Hormone Therapy Question...

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gibson00
Regular Member


Date Joined Nov 2009
Total Posts : 212
   Posted 11/12/2010 8:03 AM (GMT -6)   
Likely a dumb question....
Drugs like Lupron....what do they actually do to prostate cells? Do they actually cause the cells to die? Or do they allow them to live, but not duplicate? Only cancerous prostate cells, or normal too?

gibson00
Regular Member


Date Joined Nov 2009
Total Posts : 212
   Posted 11/12/2010 8:05 AM (GMT -6)   
OK, sorry, let me clarify, I realize the Lupron shuts off the production of test.
What I should have asked, what does that lack of test do to the prostate cells, cancerous cells, etc.
Thx!

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 11/12/2010 12:29 PM (GMT -6)   
Hi Gibson.
Your second post is what the drug does in your body. Through the pituitary gland your body is told it has enough testosterone so it shuts down production. And as you said the drugs (LHRH Agonists) do not work at the cellular levels of prostate cancer. Prostate cancer feeds on testosterone in the early stages. LHRH Agonists make testosterone unavailable so once the tumor(s) are deprived of it they either need to learn to survive without it or they begin to shrink. When I asked my oncologist if this kills the cancer he said absolutely ~ but not entirely. This is why hormonal therapies are effective early on but you are not cured.

There is another therapy that many of us took with our LHRH agonists ~ bicalutamide or Casodex. This drug DOES work at the cellular level of prostate cancer. This drug is an antiandrogen. It clings to the testosterone receptors in the cell wall and reduces the ability of the cell to consume testosterone. So Lupron does in fact reduce testosterone but it does not stop it entirely, and Casodex blocks whatever is left behind from being used.

A third agent is sometimes used as well ~ a 5ARI (alpha reductase inhibitor) such as Proscar (finasteride) or Avodart (dutasteride). This when combined with the other two is commonly called ADT3. There has not been any studies completed that show that these are effective against prostate cancer per se but there is compelling evidence that they may be. The 5ARI's can shrink the prostate and it could stand to reason then that they can also reduce prostate cancer.

I hope this helps.

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

Post Edited (TC-LasVegas) : 11/12/2010 10:40:47 AM (GMT-7)


gibson00
Regular Member


Date Joined Nov 2009
Total Posts : 212
   Posted 11/12/2010 1:30 PM (GMT -6)   
Why is Casodex often only given at the very beginning of ADT treatment? For example, when my father was diagnosed, they immediately gave him roughly 2 weeks of Casodex,after which he was taken off the Casodex and started on Lupron.
Father 65 y/o at diagnosis November 2009
Gleason 9 & 10, stage 3 - seminal vesicle involvement
Two TURPs mid Nov. 2009
Foley Catheter
Casodex for last two weeks of November '09, then Lupron.
Suprapubic Catheter March 18th, but blocked right away, back to Foley...
Started IMRT March 25th, Chemo on hold due to catheter bleeding issues, etc.
Ended IMRT and Chemo (Taxotere) late May
Mid-July - pain finally better controlled with Fentanyl patch
Late July - Superpubic Cath. removed, peeing normal again
July 21 - PSA .21

Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2458
   Posted 11/12/2010 1:38 PM (GMT -6)   
Gibson,
I believe that Lupron by itself cause a flare up. Taking Casodex first for few weeks eliminates the flareup.
Age: 67 at Dx on 12/30/08 PSA 3.8
2 cores out of 12 were positive Gleason (4+4)
Davinci surgery 2/9/09 Gleason 4+4 EPE,
Margins clear, nerve bundles removed
Prostate weighed 57 grams 10-20% involved
all PSA tests since (2, 5, 8, 11, 15, 18 months) undetectable
Latest PSA test (21 months) .005

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 11/12/2010 5:55 PM (GMT -6)   
Typically, when HT is prescribed it is the combination of Casodex and an LHRH Agonist. Casodex is commonly prescribed first (Flare) but like in my case, I took it for the whole duration of my 28 months stint on it. I am more inclined to ask why folks are prescribed this regimen don't continue the regimen until the LHRH stint is completed...

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3782
   Posted 11/12/2010 7:30 PM (GMT -6)   
Dr. Walsh, chief of Urology at Johns-Hopkins, has this viewpoint..He thinks a certain usually large percentage of PC and normal prostate cells depend on testosterone to grow and survive. He also thinks there is almost always a small percentage that are not dependent on "T" for their growth and survival. He does not think all PC cells become "hormone refractory" after a period of time..He feels the the small percentage of cells that never required "T" and don't respond to HT are the ones that finally overwhelm the patient..He feels HT causes a massive die-off of the hormone-dependent cells, drops PSA to very low or undetectable levels and puts the patient in complete remission. It then takes a period of time ranging from 1 to 10 years before the cells that are not hormone dependent multiply to the point symptoms appear..He says survival depends on what percentage of cells were hormone independent at the beginning and how aggressive (doubling time) the cancer is..This is all detailed in his book..

The logic and science he uses to back his theory up are impressive..Of course, there are many others who disagree with him and who feel ALL PC cells respond to HT to a certain extent which varies considerably among different men..
Age 68.
PSA at age 55: 3.5, DRE normal. Advice, "Keep an eye on it".
age 58: 4.5
age 61: 5.2
age 64: 7.5, DRE "Abnormal"
age 65: 8.5, " normal", biopsy, 12 core, negative...
age 66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
age 67 4.5 DRE "normal"
age 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RRP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9
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