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Medical Forum / Diseases and Disorders / Prostate Cancer / November 2007Need feedback on Eligard or Lupron or similar
I have been told that 2 months prior to Brachytherapy whether low dose ( radioactive seed implants) or high-dose (exposing prostate tissue directly to radioactive material tubes or catheters placed in the prostate) , I would be given a drug called "Eligard" or "Lupron" both of which reduce adrogen production which supposedly "feeds" the cancer. It would also shrink my prostate. Some of the side effects are: Hot flashes weakness weight gain muscle loss and possibly causing me to go shopping at Nordstrom (just kidding!) This doesn't sound too appealing to me. I am also of the understanding that I'd have to be on it for about 1 year -post Brachytherapy. I would appreciate hearing about anyone's experiences with these types of drugs as well as which type of prostate cancer was being treated. Thanks in advance. Sy > I have been told that 2 months prior to Brachytherapy whether low > dose ( radioactive seed implants) or high-dose (exposing prostate > tissue directly to radioactive material tubes or catheters placed in > the prostate) , I would be given a drug called "Eligard" or "Lupron" > both of which reduce adrogen production which supposedly "feeds" the > cancer. It would also shrink my prostate. Both Eligard and Lupron are leuprolide acetate. For details search on them at http://www.rxlist.com/script/main/hp.asp > Some of the side effects are: > [quoted text clipped - 8 lines] > types of drugs as well as which type of prostate cancer was being > treated. It's called androgen deprivation therapy (ADT). A patient might experience some, none, or all of the possible side effects (SEs); there is no way to know in advance. It therefore follows that the anecdotes of others will not be helpful in predicting what any individual will experience. And a patient is not helpless in the face of whatever SEs he has. Here is a thorough discussion of the possible SEs of ADT (called androgen deprivation syndrome, ADS) and what to do about them: http://www.prostate-cancer.org/education/sidefx/Strum_ADS.html This PCRI website is an encyclopedic and objective source of PCa information. Unfortunately, it appears that many medics are unaware of ADS, or, like the rad onc I fired, did not care to learn. They leave their patients to cope as best they can and often to suffer. I also recommend study of the premier text on PCa, _A Primer on Prostate Cancer_ 2nd ed., subtitled "The Empowered Patient's Guide" by medical oncologist and PCa specialist Stephen B. Strum, MD and PCa warrior Donna Pogliano. It is available from the PCRI website and the like, as well as Amazon (30+ five-star reviews), Barnes & Noble, and bookstores. A lifesaver. I know. I'm unsure what Sy means by "type of prostate cancer." Adenocarcinoma as opposed to (rare, fortunately) neuroendocrine carcinoma? Regards, Steve J "'MD' does not mean 'Medical Deity.'" -- Stephen B. Strum, MD >> I have been told that 2 months prior to Brachytherapy whether low >> dose ( radioactive seed implants) or high-dose (exposing prostate >> tissue directly to radioactive material tubes or catheters placed in >> the prostate) , I would be given a drug called "Eligard" or "Lupron" >> both of which reduce adrogen production which supposedly "feeds" the >> cancer. It would also shrink my prostate. Everything Steve said, plus reading some of this forum's many long discussions of ADT in the archives. (Google > Groups > Advanced Groups Search > enter alt.support.cancer.prostate in the "group" blank > enter ADT in the "at least one of the words" blank and start reading.) Some discussions get very heated, but there is a herd of very useful ponies under the steaming piles of horse pucky. Useful, extensive, informative discussions of ADT began, according to my digging, in about Nov '04. You're very right to be very concerned about ADT, as its general pros and cons and individual responses are all over the map. It has a very legitimate but very highly debatable and very highly personalized place in our arsenal. Take two hypothetical physically identical men with identical cases of cancer and even identical side effects and benefits, and offer them ADT. The two may legitimately choose very different ADT regimens or none at all because of its greatest variability of all: personal priorities. My ADT research made me dig more deeply than I ever had in my life into my personal priorities and into a medical treatment. I.P. This entire exercise is really a question of deciding whether "the cure" is worse than the disease in a sense. I am increasing uncertain about taking this Eligard/Lupron especially as I've been told all of a sudden that I'd need to take it for a year post Brachytherapy. I may take this approach and would appreciate any feedback: My PSA is 3.17 which had doubled in about 22 months Gleason is 6 (3+3) Stage is T1c I am 59 and in otherwise good health, exercise regularly and scuba dive. I am willing to get the Eligard shot for 2 months in preparation for Brachytherapy treatment. If I get some nasty side effects I can still get the Brachy procedure but not if I have to take a drug for 1 year thereafter that's going to possibly debiltate me in many ways. My "profile" for "active surveillance " is almost a 100% "fit" (based upon new studies for men 55 and up). I would get a PSA reading every 2 months and if there is a change can always get the therapy. Any feedback will be appreciated. Thanks, Sy > >> I have been told that 2 months prior to Brachytherapy whether low > >> dose ( radioactive seed implants) or high-dose (exposing prostate [quoted text clipped - 21 lines] > > I.P. > This entire exercise is really a question of deciding whether "the > cure" is worse than the disease in a sense. [quoted text clipped - 8 lines] > Stage is T1c > I am 59 and in otherwise good health, exercise regularly and scuba dive. The idea is that ADT makes cancer cells more susceptible to damage by radiation. Since radiation induced cell death takes up to two years or more, some practitioners recommend continuing beyond the initial treatment. Others recommend it only before starting radiation. I don't think there is any firm evidence supporting one approach over another. But if you pick a specific therapist, you pretty much have to follow his/her instructions. I understand why you have rejected surgery, although I think perhaps you exaggerate the likelihood of side effects. (There are surgeons who can preserve potency over 80 percent of the time for a man your age, but you may not have access to them.) But I don't see at all why you are choosing brachytherapy instead of IMRT external radiation. I am not an expert, but I don't think there is any firm evidence that brachytherapy is superior, and from what I've read, I think there is some evidence that the reverse is true. With radiation, the issue is delivering a sufficiently high dose without exposing surrounding tissues any more than necessary, and IMRT can do a good job of that. Finding a surgeon with a good record avoiding side effects may be difficult, but there should be a center doing IMRT available to you. [[ This message was both posted and mailed: see the "To," "Cc," and "Newsgroups" headers for details. ]] Thanks for your reply. I am giving preference to the Brachytherapy (pending getting more info. as to how long I might have to be on Eligard) because my understanding is that it "appears" to be highly successful (with all the caveats that implies) and even if it's a few percentage points lower it could very well be obviated by my having to take 40 trips to the hospital increasing my cortisol levels because of the stress and the possibilty of getting into a car accident. I'm being somewhat flip of course but not too much. The statistical variability is what's most perplexing to me in this whole matter and one might be better off (after getting your biopsy and other numbers) going to see an Epidemiologist and following what he or she says. Sy > I understand why you have rejected surgery, although I think perhaps you > exaggerate the likelihood of side effects. (There are surgeons who can [quoted text clipped - 10 lines] > effects may be difficult, but there should be a center doing IMRT > available to you. Hello Sy, I had a Lupron Depot shot that last for 4 months. It was to shrink the prostate as to make it a smaller target for External Beam radiation. I did decide to move on and get other treatment even though I was given the shot. The first thing that happened after about a week or so was a serious rise in my testosterone levels since I was overly aroused, and could not understand what was going on...... Then the let down came and my libido dropped, I got hot flashes.......serious, and felt weak at my work I did have aches and joint pain....did not know why. Felt tired...... Hot flashes continued and sex was out.........or I did try.......but it was not much fun. I finally came back since I never had to get another shot and was overly joyed that I would never have to get that again. I did get a settlement for Lupron Depot in a Law Suit......It was a class action lawsuit over the cost of the drug I beleive..... Jloomis > I have been told that 2 months prior to Brachytherapy whether low dose > ( radioactive seed implants) or high-dose (exposing prostate tissue [quoted text clipped - 20 lines] > > Sy > I have been told that 2 months prior to Brachytherapy whether low dose > ( radioactive seed implants) or high-dose (exposing prostate tissue > directly to radioactive material tubes or catheters placed in the > prostate) , I would be given a drug called "Eligard" or "Lupron" both > of which reduce adrogen production which supposedly "feeds" the cancer. > It would also shrink my prostate. I have been on ADT for more than four years. It's no fun. If my alternatives were different, I would definitely opt out; but they are not. As you have expressed, you can do the two months and decided if you can handle it or not for the next year. I would put everything into the basket that I could in an effort to assure a cure.  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 PSAD 0.19 years EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 PSAD .056 years Lupron 07/03 (1 mo) 8/03 and every 4 months there after PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years Casodex added daily 07/06 PSA <0.04, <0.05, <0.04 (06/12/2007) Non Illegitimi Carborundum >I have been told that 2 months prior to Brachytherapy whether low dose >( radioactive seed implants) or high-dose (exposing prostate tissue [quoted text clipped - 20 lines] > >Sy I was on Lupron for 25 months after being diagnosed with inoperable Prostate cancer and a PSA of 39.6. Had all of the side effects. Hot flashes were easy to take care of with Megestrol (Megace) My biggest probles was bouts of depression .(And suicidal thoughts) I have discussed this with several other men who have been on Lupron for extended peiods and they had similiar side effects. I would say that the physical side effects are easy to deal with but be very careful of the depression. Fortunately I have a very understanding wife. > I have been told that 2 months prior to Brachytherapy whether low dose > ( radioactive seed implants) or high-dose (exposing prostate tissue [quoted text clipped - 20 lines] > > Sy Sy ....see my recent post titled "Your experience with ADT" it'll give you a lot insight from other guys about what we my be in store for . I'm about 2 or 3 months from starting. I recommend the PCRI site how how to mitigate adverse effects. Good luck. Dominic |
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