Another 90 days gone by

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DP - 11 Apr 2006 20:43 GMT

To all:

Went in last week for my 90 day Lupron shot. I combine it with a 50MG
Casodex daily. The PSA 90 days ago was 0.10. The results now came back at
'less than" 0.10. This is as low as the non-sensitive test will go. We
discussed side effects, etc. and will decide in 90 more days whether I want
to continue for now or go intermittent.

As a side note, the hot flashes are getting bad now that the weather is
changing. I had not really suffered the flashes, just night sweats, until
the last 5 or so weeks. I had read that a very low dose of Prozac is helpful
for hot flashes. Most urologists prescribe Megace for hot flashes in men,
but it is an appetite stimulant. That's the last thing one needs on ADT.
The Prozac is usually an appetite suppressant, if any effect is seen.
Anyway, my Doctor had never heard of using Prozac, but gave me a
prescription and told me to report back if it worked or not. I will give it
a try. I will try 10MG per day, where the usual starting dose for depression
is 20MG per day.

Later,

Dale P
Denver, CO

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Steve Jordan - 11 Apr 2006 21:13 GMT

On April 11, Dale wrote:

> Went in last week for my 90 day Lupron shot. I combine it with a 50MG
> Casodex daily. The PSA 90 days ago was 0.10. The results now came back at
> 'less than" 0.10. This is as low as the non-sensitive test will go. We
> discussed side effects, etc. and will decide in 90 more days whether I want
> to continue for now or go intermittent.
>

Caution: Strum & Pogliano recommend (_A Primer on Prostate Cancer_ 2nd
ed. pp 144-147) that before considering IADT (intermittent androgen
deprivation therapy) the patient must have a history of undetectable
PSAs (UDPSA) for at least 12 months. UDPSA is defined as <0.05 ng/ml. If
this criterion is not followed, the results are predicted to be, shall
we say, less than optimal.

> As a side note, the hot flashes are getting bad now that the weather is
> changing. I had not really suffered the flashes, just night sweats, until
> the last 5 or so weeks. I had read that a very low dose of Prozac is helpful
> for hot flashes. Most urologists prescribe Megace for hot flashes in men,
> but it is an appetite stimulant.

(snip)

Here's my standard response to hot flush problems:

There are txs for hot flushes, and they seem not to be well-known among
some inattentive medics. I'll not speculate on the reason. You may
admire my restraint :-)

They are:

1. Megace (megestrol acetate): some concern has been expressed by one
medic that it might encourage PCa development where the tumor has
mutated. Unfortunately, there appears to be no way to be certain whether
this has occurred. Nonetheless, I do know that it is used successfully
to relieve hot flushes.

2. Paxil (paroxetine hydrochloride), an antidepressant. A side effect is
to relieve hot flushes.

3. Effexor (venlafaxine hydrochloride), an antidepressant. Same story.

4. Depo Provera (medroxyprogesterone, a synthetic form of the female
hormone progesterone), the "label" use of which is as a female
contraceptive. In the 400 mg (contraceptive) dosage, a study (Marx et
al.) has demonstrated excellent results in relief of hot flushes among
men on ADT (androgen deprivation therapy).

I selected this tx to relieve my hot flushes (6 per night + days) from
Trelstar (triptorelin pamoate), which with Lupron and Zoladex is one of
the LHRH agonists used to castrate PCa patients chemically thereby
depriving PCa cells of an essential nutrient, testosterone (T).

In my case, I chose Depo Sub-Q Provera 104 mg, the "label" use of which
is palliative tx of endometriosis. In August 2005, I received 104 mg in
each anterior thigh. I have not experienced even one hot flush since
then. How long this will continue is anyone's guess.

However: one must be aware that progesterone is metabolized into
testosterone, and should take care that one's PSA is sufficiently low
that a rise in T will not be harmful. In my case, my PSA rose from 0.01
ng/ml to 0.02, then subsided to 0.01, which I feel is more than
satisfactory.

Caveat: what works for me may not work for anyone else in the universe!

In the USA, such use of these drugs is "off-label" which is to say not
approved by the US Federal Drug Administration. The practical effect of
this is that the use of the drugs for relief of hot flushes will not be
paid for by insurance carriers.

I
(1) am not sure of the dosages except for Depo Sub-Q Provera, and
(2) do not know the out-of-pocket costs of the off-label use, again with
the exception of Depo Sub-Q Provera (US$200 for two pre-loaded syringes
+ $25 for the injection at my medic's office).

I consider the cost to have been well worth the result.

Had a bit of fun with my medic and his staff after the injections.
Sighed and observed that from now on I would be unable to ovulate.....

I've also been informed that estrogen patches could be helpful, but have
not looked into it.

Regards,

Steve J

Reply to this Message

tripperc - 12 Apr 2006 14:25 GMT

I started Casodex 2 weeks ago and had my first Lupron shot yesterday.
My Doc said he would prescribe the estrogen patches if/when I start
getting the hot flashes. I can't comment on the effectiveness though.

> I've also been informed that estrogen patches could be helpful, but have
> not looked into it.

Reply to this Message

DP - 12 Apr 2006 19:20 GMT

Steve,

I did what reading is available as to hot flash/flush problems in men on
ADT. There is actually not much out there as to men, but lots of advice for
women. Paxil and Prozac do the same thing, just in different ways. What
little I could find seems to say that Paxil could lead to appetite increase,
whereas Prozac is more inclined to lead to appetite suppression. I have
gained about 10 more pounds this winter. While I was not extremely
overweight before, add 10 pounds and now I am the heaviest I have ever been
in my life. I should really be 20 pounds lighter than I am now. Plan to
work more on it as the weather is getting so nice now. Anyway, either
anti-depressant seems to have some benefit for hot flashes. I am reluctant
to use any other hormone products for hot flashes, as I already have my
endocrine system totally messed up with ADT.

The time frame for intermittent therapy is really up in the air. It was not
long ago here that a report was posted stating that 8 months on and 8 months
off seemed to be adequate. I agree with you about the one year, just dread
doing it. If I have four 90 day shots, by the time it clears the body, I
will then have had at least 14 months of side effects. I will say, the side
effects seems less this time around on the ADT. One must remember that I am
7 years older now, and one of my testicles was basically "killed" during
another surgical procedure. My normal testosterone level has been at a
lifetime low without ADT. An other consideration is that with the last
injection I have now committed to over 28 months of ADT during my life.
There is always a chance that I will become refractory. I plan to have a PSA
test done the week before my next Lupron is due, because if it has quit
working, I will not take it. I know in my mind that I will very most likely
take the next Lupron shot, giving me one full year of ADT. The rest is just
speculation.

Thanks for your comments.

Dale P
Denver, CO

> On April 11, Dale wrote:
>> Went in last week for my 90 day Lupron shot. I combine it with a 50MG
[quoted text clipped - 80 lines]
>
> Steve J

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