How long will Lupron work before prostate cancer becomes resistant?

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.

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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.

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Wow, with all you’ve gone through I feel like a wimp! I wish the best for you!

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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

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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.

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Seems to depend on whether you get to PSA < 0.1 and how long it takes you get there. The best is within 6 months. It means that 99%, possibly more of the cancer cell is 'suppressed'. If it takes longer, you are still ok but it might indicate some of the cancers are a little harder to suppress. Suppressed means either killed or hybernates. Mostly killed. Above PSA 0.2 you got work to do. If under that, you are still ok.
Johns defines desease free as PSA 0.5. That is the cut off these studies use.

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All kidding aside, I asked my oncologist this same question. "How long will my ADT injections work?" Her response was right on the mark. "ADT injections work until they don't and when they don't we will try something else, again, and again, until we find something that works." What works best I asked? She replied "Quality of life, your quality of life tells me everything I need to know about our treatments success." I have taken great comfort in that of the years (last 2 years).

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