Dora:

It would help the group if you can provide his age.

B.A.

On August 24, Dora wrote:

Seems to me that I've seen Dora's posts elsewhere, but I disremember
where. So if I repeat what I've previously written, I beg pardon.

Surgery and radiation as primary treatments (txs) would likely not be
curative. Radiation can, however, be used sometimes for palliative tx of
bone metastases (mets).

See the authoritative website of the Prostate Cancer Research Institute
(PCRI) at:
http://prostate-cancer.org/index.html
Search on "Androgen Deprivation Syndrome" (ADS) and on "High Risk PC."

No one can say with certainty what if any SEs (side effects) he will
experience. Virtually all of them can be alleviated at least so some
extent. The place to go for trustworthy information is the above website.

Having said that, I can say this: a very common but not inevitable SE of
ADT (androgen Deprivation Therapy) with Lupron and like meds is hot
flushes. These are normally controllable, and the above site on ADS will
provide very useful information. I controlled mine with an injection of
Depo-Provera in august, 2005. No hot flushes since then. But what helps
me might harm others and vice versa. Therein lies the risk of relying
upon anecdotes.

Everyone here was a greenhorn, and we still are to some extent.

The PCRI website also includes an extensive glossary. It also covers
every conceivable aspect of PCa.

Regards,

Steve J

"Never -- never -- never give up!  Never go gently.  There will be plenty of
gentle after we die, so until then -- fight -- control the rhythms and tempo
of the dance, even when you have to let the PCa dancing bear lead for awhile
-- even when you have to wear the lead suit as you dance -- never let the
bear set the rhythm and tempo of your dance with life -- when the bear
finally takes control, it will be a very hollow feeling for him, because I
will be gone -- dancing in a better place."
--E. B. (Burns) Mixon, PCa survivor, June 14, 2005 on The Prostate
Problems Mailing List
Thank you, Burns. Live long and prosper.

Dora, Sorry about your struggles. Can I ask, Henry's age?

The casodex is an anti-androgen. It blocks the testosterone receptors
in the body.
Prostate cells (among many others) are sensitive and require
testosterone to live
and grow. Testosterone production by the testicles and adrenal glands
is complicated.
It is signaled and regulated in a very cyclical manner. Lupron or
Zoladex are LHRH
analogues (act like LHRH). Initial dose of LHRH will initially signal
your body to
STIMULATE testosterone, so you will have a surge. This means MORE
testosterone,
which in turn would STIMULATE the prostate cancer cells. This is why
you block
the receptors 2 weeks prior with casodex. Think of it like musical
chairs. If you
have a fixed number of chairs, and they are all filled with casodex, it
doesn't
matter if there are 10 testosterones looking for chairs or if there are
500.. all the
chairs (receptors) are filled. What if he didn't take casodex? Usually
nothing. But,
if he already has evidence of bone lesions, especially in
weight-bearing areas
(spine, legs), the Lupron will cause an initial flare and a spike in
testosterone
which in turn could, theoretically, increase his risk of pathological
fracture. Why
do we use Lupron if it stimulates testosterone? Because the way we give
lupron
is in a depot injection. It's steady and long-lasting, not cyclic like
"natural" LHRH.
After the initial spike, the ongoing presence of LHRH will then shut
down almost
all testosterone production, and hence slow prostate cancer growth.

Prostate cancer is very complex. It's easy to get overwhelmed with all
the info.
Henry's biopsy at this point, is probably of less importance compared
to his
findings on bone scan. If I had to guess, I'd predict he'll have
Gleason 8 or
higher. Gleason grade is a measure of how the cells look under a
microscope.
Think of it like "color". Red cells tend to be very aggressive, and
blue cells tend
to stay where they are and grow slowly. What's more important in
Henry's case
than biopsy grade is his stage. Stage means "where is it in my body
right now?"
Is it just in the prostate? fat just outside the prostate? lymph nodes?
bone?

I have some basic info on my website under "Prostate Cancer" at
www.DrYew.com

I agree with your docs. It seems Henry already has evidence of systemic
disease.
Therefore, there is likely not much benefit for a local treatment
(radiation or surgery),
unless he has local symptoms like bleeding in the urine, or urine
blockage.
He needs a systemic treatment. (hormones, chemo, or both).
Best wishes.

===
http://www.DrYew.com
http://www.SanDiegoRoboticProstatectomy.com
*IMPORTANT* Any comments by me are for general informational purposes
only, and should never be used to diagnose or recommend  treatments for
any condition without face-to-face consultation with a qualified
health-care provider. Thank you.
===

How old is he?

http://www.rxlist.com

http://www.fda.gov

The side effects will scare the life out of you.

Damned doctors don't tell patients half the story.

"This is chemical castration.  You'll lose libido.  You'll become
impotent."

But they won't mention "arthritis" and heart/lung problems, etc. etc.
etc.

Hi Dora, and welcome to the club that no one wants to join.

I'm sure right now you are spinning and just trying to get a grasp on what
you have been told. I'm not a doctor; I'm just a wife of a prostate cancer
(PC or PCa) survivor. Obviously your husband has PC which has metastasized
(mets). Gleason, grades and all the rest don't mean anything right now.
First this cancer is treatable. It has spread so there is no cure for it at
this time. I hope by now you have an appointment with a good radiation
oncologist (rad-onc) or an oncologist.

Take things one step at a time. There's lots to learn. Spend some quality
time together and learn together. When you are ready you can go to
http://www.phoenix5.org and look up end stage for prostate cancer. The thing
you have on your side right now is time. Use it wisely.
(HUGS)
Bev

Hi Dora...I'm sorry to read that your husband has been diagnosed with
advanced prostate cancer (PCa).  Given your husband's age, I suspect
that quality of life (QOL) is important to him (and you).  The androgen
deprivation therapy (ADT) route that you are embarking upon is
practiced at some point by most men with advanced PCa.  Many of the
other posters have discussed the effects it can produce.  For some men
it hardly has an effect, for others it can be devastating.  Effects can
include bone density deterioration, mental acuity, lethary, hot
flashes, predisposition towards other diseases, etc..  Prior to the
discovery of the Casodex - Lupron (Avodart/Finasteride) approach, men
used estrogen to suppress testosterone levels.  From what I read in the
various newsgroups and in the press, some men are beginning to use this
old approach once again.  Estrogen therapy has potential drawbacks
(breast enlargement), but the former concerns involving blood clots and
DVTs seem to have been addressed by using the trans-dermal application
route rather than oral administration.  As opposed to drawbacks,
estrogen seems to have a beneficial effect upon overall well-being
(QOL).  I'm not advocating estrogen therapy in your case, but just
wanted to make you aware that it is an available option.  You should
discuss estrogen therapy vis-a-vis ADT with an oncologist who
specializes in prostate cancer so that you can make an informed
decision.  BTW once you start ADT or estrogen therapy, it doesn't
preclude switching to the other therapy.

In terms of PCa oncologists, one of the best lives back your way in
Virginia, Dr. Charles "Snuffy" Myers, he himself is a prostate cancer
survivor.  You can Google his name or use this link to get contact
information

http://www.healthsystem.virginia.edu/internet/news/experts/myers.cfm

He is widely respected and used by many...Best wishes and good health,
ron

Hello Dora,

Everyone here understands your situation very well.

Here's the bad news. Your husband has cancer and barring a miracle,
it's incurable.

That's about it for the bad news.   The good news is that the treatment
that you mentioned will very likely surpress the cancer for a long,
long time.   Possibly beyond his expected life span.

The question then is, aside from the cancer, how's his health?  Blood
pressure, cholesterol, how's he feeling?   Is he a young 84 or is he
ailing?    Does he get out and around, active in hobbies, sports?  The
good news is that he can continue these activities.  In fact, he should
make an effort to get more exercise.

The Lupron will surpress his testosterone, drive it to zero.  With zero
testosterone, the cancer will get very lazy, even start to shrink.  It
will probably come back but a Lupron and other treatments, such as spot
application of radiation, the docs may keep it at bay for 5, 10, or 20
years.

The Lupron has many, many side effects.  These include the hot flashes,
he can get by that by keeping the temperature down and there are
medications that help.

Lupron can aggrevate joint pain, cause memory loss, induce
irritability, and so on.  Type Lupron Depot Side Effects into google.

He should monitor his blood chemistry, not just cholesterol, everything
that they commonly test for including blood sugar.

The other side effect is that Lupron zero's out libido and erections
and orgasms are a thing of the past.  I'm mad about this one.  Some
fellows report that they can "perform" while on Lupron but wasn't my
experience.

Good luck to you and your husband.  Take him to "the Fisherman's Inn"
on Kent Island, I like to have lunch there.

To everyone who has been kind enough to write me, I can't express my thanks
enough.  You have done a great deal to put us back on an even keel.

I'm embarrassed that this thread is so long but felt I had to respond
personally to every person who wrote.   If I may, I'll keep you posted as we
go along.

Dora

It's at times like this that I wish I were religious, because then I
would be able to pray for you both. As it is, you are in my thoughts
and I hope things go well for you and Henry. Everything happens slower
as we age, including the spread of cancer, and PCa is generally a slow
moving beast anyway, so the ADT should keep you going for a good while
with any luck at all. Fingers crossed, stay positive, and post here any
time you feel down and need a little sympathy.

One note I didn't see from others - ADT can cause osteoporosis, so be
on the watch for that. Treatments exist if needed, some oncologists may
prescribe them preemptively.

Dora Crawford wrote:

You can locate some side effects at   http://www.fda.gov
and search for LUPRON.  The data below is from another site.

Lupron Side Effects and Drug Interactions

Body as a whole - Asthenia, General pain, Headache/Migraine (65%)

Cardiovascular System - Hot flashes/sweats 98%, shortness of breath

Gastrointestional System - Nausea/vomiting

Metabolic and Nutritional Disorders - Edema, Weight gain/loss

Musculoskeletal System - Joint disorder - osteoarthritis, ankylosing
spondylitis

Nervouse System - Decreased libido, depression/emothion lability
(22%),
                                Dissiness, Nervousness, Neuromuscular
disorders,
                                Paresthesias

Urogenital System - Breast changes (enlargement)/tenderness/pain

Hemic and Lymphatic system - Decreased WBC

Central/Peripheral Nervous System - Peripheral neuropathy, Spinal
         fracture/paralysis

Urogenital Syem - Prostate pain

Body odor, flue syndrome, palpitations, appetite changes, dry mouth,
thirst, ecchymosis, lymphadenopathy, anxiety, insomnia/sleep disorder,
delusions, membor disorder, personality disorder, hair disorder, nail
disorder,
conjunctivitis, ophthalmologic disorders, taste perversion.

Changes in Bone Density
In controlled clinical studies, when LUPRON DEPOT 3.75mg was
administered for 6 months, vertebral bone density as measured by
dual energy x-ray absorptiometry (DEXA) decreased by an average
of 3.2% compared with the pretreatment value.
When LUPRON DEPORT 3.76 was administered for 3 months,
bertebral trabecular bone mineral density as assessed by
quantitative digital radiography (QDR) revealed a mean decrease
of 2.7% compared with baseline.
        Use of LUPRON DEPOT for longer than 3 months in the
       presense of other know rish factors for decreased bone
       mineral content may cause additional bone loss and is not
       recommended.

Lipids - Triglycerides were increase above the upper limitn of normal
in 12% of the patients who received LUPRON DEPOT 3.75mg.
HDL (good) cholesterol fractions decrease below the lower limit.
LDL (bad) cholesterol fractions increased above the upper limit.

Postmarketing
  Like other drugs in this class, mood swings, including depression,
have been reported.  There have been reports of suicidal ideation
and attempts.
Patients should be counseled on the possiblity of development or
worsening of depression during tratment with LUPRON.

03/06/2006