kchris5174 | May 1, 2023

Speaking of clinical data, I was looking through the fairly voluminous paperwork that came along with my Abiraterone (generic Zytiga). If I recall correctly, I believe that it said that the median number of months of survival was 40. However I believe that I can put myself into the upper median by doing everything that healthy living suggests (exercise, diet, etc.). Also, the data was for Abiraterone and I'm also on Eligard which may also influence my ultimate survival.

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yuliyalt | @yuliyalt | May 1, 2023

So many helpful comments, this is a great community, very grateful I found it...
I am providing additional information about my dedushka/grandpa's case (didn't find the way to amend my original ask, so doing it via this comment (if there is a way to provide more information directly to the original post, let me know).
- 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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