To all of you who have tried intermittent HT (e.g. Lupron): What have been your results and experiences with it? Logically, the argument is that the time to hormone-refractory PC might be lengthened, plus quality of life is improved during the periods of no Lupron. My urologist is afraid of it, since he says his experience is that soon after stopping HT the PSA rises. But I know that some research (see the recent report on this site) suggests it works as well as continuous tx or better. I would appreciate your input. I have been on Lupron for 4+ years now with no measurable PSA on my tests which are every 3 months. I had a radical in Oct., 2001, Gleason was 9-10, some PC found in both seminal vesicles and 1 lymph node.
Pat K
Most all PC becomes resistant to HT over time so some doctors suggest intermittent therapy. This can be done by stopping therapy when the pSA drops to a certain level or to do therapy for fixed times and then off therapy for a fixed time. Clinical trials for intermittant therapy are still in progress so it may be too early to say for sure. I agree that several months with no side effects sounds good. For now its up to you and your doc.
Hi Pat,
I'm on intermittent hormone therapy. I've noted your postings here. I'm 68, had radical prostatectomy just over two years ago when my PSA was 7.82, Gleason 9, T3, no nodes, but seminal vesicules were involved. Three months after surgery my PSA was 0.58, then in ten more days to 0.71. I then did four months of chemo with weekly IV of taxotere and 90 calcitriol tablets the day before with steroids. My PSA went down monthly from 0.78, 0.44. 0.30, & 0.21. Then it started up again in one month, & in October 2004 it was 0.27. I had the one month Lupron shot with daily casodex, and it dropped to 0.01 in one month. I had one more one-month Lupron shot, then a four month shot, and then nothing. After that, my PSA started back up, tested every three months, 0.04, 0.22, & 0.70. I just had my first one-month Lupron shot and have started daily casodex again. I expect my PSA to be down after one month, how far we don't know. Once it gets down to 0.01 I will again stop the treatment. My hair came back after the chemo, but it has thinned now that the testosterone level got back to high normal, around 540. I expect my hair to grow back thicker now with hormone suppression. How did your hair fare?
Jim
I really appreciate you sharing your experience James. It sounds like the IHT has worked well for you. What was the reasoning that you and your Doc made re intermittent VS continuous HT, if you don't mind me asking? I am thinking about IHT myself for the reasons I mentioned. And at some point, if the PSA does not rise while I am on HT, we will want to test the waters without HT and see if the PSA rises then. It has been over 4 years now with no measurable PSA. I also had nerve-sparing RP and I can tell that I have a little sexual response, especially when the HT wears off before another 3 month shot. Re hair growth I have had no hair loss on HT other than normal loss with age. I was never on Taxotere or other chemo other than the Lupron.
If there are any other folks out there with experience with intermittent HT I would love to hear your thoughts and results. I wish you all the best under the circumstances.
Pat K
Thanks for your response Michael. Keep up the good work in responding to all of our questions.
Pat K
Hi Pat & Others,
My cancer doctor who prescribed the chemo using taxotere suggested the intermittent hormone therapy after the chemo because that is the new theory in treatment. My doctor has been in close contact with others at Oregon Health & Sciences University Hospital in Portland, Oregon, where clinical trials have been conducted. The current theory is that perhaps after a time of use, the Lupron acts as a stimulant to cause the cancer to grow faster. I would assume that my doctor is reporting my data in an attempt to verify that theory. As we know, prostate cancer eventually becomes hormone refractory, the Lupron no longer does any good. One theory on that is that a different strain of prostate cancer becomes dominant which does not require testosterone to thrive. I am very interested in learning if the intermittent therapy prolongs life expectancy. One person here wrote that 15 years from time of diagnosis is all that any of us have, and that would not surprise me. Once it has spread to bones, we have about 9 months left. I recommend the intermittent therapy for you. It makes sense. If the PSA is close to zero, what more could you expect? No use in bombarding the body with the treatment if it is not needed. If you had the nerve sparing surgery, you may benefit from either Cialis or Viagra. They don't work for me, but supposedly Cialis works in 15% of cases even if nerves are gone! That I would like to see.
Jim
Thanks for the info Jim. Perhaps we will know a lot more about the intermittent approach within the next year or so based upon the ongoing research on that issue. I hope so, since theoretically anyway it holds considerable promise for improving life expectancy for us PC guys. Re the views on how much time we have left, we are talking a rough guestimate at best I think. The guy who said 15 years seemed to be talking about average life expectancy as I understood his statement, which would depend on the staging of the individual, and would not apply to all PC patients. And as far as 9 months once its in the bones, I have a friend who had bone metastases before his RP over 4 years ago and he is still surviving, albeit with the full gamut of treatments over that time, including various chemos, lupron, casodex, radiation etc. And he is still having good days and bad days. So we really don't know how long a given individual may survive, and with what quality of life. One things for sure we want to make the very best of what time we do have left.
Pat K
As I mentioned in message #3 above, my PSA started up again after the Lupron wore off. It got up to 0.70 from 0.01 after therapy. I had the one-month Lupron shot one month ago, and that brought my PSA down to 0.03. I've had my second one-month shot and intend to have just one more and then do nothing for another 6 months or so until the PSA starts back up again. At the third week after the first Lupron shot in this series with daily Casodex tablets, I noticed severe pain in the arms, chest, and legs, like burning or freezing, hard to tell which. It is what they call "hot flashes," and for me it seems to happen mostly at night. It goes away in just a few minutes, rubbing seems to help.
Jim
Thanks Jim, for the update. I'm really happy for you that the IHT is working so well. When I return to the Northwest this spring to see my regular urologist, we will certainly discuss the intermittent approach further. It seems like it makes sense. By the way, when I read your initial status, it sounds like we were very much alike. I had a radical and the histology showed PC in my seminal vesicles, and 1 lymph node. PSA of .4 3weeks after surgery, immediately went on Lupron (no Casodex) and have remained on continuous Lupron now for 4.5 years. Age 65 now. Gleason 9-10. Stage tc3. No measurable PSA since starting the Lupron, tested every 3 months. Last time I got the 6 month shot. It leaves quite a lump under the skin for months.
By the way, I had severe hot flashes for about a year. Now they are rare and mild. Not like yours apparently. I just got extremely hot and sweaty and started ripping my clothes off (except in public!). They were worse at night for sure. I have been taking a lot of soy, including soy capsules ever since and they seem to help, despite the recent research reports. I also had severe itching accompanied by tiny bumps which would bleed when scratched. Lotion seemed to help some for that.
Good luck to you, and lets keep each other posted.
Thanks,
Pat K
We would like to talk to some one that has or is dealing with prostate cancer with Lupron treatments