Zoladex wears off

July 26, 2005

Someone said in a recent message that the the effectiveness of

Zoladex begins to wear off toward the end of the programmed cycle

for the shot. Some shots are released continuously over a one month

period, some shots are supposed to last for three months. I think

some shots work over a longer period of time.

But another person in this group said the time it takes for a man to

regain the ability to produce testosterone at the pre-Zoladex level

is equal to about the lenght of time the Zoladex was administered.

I took that to mean for example that if a man was given Zoladex

continuously for a year, then if he stopped taking the drug, it

would be about a year before his testerone production returned to

the level it was before the Zoladex treatment was begun. (I have

read that if a man takes Zoladex for a long time, he is unlikely to

ever get his testosterone going again. How long that period is I

don't know. I think it is longer than a year.)

So my question is if a man takes Zoladex over a year (e.g. 4

injections) and then stops, when does the Zoladex

effectiveness " wear off " ? What does wearing-off mean? If Zoladex

begins to wear off at the end of the period for which it was

designed to be released, e.g. one month or three months, then is it

correct to assume that most men begin returning to normal

testosterone production immediately at the end of Zoladex shot cycle?

I have also read that there is a theory that in some cases it is

good for a man to get off Zoladex so that the cancer cells that are

hormone dependent or hormone responsive will outgrow the cancer

cells that are hormone independent or hormone refractory. The

theory was not explained in detail but the idea that I got was that

the dependent cells competed with the independent cells and reduced

the number of independent cells. Then the man would resume the

Zoladex and knock out the hormone dependent cells again.

July 27, 2005

Right after my diagnosis, I consulted a newly retired urologist who was

also my friend. In his prime, he was the most respected urologist in my

county and was difficult to replace. I gave him my stats (PSA 20, GL8 =

high risk) and asked him which treatment he would choose if he were in my

place. He said he would go for a clinical trial. I asked him why and he

gave me an honest answer. He said, " Because we really don't know what we

are doing. " I knew there and then that I was in for a long and bumpy

ride.

There is a lot of guesswork going on in the field of PCa treatment. All

of us are like victims of a shipwreck floating in the ocean with no

rescue ship nearby and each one must grab the first piece of flotsam that

comes by to stay alive. Hormone therapy is one of those treatment

options where there is a lot of guesswork.

Especially for high risk patients, coadjuvant androgen deprivation is

prescribed following primary therapy with the idea of increasing the

prospect of killing whatever cancer cells may have escaped the gland,

thus preventing or at least slowing down metastasis. The usual prescribed

length of continuous androgen deprivation is two years. Aside from the

attendant side effects, the risk in continuous androgen deprivation is

that it has been established that in a significant number of cases, the

patient progresses toward androgen independence, whereby the cancer cells

mutate into cells that no longer depend on testosterone for their growth.

It has been observed that two years is about the time it takes to achieve

androgen independence (AI). Once AI has set in, metastasis advances and

there is no more recourse except palliation, with the possible exception

of chemotherapy which before was unpromising for PCa but is currently

showing some progress.

The question is: What about some people who go on continuous androgen

deprivation for as long five years or longer and still show no signs of

metastasis? Logically, there are two possibilities.Either 1) they are

among the lucky ones who for some reason never develop androgen

independence or 2) they were cured and so did not need the prolonged

androgen deprivation in the first place.

How can you tell whether you belong to category 1 or 2 above? Nobody

really knows but researches are working hard to find the answer. One clue

appears to show up in the presence or absence of insulin-like growth

factors (IGF's) whereby experiments with rats indicated a correlation

betweem pogression toward AI and the introduction of high doses of IGF's.

The objective is to establish a causal relationship and having achieved

that, to see what methods of intervention are possible to block the

action of the IGF's that lead to cell mutation..

The theory behind intermittent androgen deprivation (IAD) is that if you

have hormone therapy for a relatively shorter period, you will prevent

the onset of androgen independence and then you can resume hormone

therapy again later. The usual first stopping point is when you reach

castrate level or PSA becomes undetectable or both, which commonly

happens at nine months. Then you monitor your PSA and when it starts to

rise again, you decide at what level you restart hormone therapy. The

secondary advantage of this method is that you are able to take a

" vacation " from hormone therapy, which makes for a better quality of

life.

Hope this helps.

Fred

> Date: Wed, 27 Jul 2005 07:39:43 +0100

>

> Subject: Re: Zoladex " wears off "

>

> Hello CS

>

> My understanding is that Zoladex shots do not " wear off " towards the

> end of

> the programmed cycle. They are designed so they don't do that, and

> they

> have a safety margin to last a sort while beyond the cycle, bridging

> to the

> next shot.

>

> Testosterone production does not return to normal at the end of the

> shot

> period. It takes time to do that, and I also understand that this

> recovery

> time is related to the total length of LHRH treatment. Testosterone

> never

> recovers if treament has been sufficiently long. After 5+ years on

> it I

> wondered if I could stop Zoladex and still remain at castrate level,

> not

> that I would risk doing that! I am on CPA (Cyproterone Acetate) as

> well.

>

> I have also read about the intermittent LHRH treatment that some are

> using.

> My doctors in the UK are not yet doing that and recommend that I

> stay on

> treatment for the rest of my life. Did I read that there was an

> idea that

> staying on LHRH hastened the onset of hormone refractory PCa? There

> are

> some independent cells there anyway, and eventually they outnumber

> the

> dependent ones.

>

> All my own opinion and understanding.

>

> Dave

July 27, 2005

Very interesting, Fred

Recently a very experienced retired professor of urology visited our support

group, and he said that the basic treatment for treatment had not changed

for 30 years. True, there had been refinements since then, like the ability

to avoid surgical removal of the testicles, and much safer local therapy,

but there had been no real breakthrough.

He commented about the PSA test and said that althought it is imperfect it

is the best we have. There are overnight wonders announced in the

newspapers but no good test for PCa has yet appeared. Same with cause.

There are many possible factors that appear to predispose to PCa but no one

cause has been found. (It may never be found of course; there may not be a

single cause, but rather there may be a number of things a man can do to

reduce his statistical chances of getting it.)

I think it's important to point out that two years to AI is a statistical

figure. My stats were PSA 220, GL8, T4 and spinal mets. As predicted at

diagnosis, using Zoladex it has been 5+ years to progression. The treatment

has kept me pain and symptom-free with the large tumour disappearing and the

spinal mets undetectable by bone scan. Over this time I have adjusted to

the side-effects of LHRH. Now we have added an anti-androgen for three

months and will see whether it has taken the PSA down again (I should now

this in about two weeks). I understand adding anti-androgen does not work

if the cancer is now mostly AI.

Dave

Re: " Zoladex wears off "

> Right after my diagnosis, I consulted a newly retired urologist who was

> also my friend. In his prime, he was the most respected urologist in my

> county and was difficult to replace. I gave him my stats (PSA 20, GL8 =

> high risk) and asked him which treatment he would choose if he were in my

> place. He said he would go for a clinical trial. I asked him why and he

> gave me an honest answer. He said, " Because we really don't know what we

> are doing. " I knew there and then that I was in for a long and bumpy

> ride.

>

> There is a lot of guesswork going on in the field of PCa treatment. All

> of us are like victims of a shipwreck floating in the ocean with no

> rescue ship nearby and each one must grab the first piece of flotsam that

> comes by to stay alive. Hormone therapy is one of those treatment

> options where there is a lot of guesswork.

>

> Especially for high risk patients, coadjuvant androgen deprivation is

> prescribed following primary therapy with the idea of increasing the

> prospect of killing whatever cancer cells may have escaped the gland,

> thus preventing or at least slowing down metastasis. The usual prescribed

> length of continuous androgen deprivation is two years. Aside from the

> attendant side effects, the risk in continuous androgen deprivation is

> that it has been established that in a significant number of cases, the

> patient progresses toward androgen independence, whereby the cancer cells

> mutate into cells that no longer depend on testosterone for their growth.

> It has been observed that two years is about the time it takes to achieve

> androgen independence (AI). Once AI has set in, metastasis advances and

> there is no more recourse except palliation, with the possible exception

> of chemotherapy which before was unpromising for PCa but is currently

> showing some progress.

>

> The question is: What about some people who go on continuous androgen

> deprivation for as long five years or longer and still show no signs of

> metastasis? Logically, there are two possibilities.Either 1) they are

> among the lucky ones who for some reason never develop androgen

> independence or 2) they were cured and so did not need the prolonged

> androgen deprivation in the first place.

>

> How can you tell whether you belong to category 1 or 2 above? Nobody

> really knows but researches are working hard to find the answer. One clue

> appears to show up in the presence or absence of insulin-like growth

> factors (IGF's) whereby experiments with rats indicated a correlation

> betweem pogression toward AI and the introduction of high doses of IGF's.

> The objective is to establish a causal relationship and having achieved

> that, to see what methods of intervention are possible to block the

> action of the IGF's that lead to cell mutation..

>

> The theory behind intermittent androgen deprivation (IAD) is that if you

> have hormone therapy for a relatively shorter period, you will prevent

> the onset of androgen independence and then you can resume hormone

> therapy again later. The usual first stopping point is when you reach

> castrate level or PSA becomes undetectable or both, which commonly

> happens at nine months. Then you monitor your PSA and when it starts to

> rise again, you decide at what level you restart hormone therapy. The

> secondary advantage of this method is that you are able to take a

> " vacation " from hormone therapy, which makes for a better quality of

> life.

>

> Hope this helps.

>

> Fred

>

July 27, 2005

OK

brief background info.

May of 84 psa 4.2 in November psa 11.6

The prostate biopsy was positive 6 for 6 samples

entire left lobe g scale 7+ & 6 for 6 right lobe

clean. The first ct was negative.

When they started to do the PRC they stopped because

of a 2cm tumor grade 6 in my lymph node. They took the

node.

Ive been on Zoladex now for 6mos my first psa came

back NOT undetectable but very low, slightly less than

one.

Ok guys I have some new results for a ct/with contrast

from last Monday. I now have even more questions

without good answers. BTW this ct was ordered by my

family doc and done by another rad lab.

1. Once its metastasized to the lymph nodes what

happens?

2. The latest ct showed thickening of the badder

walls.

3. The latest ct shows a bump or pouch on the urethra.

Anyone got any ideas? I see the urologist in

September.

Does it sound like its spreading to you? I have some

pain with all of this in the same areas.

Thanks

Sam

--- wrote:

> Very interesting, Fred

>

> Recently a very experienced retired professor of

> urology visited our support

> group, and he said that the basic treatment for

> treatment had not changed

> for 30 years. True, there had been refinements

> since then, like the ability

>

____________________________________________________

Start your day with Yahoo! - make it your home page

http://www.yahoo.com/r/hs

July 27, 2005

Sam,

How many CAT scans have you had? When?

Tell me about the pain you are having. (And anyone else who is

experiencing paind.) I have pain, often at the end of peeing.

Sometimes it feels as if a great pressure is being exerted somewhere,

probably in the bladder. Have an itching, aching pain in the right

side, runs longitudinally. The area stiffens up, back feels stiff.

Sometimes just a general aching in the prostate area and in the

bladder. I am afraid the pain indicates that the cancer is moving

from the prostate, through the bladder, up the ureter to the kidney.

There is a pathway that the cancer typically follows, but not

necessarily the path I have described. It is supposed to involve a

network of lymph nodes on the right side.

Also feel needle-like pain in the anus or rectum. Sometimes feel as

if an object is being pushed up the rectum.

Have been taking percoset for about three weeks. Usually a tablet at

night, occasionally one during the day in addition to the tablet at

night. Some nights I get by without a pill. First few times to take

the drug, I felt wonderful. Felt normal. (Some nausea at first.

But better if taken with food, although food may decrease the drug's

analgesic effect. Can take the drug without food and not experience

nausea now.) Took the drug at firts, no pain. Felt the way I felt

before this problem started three years ago. But lately the good

feeling is not as obvious. But still an improvement. Last night did

not take the pill, hurt, moved around, back and forth from a bed to a

recliner, finally took the percoset at about 2:00 A.M. It helped but

did not get the overall good feeling I wanted.

Feel an odd vague mental effect the next morning. Don't like the

feeling but it is not too bad. A dull feeling but it is not

pronounced.

>

> > Very interesting, Fred

> >

> > Recently a very experienced retired professor of

> > urology visited our support

> > group, and he said that the basic treatment for

> > treatment had not changed

> > for 30 years. True, there had been refinements

> > since then, like the ability

> >

>

> ____________________________________________________

> Start your day with Yahoo! - make it your home page

> http://www.yahoo.com/r/hs

July 27, 2005

The Dana Farber doesn't want my husband to go more than two weeks beyond his

scheduled date for h

is next injection. We ran into this when we were going to be away on vacation.

They had him come

in early... Next month, the Dr didn't have an appt until late in teh month.

When I told them

this would be three weeks after hubby's next " due date " they made a separate

appt for the shot. I

think the thing is to keep the level of the drug at a certain place.

--- wrote:

> Hello CS

>

> My understanding is that Zoladex shots do not " wear off " towards the end of

> the programmed cycle. They are designed so they don't do that, and they

> have a safety margin to last a sort while beyond the cycle, bridging to the

> next shot.

>

July 27, 2005

Thanks, Fred. You are sooo right! And, it is/was(?) sooo territorial.

My husband lasted on Casodex for about 4 1/2 to 5 years... He's still on Lupron

- 6 1/2 years.

--- " Federico I. Agnir " wrote: