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Medical Forum / Diseases and Disorders / Prostate Cancer / November 2006How long does Zoladex last
My urologist prescribed 13.8mg implants of Zoladex at three-monthly intervals. After two implants which brough my madly escalating PSA from 33.6 down to about 25, and which time I had a course of radio therapy 18 months ago. Meanwhile the Zoladex implants continued, and post radio treatment the PSA dropped below the 0.12 detectable level and has remained at that level ever since. However because of the side effects, I asked that the Zoladex implants cease at the beginning of this year (ie 10 months after the radio treatment) - the total dosage was six implants over a period of some 21 months. I was told the Zoladex side effects should disappear in 6 to 9 months, and I "would feel like a new man". Well I haven't felt like a "new man" and I would be interested in the experience of others who have had the heavy doses of Zoladex over a short period, and to know how long it took for the side effects to completely wear off.  SignatureStan Johnstone http://member.melbpc.org.au/~stanj/ Honorary Life Member - Melbourne PC User Group, Australia Stan, from my experience and investigation, zoladex side effects last as long as the treatments. You can control hot flashes with various medications, but the low sex drive, muscle aches, weight gain in central locations proceed along with the zoladex. I've been on zoladex for 3 years (the same dosage your Doc has you taking) + take megestrol acetate to control the hot flashes. In my non-doctor opinion, the decision to take or not take hormone injections should be dependent on evidence of PC beyond the organ. Is there any evidence (?) - was a DRE done, what was pre-Radio Therapy (never heard it called Radio Therapy - radiation, right) biopsy, staging, were lypmh nodes positive, etc. Normally, after a curative treatment, you monitor the PSA for evidence of escape, not jump to hormones, unless we're missing some facts like I asked above. Nevertheless, good luck. Rich > I was told the Zoladex side effects should disappear in 6 to 9 months, and I > "would feel like a new man". Well I haven't felt like a "new man" and I > would be interested in the experience of others who have had the heavy doses > of Zoladex over a short period, and to know how long it took for the side > effects to completely wear off. > My urologist prescribed 13.8mg implants of Zoladex at three-monthly > intervals. After two implants which brough my madly escalating PSA from > 33.6 > down to about 25, and which time I had a course of radio therapy 18 months > ago. Welcome to the group, Stan. > I was told the Zoladex side effects should disappear in 6 to 9 months, and > I [quoted text clipped - 3 lines] > of Zoladex over a short period, and to know how long it took for the side > effects to completely wear off. It is mentioned in Strum's "A Primer on Prostate Cancer". When I started this response, I thought I was going to be able to go right to it -- but such is not the case. I did find a discussion of IADT where he discusses how long some were off ADT before going back on. It seemed clear the those that were off 44 months had sexual functioning during the off time, whereas he mentions nothinf of sexual function for those who were off 22 months. My recollection (albeit inhibited by Lupron) is that it takes up to 24 months for sexual function, but that some never regain it. Since sexual function is tied to T, then it is probably a good indicator in your case for "feeling like a new man." I've been on ADT for 3½ years and ADT2 for 6 months. I seem to ward off a lot of the SEs by walking 3-5 miles 3-5 times a week. You have an unqualified Life Membership to the alt.support.cancer.prostate newsgroup. SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05, 2/06, 6/06 PSA .07 .05 .06 .09 .08 .132 .145 Casodex added daily 07/06 PSA <0.04 Non Illegitimi Carborundum Stan, after reading Steve's response, I am confused. I thought you were asking if the SE's would wear-off while on zoladex, not after. Also, I probably jumped to the question "should I stop zoladex ...." Anyway, welcome to the group, there's some good members and information here. Rich Stan, If memory serves me correctly; I began to feel better about 2-3 months after the last Lupron injection should have worn off. I was on it for about 6 mos. prior and 6 mos. post seeding with Pd103 seeds. The original stated purpose of ADT was to shrink the prostate, it worked well for that purpose. Following seed implantation, my Dr. wanted to keep the testerostone low until the radiation had a chance to do it's job. So far it's been pretty good, I go back in Feb.07 for another check up. As far as being a new man goes; I'm soon going to be 65 not 25, I work full time as a construction project manager and hit the gym 3 times a week and with a little help from the pharma community all is functioning well. Tom >> My urologist prescribed 13.8mg implants of Zoladex at three-monthly >> intervals. After two implants which brough my madly escalating PSA from [quoted text clipped - 31 lines] > You have an unqualified Life Membership to the alt.support.cancer.prostate > newsgroup. > Stan, > If memory serves me correctly; I began to feel better about 2-3 months > after the last Lupron injection should have worn off. I was on it for > about 6 mos. prior and 6 mos. post seeding with Pd103 seeds. > Tom How long does each shot last, and what kind of side effects did you have? Should we have a fight song? > You have an unqualified Life Membership to the alt.support.cancer.prostate > newsgroup. > Should we have a fight song? > >> You have an unqualified Life Membership to the >> alt.support.cancer.prostate >> newsgroup. I don't think so. Only the other team knows when they've scored. Stan, Yur doctor's recommendation of using ADT along with radiation seems to be the accepted standard for high risk cases such as yours. Most other doctors would probably have recommended the same. If your PSA stays low and the treatment seems to have worked, then it is possible that he was right. I don't know if it's true, and I can't recall the source, but I seem to remember reading that men who have androgen deprivation for less than 2-3 years, and are not very old, almost always fully recover testosterone production. You can find out if that's the case by getting a test to see what your current level of blood testosterone is. If it has returned to pre-treatment levels, or even if it hasn't, then you might wish to try other ways to bring back yourself back to full health. I was only on ADT for 4 months and my T level came back to normal after about 6-7 months. Still, I found exercise to be very important. Aerobic exercise helped restore my energy levels. I suffered from arthritic like side effects in my fingers which I attribute to the ADT. Hand exercises helped restore full function and flexibility in my fingers (I still wake up with stiff fingers and have to work them to get the stiffness out.) Sexual function is another matter because it is affected by radiation as well as by testosterone level. I don't think mine ever recovered to the level it was at before treatment, but it has recovered and is still workable. It's hard to disentangle all of these effects from the effects of advancing age. We don't recover from the hits we take the way we did 40 years ago. I can't run the way I used to. I can't manage sex as often. But we do the best we can. I suggest that, as first steps, start an exercise program if you haven't already done that, and get your testosterone level checked. Best of luck. Alan > I was only on ADT for 4 months and my T level came back > to normal after about 6-7 months. The more stories I hear like that, the more I question the value of intermittent ADT. Who really gains more during the hiatuses, the pt or the disease? I.P. >> I was only on ADT for 4 months and my T level came back >> to normal after about 6-7 months. > > The more stories I hear like that, the more I question the value of intermittent ADT. > Who really gains more during the hiatuses, the pt or the disease? There are two different motivations for intermittent ADT. One is to give the patient some recovery time, but the other is to prolong life. There are some practitioners of it (Strum is one if I remember correctly) who claim that, for some classes of patients, ADT can work longer if given intermittently. One theory of this that I've seen is that ADT suppresses cancer for some number of months. Let's say, for example, that a particular patient will get 36 months of benefit from it. One way to deliver it is to give 36 straight months. Another is to give 12, wait until some PSA threshold is reached which may take 12 more months, then give 12 more, wait, then 12 more, coming out at 5 years with a very low PSA instead of 3. I have no idea whether this theory is true, or if it is true for some class of patients, what distinguishes that class. Another, different kind of ADT, is to give some period of an LHRH agonist like Lupron, followed by some period of a completely different type of ADT like Casodex, then switch back to Lupron later, and so on. I don't recall if anyone on this newsgroup has had intermittent ADT. If there is someone, maybe he can tell us what his doctor's motivation was and what his experience was - though of course no one person's experience is much of a guide to others. Alan > There are two different motivations for intermittent ADT. One > is to give the patient some recovery time, but the other is to prolong [quoted text clipped - 15 lines] > of course no one person's experience is much of a guide to > others. Hi Alan...... Yes.....Ron is on intermittent ADT and his last shot of Zoladex was Nov. 8th, 2005.....so say a year ago. That would have worn off around Feb. 8th, 2006. He was extremely weak last Xmas and had difficulty walking, so the doctor took him off all meds for that reason. He said that Ron seemed to get hit harder than most men. He was on Zoladex and Casodex for exactly one year, but didn't suffer any side effects for about 7 months.....normally it is about 3 months when they start kicking in. We kept a close watch on both his PSA and his T levels.....testing every 3 months. He started to regain his male muscle mass (legs in particular) noticeably in about a month or two, but it is a long climb back to normal. His T level was 0.1 in February on Zoladex and it slowly climbed to 1.0 by mid September. However, we did go to the Maritimes in July and he really had no problems walking and/or driving around the entire Provinces of PEI and Nova Scotia. He didn't get as tired as he thought he would. However, due to circumstances (annual physical), the family doctor just included his PSA and T tests a month early and I was quite surprised to see his testosterone was at 3.9 (up from 1.0) in just two months. So I would say that it would be about 8 or 9 months before the total effects of the HT were gone......which seems to be the general consensus. Now is the not so fun part. His PSA is now at 0.1 (slowly up from 0.02, or 0.05 depending on the lab, almost a year ago). The oncologist (Dr. Loblaw) said that he would let it get up as high as 10 before putting him back on Zoladex ONLY. No more Casodex for now. Dr. Loblaw is a research and radiation oncologist and he now thinks that Ron's bizarre soaring PSA of the summer of 2004 (3 full points in 8 days!!) was not cancer mets. Apparently there have been two other patients who have risen rapidly to about 20 and then settled down to undetectible. Ron's PSA was higher than that from Aug. to Oct. So.....bottom line is that we don't know if the doctor is right, but pray he is. And the other is that intermittent ADT (or HT as I call it) works well in that Ron was hit harder than most patients, but rapidly regained his strength and we go on from there. It is uncharted territory, I guess......but it sure beats the alternative!!! Either of them. As an afterthought, Ron's PSA dropped from 25+ to 0.02 in 3 months thanks to Zoladex and Casodex. That surprised both oncologists and they were quite happy with the fast response. And perhaps that is why they are wondering what caused the bizarre soaring. Nothing showed on either the bone or cat scan. If I have forgotten something here, just ask. I haven't informed the news group of all of the ups and downs this past 2 years. Basically because I discovered I was rather private when the sh*t hit the fan. (G) Still am, but if anything Ron or I have to say helps someone, then that is OK. Cheers.....Heather Hello Heather, The report on Ron sounds very positive to me. Having his PSA grow to only .1 after 9 months off HT sounds excellent. It will probably grow faster now, but could still take quite a while to reach the threshold for getting back on HT. And if and when it does reach that threshold, there's a good chance of at least several more cycles with the same outcomes. I know the HT was very tough and I'm glad that Ron has recovered well from it. Here's hoping he can go for many months before he has to reconsider HT. Do you know why the doctor is recommending only Lupron next time, not Casodex? Is he suspicious that the worst of the side effects were from Casodex, or perhaps from the combination? In any case, Ron's response to the drugs was so positive that it sounds like a good idea to just use one next time and hold one in reserve. Has the doctor considered a finasteride like drug (e.g., Avodart) as a maintenance drug between HT rounds? I think Strum uses that as a way to prolong the period between HT rounds and it presumably has significantly fewer side effects. Best wishes. Alan Hi Alan......see inline. > Hello Heather, > [quoted text clipped - 4 lines] > reach that threshold, there's a good chance of at least several > more cycles with the same outcomes. Thank you. Your kind words are most appreciated. Funny.....I never think that far ahead, but I do believe that this intermittent HT will give him a lot more quality time than any of us know at this point. Perhaps until that magic time when there is a total cure for this beast!! > I know the HT was very tough and I'm glad that Ron has recovered > well from it. Here's hoping he can go for many months before > he has to reconsider HT. That it was.....he was very unhappy a year ago but unfortunately I had not discussed IHT with him and he hedged on it for just one more shot of Zoladex. The SE's then changed his mind very quickly. He perked up tremendously once he quit the HT. > Do you know why the doctor is recommending only Lupron next > time, not Casodex? Is he suspicious that the worst of the side > effects were from Casodex, or perhaps from the combination? > In any case, Ron's response to the drugs was so positive that it > sounds like a good idea to just use one next time and hold one > in reserve. I really don't know.......but will ask. We had a medical oncologist here in town that was giving the shots for a while. Dr. R. put Ron on Megace. Once we decided to go back to Sunnybrook Hospital and Dr. Loblaw, he took Ron off Megace immediately and also told him to stop the Casodex. Seems Megace causes a lot of the excess weight problem. Ron never had another hot flash, btw. I have wondered why re the Casodex myself, but perhaps in Ron's case (as in Steve K's), the shots may be strong enough for now and we were doing a bit of *overkill*. Just a guess on that one. But he was very definite that he would not put him back on it. > Has the doctor considered a finasteride like drug (e.g., Avodart) > as a maintenance drug between HT rounds? I think Strum uses > that as a way to prolong the period between HT rounds and it > presumably has significantly fewer side effects. Again.....I don't know......sorry. But I will ask him. Just looked it up and it seems to be for BPH. Correct me if I am wrong. Btw....just as an interesting aside. During Ron's annual physical, I jokingly said to the family doctor "you don't have to do a DRE anymore". He looked surprised and then asked Ron if he could do one. He had never checked someone after radiation and was a bit intrigued. Contrary to what I thought, he could feel what remained of the prostate, but said it was very flat. No lumps, bumps or hardness. Best wishes to you as well. And thanks again to you and a few others who were there for me during the *annus horribilus* as Queen Elizabeth would say. That was so devastating to the both of us and I just couldn't talk about it. Hanging in by my fingernails, actually. Cheers...Heather On November 26, in reply to Alan Meyer's inquiry about using > Again.....I don't know......sorry. But I will ask him. Just looked it > up and it seems to be for BPH. Correct me if I am wrong. > Finasteride is Proscar (or, for the balding, Propecia). Avodart, the newer drug, is dutasteride. The "label" use of these drugs, in the dosage we are concerned with here, is indeed to treat BPH. However, as is the case with many other drugs, there's the "label" use and then there's the "off-label" use. It's the latter that's the topic. Per http://www.rxlist.com Avodart "is a selective inhibitor of both the type 1 and type 2 isoforms of steroid 5a-reductase (5AR), an intracellular enzyme that converts testosterone to 5a-dihydrotestosterone (DHT)." Proscar also inhibits 5AR, though only the type 1 isoform. And as the T recovers from ADT, it's the prevention of that conversion to DHT that is desirable. DHT is many times more effective than T in encouraging development of PCa cells. An excellent study was published in the May 2006 issue of the Journal of Urology, "Intermittent use of testosterone inactivating pharmaceuticals using finasteride prolongs the time off period." Familiar names among the six authors are Mark Scholz, his former partner Stephen B. Strum, and Dr. Scholz's current partner, Richard Lam. Their conclusion is: "Finasteride doubles the duration of TOP (time off period). AIPC (androgen-independent prostate cancer) was not increased by finasteride after almost 9 years of observation." The article can be found on PubMed. The ID number is 16600727. After that article was written, but before publication, Scholz and Lam elected to change all their Proscar patients to Avodart. Regards, Steve J "Do not go where the path may lead, go instead where there is no path and leave a trail." -- Ralph Waldo Emerson Thanks for the explanation and excellent information. I will speak to the doctor about this. I checked your first link and will find the PubMed info. Cheers....Heather > On November 26, in reply to Alan Meyer's inquiry about using >> Again.....I don't know......sorry. But I will ask him. Just looked [quoted text clipped - 46 lines] > and leave a trail." > -- Ralph Waldo Emerson > There are two different motivations for intermittent ADT. One > is to give the patient some recovery time, but the other is to prolong [quoted text clipped - 9 lines] > more months, then give 12 more, wait, then 12 more, coming > out at 5 years with a very low PSA instead of 3. I realize your numbers are just illustrative figures, but it seems to me that this theory of significant IADT life extension has been shaken by the many studies concluding that ADT of ANY regimen prolongs life by an average of only 6-8 months. Even the most optimistic study I've seen discussed here averaged only about 14 months, and that was for specific circumstances and has not been bolstered by other studies, last I heard. Let's hope that ongoing better-focused, better-managed, newer studies of ADT timing protocols deliver firmer answers and, even better, BETTER outcomes. But even then, results take many years to emerge. I.P. > ... > I realize your numbers are just illustrative figures, but it seems to me that this > theory of significant IADT life extension has been shaken by the many studies concluding > that ADT of ANY regimen prolongs life by an average of only 6-8 months. Even the most > optimistic study I've seen discussed here averaged only about 14 months, and that was > for specific circumstances and has not been bolstered by other studies ... One of the problems with studies in this area is that the response to ADT varies so widely. Some patients get ADT and experience very little drop in PSA, only for a short time. Others experience very large drops, down to undetectable, for a long time. Some men may have cancers that are highly hormone dependent and some do not. Some may have physiologies that respond strongly to the drugs (suppressing T down almost to zero) and some do not. Taking an average may not tell us much about how much benefit ADT provides in individual cases. A more useful study might be one that stratifies outcomes based on initial response to ADT. I remember reading some study, it may have been by Strum or perhaps by the guys that Ed Friedman cites, that men who get below .05 PSA on ADT will have many years of additional life. Alan > One of the problems with studies in this area is that the response > to ADT varies so widely. Some patients get ADT and experience [quoted text clipped - 6 lines] > Taking an average may not tell us much about how much benefit > ADT provides in individual cases. Very true. The sigma is huge, for the reasons you point out. I.P. >> I was only on ADT for 4 months and my T level came back >> to normal after about 6-7 months. > > The more stories I hear like that, the more I question the value of > intermittent ADT. Who really gains more during the hiatuses, the pt or the > disease? When it was a theory, it seemed to have a sound basis. Then when the first reports started coming in, the theory looked promising. Studies and reports still keep coming in and none that I have seen indicate that the patient loses time overall. As such, if the patient gains decent time intermittently, then it seems to fall right into your theory of QOL is more important than L itself. Just a thought. I really have no conviction regarding IADT. SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05, 2/06, 6/06 PSA .07 .05 .06 .09 .08 .132 .145 Casodex added daily 07/06 PSA <0.04 Non Illegitimi Carborundum |
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