1. < Prostate Cancer

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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yuliyalt | @yuliyalt | 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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My grandfather has Gleason score 6 and slowly raising PSA - 16.9. Currently, he has no treatment, just monitor and bone scans/blood test. When we ask doctor is any treatment should be administered, she said Lupron injections. But I am not convinced he needs it and side effects might outweigh the benefits. My grandfather is a healthy 79 year old man, who is currently takes no medication of any kind.

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yuliyalt | @yuliyalt | May 1, 2023
In reply to @hbp "I am 76 and was on lupron and Erleada for a year ( 2 drugs that..." + (show)
@hbp

I am 76 and was on lupron and Erleada for a year ( 2 drugs that are often given together now) and the side effects were not bad. In my opinion, 79 in and of itself is not too old to get treatment as your grandfather might have 5-10 or more years of quality life. Also, taking these meds is not irreversible and if he has a terrible reaction he can stop it. Good luck

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Thank you for your response. I will research and ask doctor about Erleada.
We are trying to weigh pros and cons of starting the hormone therapy, since from what I read it is recommended for advanced type of cancers. My grandfather has a localized, slow developing prostate cancer (Gleason grade/score is 6 and PSA is slow rising, currently at 16.9).
We are trying to decide between no treatment at all (continue as is) and starting the Lupron injections....?

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yuliyalt | @yuliyalt | May 1, 2023
In reply to @round5 "I would look at the Orgovix or a low dose Lupron shot. Nothing more than 22.5mg(3..." + (show)
@round5

I would look at the Orgovix or a low dose Lupron shot. Nothing more than 22.5mg(3 month shot) maybe less then that then if he doesn’t tolerate it,it will where off quicker.

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Thank you. I will look at Orgovix, haven't research this yet. We are trying to decide between continuing with no treatment at all (generally healthy 79 year old male, with Gleason grade/score is 6 and slow rising PSA of 16.9, localized tumor) and starting the hormone therapy with all of the potential side effects...?

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yuliyalt | @yuliyalt | May 1, 2023
In reply to @digby2023 "I faced some of this thinking and I am 10 yrs younger. Lupron made me weak..." + (show)
@digby2023

I faced some of this thinking and I am 10 yrs younger.
Lupron made me weak and I am still walking with instability which I partly blame on Lupron. However,
it’s an effective part of the process of getting rid of the prostate cancer. I think of this like a mechanic going to
rebuild an engine without a full set of wrenches. Lupron starves the cancer…a good thing because without its testosterone food cancer should not grow.
A PSA score of 17 is about 2 times the level I started on hormone therapy before getting brachytherapy.
I have had all the treatments now and my PSA is 0.022.
Would I elect what I did again? You bet!

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Thank you. My grandfather had brachytherapy when he got diagnosed in 2014.
Now, we are trying to decide between continuing with no treatment at all (generally healthy 79 year old male, with Gleason grade/score is 6 and slow rising PSA of now 16.9, localized tumor) and starting the hormone therapy with all of the potential side effects...?

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yuliyalt | @yuliyalt | May 1, 2023
In reply to @michaelcharles "Q: what Drs and Specialties are recommending ADT? And why? In 2000, my father was 80..." + (show)
@michaelcharles

Q: what Drs and Specialties are recommending ADT? And why?
In 2000, my father was 80 with no medical problems. His PSA was tested (for no reason known to me) and was 11. He had a 12 core biopsy that had 1 hit (Gleason score not known). He chose "watchful waiting", and I never heard about prostate cancer again. He passed at almost 95 from "old age".
There are many questions about my Dad's situation that I have in retrospect, since my high risk Gleason 9 cancer was identified in 2022.
So my post may be "uninformed ".

Is his only "symptom" an elevated PSA. Why was a PSA performed on a healthy 79 yr old? Has it been repeated? Has a biopsy been considered and performed, and was any cancer found and what was the Gleason score? Again, who is treating him and is ADT the Dr's recommendation, and why?

FYI: I have had RP and am undergoing salvage radiation and hormone therapy presently, and generally believe in treatment.

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Thank you for your comment. Such an interesting case with your father... glad he lived a long live. Wishing all the best on your journey as well.
My grandfather got referred by his urologist and got diagnosed with prostate cancer in 2014.
That same year he had brachytherapy. Since then, we have been "watchfully waiting", testing and monitoring. When asked his doctor about his treatment, they recommended Lupron injections.
My question - does generally healthy 79 year old with low Gleason grade - 6 and slow rising PSA, now 16.9, 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?

REPLY
yuliyalt | @yuliyalt | May 1, 2023
In reply to @michaelcharles "Yuliyalt: To expand a bit; one does not treat elevated PSA. You treat prostate cancer. And..." + (show)
@michaelcharles

Yuliyalt:

To expand a bit; one does not treat elevated PSA. You treat prostate cancer. And sometimes not.

Does your Grandfather have an actual cancer diagnosis, and if so, what is the Gleason grade.

Falling is a significant risk on hormone therapy, and particularly for elders.

Other posts have noted instability. A close friend on hormone therapy had "dizziness", tripped, fell, hit his head and required surgery to relieve hematoma pressure on his brain.

I have at times, especially the first couple of weeks, felt "wozziness" or "off".
So I think falling is a real side effect.

Most importantly, what is/are his dr(s) saying?

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Thank you for your comment.
My grandfather got diagnosed with prostate cancer in 2014 and had Brachytherapy that same year. Currently, he has Gleason score 6 and slowly raising PSA – 16.9. He has no treatment, just monitor and bone scans/blood test. When we ask doctor is any treatment should be administered, she said Lupron injections. But I am not convinced he needs it and side effects might outweigh the benefits. My grandfather is a healthy 79 year old man, who is currently takes no medication of any kind.

REPLY
yuliyalt | @yuliyalt | 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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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?

REPLY
1 reply
yuliyalt | @yuliyalt | May 1, 2023
In reply to @mikewo "You don't say if your grandfather is going to do any treatment at all or how..." + (show)
@mikewo

You don't say if your grandfather is going to do any treatment at all or how long he says he wants to live. Has he had an MRI or just a high PSA. Studies have shown that depending upon the severity of the cancer that for men over 70 Androgen Deprivation Therapy makes no difference in biochemical reoccurrence or mastastis from the prostate. Not enough information in your question to give a logical answer based on actual studies and data.

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Thank you for your comment. A few additional questions: are Lupron injections part of Androgen Deprivation Therapy? Here is the additional information about our case:
- 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?

REPLY
1 reply
yuliyalt | @yuliyalt | May 1, 2023
In reply to @digger "Is he on.Flomax I read article that said, if you’re on Flomax, you could possibly have..." + (show)
@digger

Is he on.Flomax I read article that said, if you’re on Flomax, you could possibly have a high PSA test because of it. Just thought I’d throw that out there. Good luck Dave

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Thank you for your comment. No, he is not on any medication or treatment at all now. We are trying to decide if he should be and if so, what type of treatment.
His Gleason grade/score is 6 and slow rising PSA of 16.9. Tumor has not spread.
He is a healthy man and we are trying to weigh in the pros and cons of any treatment, but especially hormone therapy, as it comes with slew of side effects...

REPLY
1 reply
yuliyalt | @yuliyalt | 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.

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This is very helpful, thank you. Very sorry about your side effects from Lupron. That is exactly why we are trying to weigh in our options...
My grandfather currently is not taking any medication or on any treatment and is feeling well, he is our rock. His Gleason grade/score is 6 and slow rising PSA is at 16.9 now, we monitor and do tests every 6 months. When asked his doctor about treatments, she recommended Lupron injections but in my preliminary research, it is typically recommended for aggressive cancer. So, we are trying to decide between no treatment at all (continue as it) vs. starting hormone therapy...?

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