Hormone Suppression

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Comment by Ralph Valle on September 27, 2009 at 1:34pm

Hello RayAnthony,
Hormone suppression is not a cure. The normal process is androgen independence. Many men respond to this therapy for years. Some do as continuous and others as intermittent. Intermittent results appear to be equal to continuous and therefore in its effect on quality of life is a preferred method.

You have been on a cycle of six months on and six off. You could continue to respond for years. As you mention in your post, these off-cycles tend to be shorter in time as androgen independence (AI) develops. Have you noticed slower PSA responses in your on-cycles? Are your off-cycle PSA rising faster? These are signs that AI is developing. As far as getting of the threadmill, it all depends of how your PSA doubling time is during an off-cycle. Hope that can be measured in years rather than months.

Comment by RayAnthony on September 26, 2009 at 6:10pm

Hi Ralph, I was under the impression that each time that one has the hormone implant that it decreases in its ability to be effective, is this so?. I have one month to go on my latest implant of six months duration and my psa has gone down to 1.4 which is the lowest it has been in six years,this gives me hope that maybe I can get off this treadmill one day. BWAH.

Comment by Ralph Valle on August 21, 2009 at 10:37pm

Dr. Wilson,
Your PSA doubling time (PSADT) should be a guide to resume androgen deprivation. You are so very young! I saw you experimented with Androcour (an steroidal antiandrogen) without much success. Intermittent androgen deprivation rather that permanent deprivation is probably your best shot at this point.

Use a non-steroidal antiandrogen like Casodex before a shot of Zoladex (two weeks at 50 mg qd should do it). Consider adding a 5-alpha reductase inhibitor to reduce your dihydrotestosterone (DHT) and promote maximal deprivation for a period of at least 12 to 16 months. Be sure to have your level of testosterone measured 4 months after the Zoladex shot.

There is a descriptive article at the PCRI site at:
http://www.prostate-cancer.org/resource/pdf/Is2-4.pdf

Wish you the very best,

RalphV

Comment by E. Michael D. ("Mike") Scott on August 21, 2009 at 7:23pm

Brent:

If you had one Zoladex injection 5 months ago and then no further injection, it makes perfect sense to me that your PSA could have gone back up to a value of 6+.

Under normal circumstances, people in your situation who start hormone therapy don't come off it again for at least 9 or 12 months before trying an intermittent regimen.

I don't think you need to try the Taxotere yet ... but you probably do need to think about another shot of Zoladex ... possibly with an antiandrogen like Casodex at the same time.

Comment by Rick D. on August 21, 2009 at 1:12pm

couple of thoughts, brent ....

have you had a bone scan - if not, then perhaps you should request one asap. it sounds like you may need something stonger to stem the PrCa asap .... taxotere for example. btw, taxotere is required if you want to get on to an abiraterone trial, assuming you can find one close enough to be convenient.

if the PrCa is identifiable inthe bone, then targeted radiation may be an option. i have a good buddy whose PrCa is recurrent; Chuck Ryan at UCSF, on of the leading PrCa oncologists inthe US has recommended radiation. chances of 'cure' (his word) are small but possible.

of course diet and exercise ae both critical, but i'm sure you know that. have you cut out animal protein?

rd

Comment by Dr Brent Wilson on August 21, 2009 at 12:50pm

Hi All,

I was seeded in 2004, but have on the basis of psa alone been diagnosed with recurrent PCA. Five months ago I had a Zoladex injection, which brought my PSA down from 3.69 to 1.56. After the three months for the active stage of the injection, my doc agreed to me having two months off. My latest PSA reading, after that two months, is 6.59. Does this rate of increase seem feasible?

Cordially

Brent

Comment by Steve J on August 9, 2009 at 1:57pm

For Craig and others, here's what I posted August 6 on the "Any help for hot flashes" thread:

There are txs for hot flushes, and they seem not to be well-known among some inattentive medics.
They are:
1. Megace (megestrol acetate): some concern has been expressed by one medic that it might
encourage PCa development where the tumor has mutated. Unfortunately, there appears to be no way
to be certain whether this has occurred. Nonetheless, I do know that it is used successfully to relieve
hot flushes.
2. Paxil (paroxetine hydrochloride), an antidepressant. A side effect is to relieve hot flushes.
3. Effexor (venlafaxine hydrochloride), an antidepressant. Same story.
4. Depo Provera (medroxyprogesterone, a synthetic form of the female hormone progesterone), the
"label" use of which is as a female contraceptive. In the 400 mg (contraceptive) dosage, a study*
(Langstroer et al.J Urol. 2005 Aug;174(2):642-5, Pub Med ID 16006929) has demonstrated excellent
results in relief of hot flushes among men on ADT (androgen deprivation therapy).
I selected this tx to relieve my hot flushes (6 per night + days) from Trelstar (triptorelin pamoate),
which with Lupron and Zoladex is one of the LHRH agonists used to castrate PCa patients chemically
thereby depriving PCa cells of an essential nutrient, testosterone (T). I also had hot flushes from the
other two meds.
In my case, I chose Depo Sub-Q Provera 208 mg, the "label" use of which is palliative tx of
endometriosis. In August 2005, I received 104 mg in each anterior thigh. I have not experienced even
one hot flush since then. How long this will continue is anyone's guess.
However: one must be aware that progesterone is metabolized into testosterone, and should take care
that one's PSA is sufficiently low that a rise in T will not be harmful. In my case, my PSA rose from
0.01 ng/ml to 0.02, then subsided to 0.01, which I feel is more than satisfactory.
Caveat: what works for me may not work for anyone else in the universe!
In the USA, such use of these drugs is "off-label" which is to say not approved by the US Federal Drug
Administration. The practical effect of this is that the use of the drugs for relief of hot flushes will not
be paid for by insurance carriers.
I
(1) am not sure of the dosages except for Depo Sub-Q Provera, and
(2) do not know the out-of-pocket costs of the off-label use, again with the exception of Depo Sub-Q
Provera (US$200 for two pre-loaded syringes + $25 for the injection at my medic's office).
I consider the cost to have been well worth the result.
Had a bit of fun with my medic and his staff after the injections. Sighed and observed that from now
on I would be unable to ovulate.....

* "Parenteral medroxyprogesterone for the management of luteinizing hormone releasing hormone
induced hot flashes in men with advanced prostate cancer"

Comment by Craig Pynn on August 9, 2009 at 12:28am

I'm into month 5 of a two-year course with the LHRH agonist, Vantas, which is implanted in my left bicep--and will be dug out next March and replaced with a second one-year supply. (Beats monthly or bi-monthly shots, though & allows me to stay away from doctor's offices for extended period, thereby improving my morale.) Completed 42 sessions of radiation in June (79 Grays). Also receiving Zometa infusion every 3-months since I already had osteopinea before all this started. I've found that the most important thing I can do for myself is 30-40 minutes of resistance exercises at least 5-days a week along with bike riding & walking. It certainly helps my mood, if not the hot flashes that occur every one to two hours around the clock. Am trying to avoid drugs to counteract the flashes. We'll see.

Comment by Rick D. on August 6, 2009 at 1:01pm

j-j - you inspired me to start a new 'exercise' group here on NPCI ... i have been thinking of this for a while. hopefuly we will keep that group informed of all exercise developments, including the availability of the UCSF pamphlet, so i encourage you to sign up!

perhaps we can get you out in a racing shell sometime in the future! btw, i spent a summer in geneve working for SBS, as well as a winter in saanenmoser many, many years ago between school and university!

salut, rick

Comment by Jean-Jacques MERMOD on August 6, 2009 at 8:11am

Hi Rick it's a great feeling not to be alone with all of this
thanks for your advice
I also share the interest in rowing with you,
now on an nold wooden boat on lake of Geneva,
previously on a "Canoe Français" a sort of heavy skull
cheers jj

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