PCa 'Flare' and risks using LHRH- drugs w/o flutamides used prior~ pg. 140 Dr. Strum's book

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Date Joined Dec 2008
Total Posts : 3149
   Posted 7/18/2010 11:17 AM (GMT -6)   
Within Dr. Strum's book he has patient cases for examples for us laypersons to see what happens to some patients, page 140 has Physician's Note 18: (probably one of worst scenarios of what 'Flare' could do to a patient): (paraphrased slightly)
Patient MF had elected a watchful waiting approach until his PSA rose to 31.0.  At that time, his docs gave 3-mo. Lupron injection without any precautionary measure to prevent flare. Six days later, he developed severe back pain. Radiologic studies showed right hydronephrosis due to tumor obstruction of the right ureteral orifice at the junction with the bladder. Emergency surgery was performed to decompress the kidney, but because this was unsucessful , a right ureteral stent had to be placed, this required 5 hrs. in operating room. Forty-eight hours later, the patient experienced a massive heart attack. The patients's pain and suffering from the exacerbation of PC growth, the need for two emergency surgeries, and a massive heart attack could all have avoided if measure relating to the prevention of flare had been undertaken.  (my uro-doc gave me Zoladex without casodex prior...my PSA was 46.6 and I was loaded with PCa, even total urinary blockage, amazing the risk scenario I could have been placed into)
Further Dr. Strum talks about two types of 'flare issues'...biochemical flare (p 138) and clinical flare.  Biochemical flare is just a rise in PSA(stimulated growth to benign and malignant PCa) that could happen temporarily while the drug takes it full effect, which could even be  in weeks amount of time.
Clinical flare are the issues that are threatening to a patients well being (even lawsuit level issues) here are some of the issues we patients should know could happen if clinical flare happened to you:
1) could reduce urinary stream or possibly lead to complete obstruction of flow (retention)
2) increased bone pain if bone mets are present
3)In more serious scenarios- could result in spinal cord compression with possible paralysis if PC tissue near spinal cord is stimulated to grow.
4) flare may result in kidney failure if the lymphnodes near the ureters-drainage tubes from the kidneys-increase in size due to increased tumor growth and compress the ureters (see case history above I put herein).
These cases mentioned in Dr. Strum's book are on real people(cases), there are some other cases of getting things done right and more.  I hope nobody on this forum ever has to find out about clinical flare, my genius uro-doc put me in harms way big time....I fired him after 2 yrs. of being his cash cow, best thing I ever did. (that was in early 2004).

Ed C. (Old67)
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Date Joined Jan 2009
Total Posts : 2461
   Posted 7/19/2010 8:58 PM (GMT -6)   
I always enjoy reading your posts. You provide a lot of information to all of us. Thanks
Age: 67 at Dx on 12/30/08
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09 Dr Fagin, Austin TX
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Posterior lateral lesions measuring 1.5 x 1.4 x 1.0 cm showing focal capsular penetration over a distance of 3mm in circumference.
Prostatic adenocarciroma accounts for approx. 10-20% of the hemisphere.
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx, Negative margins
seminal vesicles clean, lymph nodes: not dissected
continent after 5 months
2 months PSA test 4/7/09 result <0.1
5 months PSA test 7/9/09 result <0.1
8 months PSA test 10/9/09 result <0.1
11 months PSA test 1/21/10 result 0.004
14 months PSA test 4/19/10 result 0.005

John T
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Date Joined Nov 2008
Total Posts : 4269
   Posted 7/19/2010 9:06 PM (GMT -6)   
Good information Zufus, I knew about flare, but didn't know it could cause immediate problems. It is surprizing how many patients are given Lupron without being given Casodex 7 days prior.

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.


Veteran Member

Date Joined Dec 2008
Total Posts : 3149
   Posted 7/20/2010 6:58 AM (GMT -6)   
Yeap thanks guys, John right on the money (LOL) I have seen other patients getting LHRH drugs without casodex or flutamides prior, sure the lower stats guys have less risks for major problems, but Dr. Strum says this in his book:

There is no reason period for allowing a patient to be subjected to any PCa flare or growth intiated by using LHRH without prior use of casodex or flutamides (7-14 days is typical time it takes for the LH side of this to be down regulated). So, patients are subjected to stimulation of PCa during that period. The sudden surge in LHRH actually stimulates sexual urge in men during this 7-14 day time, maybe good side effect but wrong place and time (LOL). (combining Strums words and my own paraphrasing)

Just imagine if uro-docs were prescribing anything other than the 2-3 drugs they normally use???? Probably make lawyers drool and park near their offices (LOL).
Youth is wasted on the Young-(W.C. Fields)

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