Is this true about Lupron?

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Purgatory
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Date Joined Oct 2008
Total Posts : 25364
   Posted 5/6/2011 9:41 AM (GMT -6)   
Still studying the subject of HT, and looked up Lupron on wikodpedia, the following is right from that source.  I underlined two parts, is it true what this says?  I don't always trust wikopedia.
 

Further, an article by Carla K. Johnson of the AP, dated August 26, 2009 noted a recent study that found that this prostate cancer drug is very risky especially for men with heart problems. The AP article stated, "The hormone treatment was linked with a 96 percent higher risk of death after adjusting for other risk factors." A similar study issued in JAMA in July 2008 also found that the drug offered no life-prolonging benefits in men with advanced prostate cancer vs. men who did not take any form of hormone therapy, or conservative management. Women with Endometriosis also suffer significant side effects. Also, in June 2009 the label was changed again to warn about "convulsion" in the post-marketing surveillance. The label shows that 98% of women had adverse events including 65% suffering headache/migraine, 31% depression, 31% insomnia, and 25% Nausea/vomiting. Many other adverse events are listed in the label. See full label at FDA.gov. The label also notes that women with no history of depression or psychiatric illness reported suicidal ideation and attempt. Additionally leuprolide therapy in conjunction with radiation has been shown to result in a statistically significant shortening of the penis.[13]

 


zufus
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Date Joined Dec 2008
Total Posts : 3149
   Posted 5/6/2011 10:15 AM (GMT -6)   
Purg- you looked it up in "wikopedia"...no wonder you got that info (LOL)...OK I was being a smart _ss wikipedia.

Post Edited (zufus) : 5/8/2011 12:10:47 PM (GMT-6)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 5/6/2011 12:44 PM (GMT -6)   
Excuse the bad spelling, not perfect. If what I underlined was even remotely true, then why bother?
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06, 2/11 1.24, 4/11 3.81
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10

reachout
Veteran Member


Date Joined May 2009
Total Posts : 725
   Posted 5/6/2011 3:10 PM (GMT -6)   
Purg, I looked up the wikipedia entry concerning the July 2008 JAMA study that allegedly concluded that Lupron "offered no life-prolonging benefits in men with advanced prostate cancer vs. men who did not take any form of hormone therapy, or conservative management. "

First, note that the wikipedia article has no reference to the actual study, so I went to the JAMA website and searched all articles from July 2008. I found only one that was relevant, so it must be the one they are referencing.

That article is titled "Survival Following Primary Androgen Deprivation Therapy Among Men With Localized Prostate Cancer," and concluded that "Primary androgen deprivation therapy is not associated with improved survival among the majority of elderly men with localized prostate cancer when compared with conservative management."

However, the article contains the following context: "Despite a lack of data, increasing numbers of patients are receiving primary androgen deprivation therapy (PADT) as an alternative to surgery, radiation, or conservative management for the treatment of localized prostate cancer. "

In other words, this article's conclusions are only valid for elderly men (median, 77 years) with advanced prostate cancer who never used surgery, radiation, or "conservative management," which I assume is some sort of active surveillance. It's not a huge surprise to me that for those men it didn't make much difference whether or not they used HT. By the time they tried HT it was probably too late. And there is no mention of Lupron in the abstract, so they may have used something else.

That's not to say that the same thing might not happen with those of us who tried surgery and/or radiation, or that were very watchful as to PSA, etc. But to conclude that it does would be an unjustified conclusion from this article. Bottom line, be careful about conclusions drawn from wikipedia.

Here is a link to the abstract:

http://jama.ama-assn.org/content/300/2/173.abstract

There's a lot more stuff there but I'm too tired to absorb it. If I misunderstood it, please correct me.
Age: 66
PSA: 7 tests over 2 years bounced around from 2.6 to 5.6
Biopsy 8 of 12 positive, Gleason 3+4, T2a
DaVinci August 2009, pathology Gleason 4+3, neg margins, T2c
Continent right away, ED
Viagra, Cialis did't work, Trimix works well
Post-surgery PSA:
3, month: undetectable <.1; 6 month: undetectable <.014 (ultrasensitive); 9, 12, 15 month: undetectable <.1; 18 month detectable .05

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 5/6/2011 3:24 PM (GMT -6)   
that's why i never entirely trust wikipedia, i was just using it as a general reference point
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06, 2/11 1.24, 4/11 3.81
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10

John T
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Date Joined Nov 2008
Total Posts : 4188
   Posted 5/6/2011 4:12 PM (GMT -6)   
Purg,
If you want to know about Lupron and side affects go to the PCRI website. There are many articles written by professionals on the subject of HT and side affects.
JT
66 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.

livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 5/6/2011 4:14 PM (GMT -6)   
I have a love hate relationship with Lupron. The hate is the total loss of libido and other side effects. The love is it worked and I have now been off for nearly two years. My PSA is creeping up and I am sure I will go back on it in the future. Now that will be tough because I know first hand the side effects. Bottom line for is it really did work.

peace to all
Dale

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 5/6/2011 4:42 PM (GMT -6)   
It's a real risk trusting Wiki anything.
i don't trust this post at all. There are already completed level 1 studies that show that HT is one of our very best tools in prolonging the life of prostate cancer patients. You need to stick to those studies.

There is a lot of negative press with HT, and in many cases deservedly so. Most are in relation to women with endometriosis or with issues with the male cardiovascular system after treatment for prostate cancer. But for either the use of the drug may and usually does outweigh the side effects.

There has been one Nobel Prize in Medicine for prostate cancer research. And it was won by Charles Huggins at the University of Chicago for his work that discovered that testosterone ablation prolongs life of these patients. (Uof C also has some more great names out of that program including Vogelzang, Chodak, Bostwick, etc...)

Tony
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:
Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

kbota
Regular Member


Date Joined Aug 2010
Total Posts : 486
   Posted 5/6/2011 5:39 PM (GMT -6)   
Tony, thanks for the clarification. Like Purg, I have heard about the studies that show no benefit from Lupron. My uro is clearly convinced that Lupron is of huge benefit in certain situations.......such as mine.

In addition, I would hate to think that I'm going through this for nothing, plus taking on the additional risk to my heart.

K
Age 57 at Dx
5/09 PSA 2.26
6/2010 PSA 3.07 FPSA 18% DRE +
Biopsy, 7 of 18+, >60%, 4+5=9
7/21/2010 - RRP
Nodes neg, Ves neg
tumor contained, still 4+5=9
pni ext.
9/3, 2010 PSA - 0.04
9/3/2010, I'm 99% continent
10/14/10, PSA still 0.04, and lupron #1, now 99.9% continent
Total ED, 3 caverject failed
10/20/10 OD'd .5cc trimix, after 3hrs, neo synephrine shot
tried .15 & .17 cc neg, next .2

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 5/7/2011 7:28 AM (GMT -6)   
Purg- remember my mantra about PCa...question everything and all the time...you will find it holds plenty of water, so use Flomax for getting various inputs and informations (LOL). John T gave you one good source on this. There are examples of patients with body scans with mets, then given such drugs...and new scans revealing much less seen mets..so another form of proof...'just doesn't usually get it all type of thing'. There might even exist an anectdotal cure scenario or looking like a cure scenario. The disease variations are immense, this is why the bell curves are the way they are.

Just look at Dr. Fred Lee with uncureable PCa, alive and nearly age 84 or so and been like 30 yrs. since Dx/treatment, 28 yrs. since failed and known mets to lymphnodes....using only one drug....I think he is pleased??? I was pleased to read about it and meet his surgeon friend(Dr. Bob B) whom helped write/publish his biography piece on it, both are Michigan guys.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 5/7/2011 8:18 AM (GMT -6)   
zufus,

good info, of course.

but, and i am happy for dr. lee, but most would view a case like his, as an ultra rare exception to the normal run of having PC. Don't you think that is fair to say?

david
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06, 2/11 1.24, 4/11 3.81
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7197
   Posted 5/7/2011 10:02 AM (GMT -6)   
David:
 
I sent you an email.
 
Zufus:  While it is gratifying to read of such cases, looking at the VERY RARE exception is meaningless. If whatever he has done was truly useful, then the success would not be the RARE exception.
 
But I do get the sense that HT prolongs survival siignificantly. THAT does NOT seem to be that RARE!
 
Mel

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3634
   Posted 5/7/2011 10:26 AM (GMT -6)   
In ProstateDocs last two blogs, he covers this subject in great detail...

For SURE, the benefit of hormone treatment MUST be weighed against the rather severe side-effects which are well known...It should also be pointed out that many of these side-effects can be mitigated with a careful diet and exercise....

It should also be noted that the "side-effects" of uncontrolled prostate cancer , especially aggressive PC, are far worse than the HT side-effects...
Age 68.
PSA age 55: 3.5, DRE normal.
age 58: 4.5
61: 5.2
64: 7.5, DRE "Abnormal"
65: 8.5, " normal", biopsy, 12 core, negative...
66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
67 4.5 DRE "normal"
68 7.0 3rd biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT. 2-15-'11 PSA 0.0

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 5/7/2011 10:49 AM (GMT -6)   
So to clarify some thinking here, if we see men who have defied the odds, and prolonged their life, with a decent quality, we should disregard the outcome because the odds are too long, and just give up ?

Men like Todd, Dale, Dr. Lee, etc, are an inspiration to me. Up here in Ohio we have people standing in line for lottery tickets that have a 1 in 200,000,00 chance. Some of them will never be "cured" by winning, but they still have a hope that they can.

In my opinion, I don't think we should quit because we don't like the odds. As long as I think their is hope, I intend to keep trying. Frankly a 25 to 35 % chance of SRT doesn't excite me either, but I will undergo it when I need it. In some ways many of us are marking time until the next Provenge comes along that will kill this bugger.

Goodlife

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 5/7/2011 10:58 AM (GMT -6)   
mel - got your email and answered

fairwind - its that balancing of quantity of life over quality of life that makes such decisions difficult in life. and in the end, it comes down to a very individual choice. one many of us will have to weigh out in time.

goodlife, you make a good point, but i don't think anyone is talking about giving up as being a viable option. i was only given a max of 20% of my srt working to begin with, and despite having terrible prior radiation experience, i still took the 20%. In my case I lost, and I never expected such serious damage done to me that I will have to live with for the rest of my life in the proces and still be dealing with srt failure. for me, if i had known what was going to happen, I would have never underwent the hell i went through, all for nought.
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06, 2/11 1.24, 4/11 3.81
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10

davidg
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Date Joined Feb 2011
Total Posts : 4093
   Posted 5/7/2011 12:12 PM (GMT -6)   
Speak to your physician about it, check your heart, check your sugar. I seem to recall the FDA getting involved with this and other drugs like Zoladex (sp?). I believe that if surgery and radiation are no longer an option and the cancer has spread to the bones Lupron is very effective in lowering testosterone levels. Good luck.
40 years old - Diagnosed at 40
Robotic Surgery Mount Sinai with Dr. Samadi Jan, 2011
complete urinary control and good erections with and without meds
Prostate was small, 34 grams.
Final Gleason score 7 (3+4)
Less than 5% of slides involved tumor
Tumor measured 5 mm in greatest dimension and was located in the right lobe near the apex.
Tumor was confined to prostate.
The apical, basal, pseudocapsular and soft tissue resection margins were free of tumor.
Seminal vesicles were free of tumor.
Right pelvic node - benign fibroadiopse tissue. no lymph node is identified.
Left pelvic node - one small lymph node, negative for tumor (0/1)

AJCC stage: pT2 NO MX

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 5/7/2011 1:00 PM (GMT -6)   
OS,
That depends on your definition of "serious". For me I tolerated my SE's well, but I stayed very active. I also think it also depends on your attitude and exercise. Most men get hot flashes but I don't think that's a serious side effect and there are things that you can do about them. The serious side effects are cardiovascular and osteoporosis but most men don't get them. In fact, while the risk is higher few men get these side effects unless they are on these drugs for a very many years. Much of the cardiovascular issues can be attributed to weight gain. It's very important to be getting exercise while on HT to help avoid this side effect. Exercise is also important for bone strength. one other side effect that can also get more serious is depression. I had it briefly but it was easily addressed. Once again I think physical therapy helps here too.

I am very happy to hear that David's new cancer center is addressing these things already. When I read his other post that they are prescribing physical therapy before even prescribing an advanced therapy I recognized the protocol. It's a good prescription for anyone considering such therapies.

It's a proactive oncology approach, in my opinion.

Tony
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:
Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7197
   Posted 5/7/2011 1:57 PM (GMT -6)   
Goodlife:
 
I think you are referring to my post when you say:
 
>>>>>>>>>>>>>>>>>
So to clarify some thinking here, if we see men who have defied the odds, and prolonged their life, with a decent quality, we should disregard the outcome because the odds are too long, and just give up ?

Men like Todd, Dale, Dr. Lee, etc, are an inspiration to me. Up here in Ohio we have people standing in line for lottery tickets that have a 1 in 200,000,00 chance. Some of them will never be "cured" by winning, but they still have a hope that they can.

In my opinion, I don't think we should quit because we don't like the odds. As long as I think their is hope, I intend to keep trying. Frankly a 25 to 35 % chance of SRT doesn't excite me either, but I will undergo it when I need it. In some ways many of us are marking time until the next Provenge comes along that will kill this bugger.

>>>>>>>>>>>>>>>>>>>>>
Please tell me where I said we should give up? That is hardly the alternative. I am doing SRT, with a 30%-40% chance of getting lucky. That is a form of rolling the dice. But if patient XXX miraculously lives 20 years as a G9 under a certain protocol, but 99.9% do not at all, do you want to try for the 0.1%.
 
You are setting up a straw man here. The alternative is not to do nothing. The alternative is to do something, but not necessarily what the ONE PERSON did.
 
Mel

Sancarlos
Regular Member


Date Joined Feb 2010
Total Posts : 242
   Posted 5/7/2011 3:44 PM (GMT -6)   
TC-LasVegas said...
The serious side effects are cardiovascular and osteoporosis but most men don't get them. In fact, while the risk is higher few men get these side effects unless they are on these drugs for a very many years. Much of the cardiovascular issues can be attributed to weight gain. It's very important to be getting exercise while on HT to help avoid this side effect. Exercise is also important for bone strength. one other side effect that can also get more serious is depression. I had it briefly but it was easily addressed. Once again I think physical therapy helps here too.

Tony


Good points, especially the comment about exercise. Exercise is important to physical well being, whether we are on HT or not. And it is more important to those who tend to gain weight as do some people on HT.

Being on HT has not been a walk in the park, but the side effects appear to have diminished over time. I am certain that after my first two or three Lupron injections I had more side effects such as sore muscles and joints, hot flashes, and general fatigue, than has been the case after the last two injections. So for some the side effects become less troublesome with time.

Sancarlos
Age 66, PC diagnosed 7/2009 at age 65
Stage: T2c, Gleason: 9 (4 + 5), 6 of 6 cores positive
Bone, CAT and MIR scans negative

Treatment: brachytherapy (103 palladium), 100 gy, 11/2009 + IMRT on Novalis, 45 gy, 3/2010 + ADT3 (Lupron + Casodex+Avodart)

PSA: 7/2009, At time of diagnosis -- 11.9
10/2009 -- 5.0 ; 12/2009 -- 0.56 ; 5/2010 -- 0.15
8/9/2010 -- 0.06 ; 11/2010 -- 0.013; 3/25/2011-- 0.005

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 5/8/2011 5:34 AM (GMT -6)   
SAB might be found to be about equal in HT therapies in patients that are not already refractive (hrpca) in other words HT naivee patients or not treated with androgen deprivation prior. (2005 findings)

Post Edited (zufus) : 5/8/2011 12:12:08 PM (GMT-6)


F8
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Date Joined Feb 2010
Total Posts : 3780
   Posted 5/8/2011 9:46 AM (GMT -6)   
Zufus -- you case is definitely atypical like milken's.  do you think luck or the non-standard treatment made the difference?
 
ed
 
 
age: 56
PSA on 12/09: 6.8
gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10
2/8/11 PSA <.1, T= 6 ng/dl

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4188
   Posted 5/8/2011 10:23 AM (GMT -6)   
F8,
What is typical? There are quite a lot of patients that have been on HT for well over 10 years and still going strong. Some doing just mono therapy, others ADT3, and others exotics. I just don't know what is typical when you get to the advanced stage. I believe that being treated by an oncologist specializing in PC can extend life and minimize SEs by tailoring treatments to how the patient reacts to the meds. I think that too many patients just go to the doctor and get a shot of lupron every three months and this works well for some patients; I personally know two individuals, one going on 15 years and the other over 10 years doing well on this protocol while others last only a few years.
JT
66 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 5/8/2011 10:33 AM (GMT -6)   
Editted for request...

Post Edited (zufus) : 5/8/2011 12:13:15 PM (GMT-6)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 5/8/2011 11:40 AM (GMT -6)   
This thread of course, has lots of good info, but my original interest was specifically in Lupon, as it is so commonly used in HT.
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06, 2/11 1.24, 4/11 3.81
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 5/8/2011 12:08 PM (GMT -6)   
Editted alot of it now....  cool

Post Edited (zufus) : 5/8/2011 12:14:08 PM (GMT-6)

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