My husband's PSA rose after two Lupron treatments. Thoughts?

That can happen. Did they start him on Casodex (Bicalutimide) prior to his Lupron injections?

Were they one month shots or three month shots?

When my PSA started rising while I was on ADT, they told me I was castrate resistant and put me on Zytiga, which brought my PSA back down. That was after being on ADT for 2 1/2 years, however. That would be unusual when Lupron is first started, but it does happen.

If they didn’t give him Casodex (Biclutamide) For at least two weeks before Lupron, then it can cause a testosterone rise and a PSA rise. The thing is that only lasts for about three weeks and then the testosterone goes back down and the PSA should also.

Has he had a biopsy? What was the Gleason score? Has he had a PSMA PET scan? If it’s a high Gleason score and the scan showed metastasis outside the prostate then the PSA Can continue rising, even with Lupron.

The doctor may want to put him on an ARPI like Zytiga, apalutamide, Enzalutamide or Darolutamide Which can usually keep the PSA down for a significant amount of time.

To distill what Jeff wrote, prostate cancer can be "castrate-sensitive" or "castrate-resistant."

If it responds to hormone therapy (ADT) like Lupron, then it's classified as castrate-sensitive.

If it does not respond to hormone therapy, then it's classified as castrate-resistant.

Sometimes metastatic (incurable) prostate cancer like mine starts out as castrate-sensitive, but then becomes castrate-resistant after a few years.

Oncologists used to assume that transition would *always* happen for metastatic prostate cancer within a couple of years, but researchers have recently discovered that newer drugs like the -lutamides, if started at the same time as an ADT like Lupron or Orgovyx, can delay or even prevent the transition to castrate-resistance indefinitely in many cases. My cancer is still castrate-sensitive after 4 years, 3 months on ADT + Apalutamide.

There are excellent treatments available for both situations, but they're somewhat different, which is why it's important for your husband's oncology team to determine which classification currently applies to the OP's husband's cancer

@jeffmarc
Thanks so much for all of this information and for sharing your experience.

@caheil
It appears your husband has become castrate resistant Since he’s been on Lupron for one year.

Median survival after becoming castrate resistance is two years That means as many live longer as less. It’s been six years since I became cancer resistant.

I started Casodex for a little over a year right after it happened and then went onto Zytiga for 2 1/2 years and I’m now on Darolutamide (Nubeqa) For almost 3 years. The last 25 months I’ve been undetectable. Not bad for a two year median survival.

The drugs are great these days and your husband Should be on one of these drugs after Casodex starts to fail him. Just wanted to let you know the sequence of events that works for some people.

To distill what Jeff wrote, prostate cancer can be "castrate-sensitive" or "castrate-resistant."

If it responds to hormone therapy (ADT) like Lupron, then it's classified as castrate-sensitive.

If it does not respond to hormone therapy, then it's classified as castrate-resistant.

Sometimes metastatic (incurable) prostate cancer like mine starts out as castrate-sensitive, but then becomes castrate-resistant after a few years.

Oncologists used to assume that transition would *always* happen for metastatic prostate cancer within a couple of years, but researchers have recently discovered that newer drugs like the -lutamides, if started at the same time as an ADT like Lupron or Orgovyx, can delay or even prevent the transition to castrate-resistance indefinitely in many cases. My cancer is still castrate-sensitive after 4 years, 3 months on ADT + Apalutamide.

There are excellent treatments available for both situations, but they're somewhat different, which is why it's important for your husband's oncology team to determine which classification currently applies to the OP's husband's cancer