How Often Is Lupron Administered & Is There A Better Choice?

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Heavy Leaker
Regular Member


Date Joined Feb 2010
Total Posts : 63
   Posted 5/28/2010 6:35 AM (GMT -6)   
My question might be a little premature for me but my reason for asking is related to financial costs.  My insurance plan renews in a few weeks & I pay the entire costs myself.  By getting some idea of how often Lupron is administered I can determine if it is cheaper for me to continue with my present plan where I pay 50% of the costs of prescriptions or change my drug plan to where I would pay a $25 copay for drugs.  The change in plan would cost me an additional $140 a month in premiums.  Currently, I do not take any prescription drugs.  for that reason, if lupron is less than $300 a month, I am better off staying with my present plan.  Also, does taking Lupron or getting radiaiton require other drugs?
 
I am being a little premature in anticipating this development but am doing it due to the insurance renewal anniversary date.  My surgery was done in October of 2009.  As you can see in my signature, my margins were negative and my Gleason was 3+4.  My first PSA at 6 weeks was undetectable but my second PSA at 6 months was .1. 
The surgeon said that scar damage to my prostate from 4 biopsies made it very difficult to peel my prostate from my rectal wall & that the PSA could be coming from benign tissue left behind since my margins were clear.  My surgeon says that if my PSA goes up to .3 I will need radiation.  Since I have had a lot of incontinence problems, my surgeon would delay radiation until I have had a year of recovery from surgery to maximize the time for improvemnt of continence as he says radiation will halt any improvement in continence.  For that reason he will prescribe Lupron to hold cancer growth in check till then.  That is the reason for asking how often Lupron is administered.
 
I also want to hear any thoughts about whether or not I should even go on hormones until radiation is given & if there is any scientific evidence that says I need to go the radiation route at .3 PSA since the PSA could be from benign prostate tissue left behind.  Also, are there any hormones with better effectiveness & less side effects than Lupron?  Thanks in advance!
 
4 biopsies over 4 years starting in 2006, 4th biopsy showed 5% of one core Gleason 3+3=6.  PSA in 2005 6.0, rose to PSA 18 shortly before surgery.  Chose surgery over radiation due to conflicts in PSA versus biopsies.  PSA 18, Gleason 3+3+6, Age 58, Rising PSA since 1999, Biopsy 5% of one core
Robotic surgery 10/26/09  T2B Tumor 30% of prostate  involving left & right lobes  NOMX Gleason 3+4=7  Urethral Resection margins &  resection surface clean Seminal vessicles clean.


Opa N
Regular Member


Date Joined Sep 2009
Total Posts : 150
   Posted 5/28/2010 8:21 AM (GMT -6)   
Hello Heavy,
Lupron for men with PCa comes in 3 dosages: 7.5 mg, 22.5 mg, and 30 mg. That is a 1, 3, and 4-month dose. Lupron is administered by your doctor's office, in my case my Uro/Surgeon. I am on a Medicare Advantage Plan, which has a prescription plan included. The doctor ordered the Lupron, administered it, and billed the insurance company for it. It showed up not on my prescription plan, but as a medical procedure. I had the 30 mg dose, which I believe my doctor billed out at about $2,000.00. There was an insurance payout, a write-off, and then a bill to me for a balance, which was about $160.00.
I suggest you ask the billing office at your Dr., and also your insurance company about the billing procedure, and the expected copay from you. I don't think your prescription drug plan will come into play for Lupron, Hope this helps.
Roger
Age 67 at diagnosis. Treated for coronary artery disease (CAD) since 1998, and under control with medications.
2/6/09 Routine physical, with DRE and PSA Test. PSA 4.02. Referred to Uro
4/20/09 TRUS w/needle biopsy
4/23/09 Diagnosis PCa with Gleason 4+3 in 2/2 cores, Gleason 3+3 in 5/10 cores.
CT scan and Bone Scan both negative. Stage T2C.
8/27/09 DaVinci RP at WakeMed Cary NC with Dr. Tortora. Discharged 8/28.
9/8/09 Catheder removed. Path post-surgery confirms PCa, with Gleason 3+3 with scattering of 4. Positive margins in L & R posterior, R and L seminal vesicles, with perineural invasion. Stage T3b.
9/30/09 PSA Post-Op <0.01. Met w/Uro/Surgeon to review surgery and path report. Referred to Medical Oncologist and Radiation Oncologist. Appointments set for 10/8.
10/8/09 Met w/ both oncologists. Adjuvant Combination Therapy to begin ASAP.
10/21/09 First Lupron injection. 30 mg dose (4 month)
11/2/09 PSA 2-month <0.01. Cystoscope w/calibration and dilation to remove scar tissue from urethra. Big relief.
12/18/09 psa 4-Month <0.01 undetectable. MRI/CT scan set for 1/5/10 for IMRT planning. RT to begin week of 1/11/10. Anticipate 64-66 grays over 32-33 treatments.
1/14/10 Start RT with 32 treatments # 2 gys per.
2/26/10 IMRT completed.
3/1/10 Second Lupron injection, 30 mg dose (4 month)
5/10/10 PSA 8 month and 2 month post RT <0.01 undetectable

Initial incontinence pretty bad, starting w/6 Depends pants/day. Gradual improvement, with dramatic reduction in leakage around 9/20/09, to 1 pad during the day and 1 at night (for security). Actually totally dry at night. After 1/16/10 down to a female regular pad. Barely felt. 4/30/10 threw pads away. Dry at last.


don826
Veteran Member


Date Joined May 2008
Total Posts : 1010
   Posted 5/28/2010 9:44 AM (GMT -6)   
Hi HL,

There are alternatives but they work the same way and I really do not know if they are better or more economical. The latest is degarelix just approved recently so likely to be costly. I took the four month injection for two years. Just coming off of the stuff. It was recommended in my case due to metastasis to the lymph node and was administered concurrent with radiation as primary treatment. I am uninsured and my doctor gave me big break on the stuff. I think I paid around $1200 per shot.

Best of luck to you.
Don
Diagnosed 04/10/08 Age 58 at the time
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan clear and chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
Started Casodex on May 2 and stopped on June 1, 2008
Lupron injection on May 15 and every four months for next two years
Started IMRT/IGRT on July 10, 2008. 45 treatments scheduled
First 25 to be full pelvic for a total dose of 45 Gray to lymph nodes.
Last 20 to prostate only. Total dose to prostate 81 Gray.
Completed IMRT/IGRT 09/11/08.
PSA 02/08 21.5 at diagnosis
PSA 07/08 .82 after 8 wks of hormones
PSA 10/08 .642 one month after completion of IMRT, 6 months hormone
PSA 03/09 .38 six months post radiation and nine months into hormones
PSA 06/09 .36 or .30 depending on who did the test
PSA 09/09 .33 one year after IMRT and 16 months into hormone
PSA 03/10 .32 18 months after IMRT Still on hormones


BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 5/28/2010 10:06 AM (GMT -6)   
Hi HL, I just went through the same thing you are doing. Choosing between two plans offer by me company, One had a drug coverage limit of $2000 that would be a real problem for me since I knew that I would be going on HT. I found after looking into it that the limit only applied to perscription drug taken at home. Any drug administered in a doctors office or hospital was covered under other sections related to hospital visits, treatment etc.. BB
Dx with PC Dec 2008 at 56, PSA 3.4


Biopsy: T1c, Geason 7 (3+4) - 8 cores taken with 4 positive for PCa, 30% of all 4 cores.

Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive - tumor volume 9%
nerves spared, no negitive side effects of surgery

One night in hospital, back to work in 3 weeks

psa Jun 09 <.01
psa Oct 09 <.01
psa Jan 10 .07 re-test one week later .05
psa Mar 10 .28 re-test two weeks later .31
psa May 10  .50

Aril 10 MRI and Bone Scan show lesion on lower spine, false positive. 
 
Started HT 5/25/10 with 3 month shot of Trelstar. SRT scheduled for late July


Heavy Leaker
Regular Member


Date Joined Feb 2010
Total Posts : 63
   Posted 5/28/2010 6:20 PM (GMT -6)   
BB_Fan said...
Hi HL, I just went through the same thing you are doing. Choosing between two plans offer by me company, One had a drug coverage limit of $2000 that would be a real problem for me since I knew that I would be going on HT. I found after looking into it that the limit only applied to perscription drug taken at home. Any drug administered in a doctors office or hospital was covered under other sections related to hospital visits, treatment etc.. BB

Thanks for that info.  What state do you live in?  I'm in New Jersey.  What you are saying makes a lot of sense.


4 biopsies over 4 years starting in 2006, 4th biopsy showed 5% of one core Gleason 3+3=6.  PSA in 2005 6.0, rose to PSA 18 shortly before surgery.  Chose surgery over radiation due to conflicts in PSA versus biopsies.  PSA 18, Gleason 3+3+6, Age 58, Rising PSA since 1999, Biopsy 5% of one core
Robotic surgery 10/26/09  T2B Tumor 30% of prostate  involving left & right lobes  NOMX Gleason 3+4=7  Urethral Resection margins &  resection surface clean Seminal vessicles clean.


BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 5/28/2010 8:57 PM (GMT -6)   
Hi HL, I am in CT. Not far away. I have coverage through Anthem BC/BS. I think this coverage is probably pretty standard, but can't be sure, and it is too important to make assumptions. BB
Dx with PC Dec 2008 at 56, PSA 3.4


Biopsy: T1c, Geason 7 (3+4) - 8 cores taken with 4 positive for PCa, 30% of all 4 cores.

Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive - tumor volume 9%
nerves spared, no negitive side effects of surgery

One night in hospital, back to work in 3 weeks

psa Jun 09 <.01
psa Oct 09 <.01
psa Jan 10 .07 re-test one week later .05
psa Mar 10 .28 re-test two weeks later .31
psa May 10  .50

Aril 10 MRI and Bone Scan show lesion on lower spine, false positive. 
 
Started HT 5/25/10 with 3 month shot of Trelstar. SRT scheduled for late July


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 5/30/2010 6:00 AM (GMT -6)   
The LHRH drugs (lupron, zoladex, precisis, trelstar etc.) averages out to around $10,000 a year more or less, you can get monthly injections, or 3 mo., or one year implant even. Beautiful stuff and we are over charged, same lupron in Spain for 3 mo. shot is around $400 US dollars, here maybe $2500. (feel the love) Can't expect your uro doc to drive around in a Chevy now can we. Its our culture and compassion not for people but for $$$$ that comes first...this is the way it is, works well for the powerful, endowed and power players. Not as much fun for the proliterates and surfs (LOL).

Comparison for fun: DES man made drug that out performs LHRH drugs and per Journal article works even on HRPCa, when the other stuff has stopped working(which I have witnessed). I found a source for around $125 per year and have been using it for 4-5 yrs. (intermittently at some times). I had 8-9 consecutive rises (although very tiny numbers) on ADT3 combo drugs(2002-2003 era), started DES about 5 yrs. ago and psa declined and stabilized so well, that I went off drugs for 1 yr. as a test, then resumed with slight psa rise and have had fabulous results and stabilization for years (so far). Side effects basically none, no hot flashes, no sweats, no muscle aches, no weigh issues, feel great and cannot express enough the differences. What a country ADT3 combo back in 2002-2005 costs maybe $13,000+ a year, DES outperformed and did me much better at $125 per year. Go figure. Of course your uro doc will not mention any choices other than the high profit margin stuff, I guess it is all in YOUR best interests! (lol)
Youth is wasted on the Young-(W.C. Fields)

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