Lucrin Depot 3 Months + 100mg daily Androcur

[Darby]

Quick summary:  Radical Prostatectomy  2000, 30 radiation treatments 2007, 30 radiation treatments Dec/Jan 2015/2016 following PMSA Pet scan (no bone metastases)
 

Three months ago after my PSA doubled over 3 months  to 1.2, my oncologist started me on Lucrin Depot 3 Months . The hot flashes started pretty soon after and progressively they got worse. They were exacerbated by stress/anxiety thoughts and situations and also by simply changing which side I was lying on in bed which I do several times a night.  I also started experiencing some depression which I think was due in some part to tiredness from the hot flashes and night time trips to the bathroom. (PSA test two weeks ago showed PSA and testosterone to be 0)

 

Last Thursday my oncologist started me on daily doses of 100mg Androcur which he said often helps control the flashes.
 

Is this an unusual combination of treatments?  I haven't found anything

 

 

[Kezza2]

Thats a bit weird.  They usually give you Androcur for a couple of weeks before they start Lucrin to stop the flare up in PSA.  It is not a combination I have heard of before.  Check what each is supposed to do, eg LHRH antagonists, but I think maybe they do the same thing.  Maybe the Onc is replacing Lucrin with Androcur ??  I have been on Lucrin since 2000 and still get hot flushes, but they are less severe, and tend to be just when I go to bed.

[Charles (Chuck) Maack]

More often Androcur, as noted by Kezza2, is started ten days to two weeks before injecting Lucrin to prevent the flare effect that occurs with initial Lucrin causing a period of increased testosterone production until leydig cells in the testis are worn down from the Lucrin effect and testosterone production by the testis/leydig cells pretty much shut down, and then continued as part of the androgen deprivation treatment.  Thus, Lucrin shuts down testicular production of testosterone, Androcur is primarily prescribed to block androgen receptors on cancer cells from testosterone access (your adrenal glands still produce a small amount of testosterone not effected by Lucrin.  In short, yes, both Lucrin and Androcur can be part of androgen deprivation. 

[Darby]

Thanks for your answers.  The onco gave me the prescription for the Androcur and for the next two shots of Lucrin at the same time.

 

Quote

" In short, yes, both Lucrin and Androcur can be part of androgen deprivation." 

 

Good to know.  Thanks again.

[Sisira]

Yes, Chuck is correct. I was diagnosed only in March 2015. I received the same combination continuously for 2 years, called ADT2 but the brand names of the drugs were different. Zoladex + Calutide ( Bicalutamide ). Same action as he has explained. This was after my RP followed by IMRT. Quite impressive. You are talking after 17 years! What was your PCa staging, Gleason Score and the PSA at diagnosis?

Good luck

[tonymax]

Darby,I had an unsuccessful prostatectomy in 2003 and started on continuous Lucrin that year and still on it. My PSA was still 6 after surgery and Gleason 8 - scans clean. Had some mild hot flushes early on but nothing much now. I gather Androcur may help with the flushes but can also play havoc with psychology and depression with some guys - based on feedback, I have never used the stuff. My PSA bottomed at 0.07 on the Lucrin but had risen to 70 by mid 2014 - CT scan showed tumour right pelvic lymph node but rest clean and bone scan clean. Added Enzalutamide then and PSA now down to 1 - so the roller coaster continues.

Tony Maxwell

 

[Darby]

15 hours ago, Sisira said:

.... What was your PCa staging, Gleason Score and the PSA at diagnosis?

Good luck

 

PSA 9  (3+4)7 and Stage T2a

Thank you.

[Darby]

13 hours ago, tonymax said:

..... I gather Androcur may help with the flushes but can also play havoc with psychology and depression with some guys,.... PSA now down to 1 - so the roller coaster continues.

Tony Maxwell

 

 

It never ends, does it, Tony?  Just looking through my very thick folder of test results, treatment etc has brought a lot of memories flooding back, and not pleasant ones.

The doc did warn me about the possibility of depression and as I have a long and often serious history of 'the black dog', he's asked me to see my GP about medication.

The flashes are driving me nuts so I hope the Androcur does help soon (this is only the 4th day).  I have to 5 or more some nights and they seem to be getting stronger.  Each trip to the bathroom generates one when I get back into bed and changing sides most often starts one too.  And it's embarrassing sometimes.  In the local papershop last Friday the lady asked me what was wrong as my face was flushed and I was covered in perspiration. If I'm ever interviewed by the cops they'll presume guilt immediately!  
 

[tonymax]

If Lucrin is giving these problems might be worth looking at alternatives Zoladex, Eligard etc

Have heard comments in the past that Lucrin can be difficult for some guys re side effects.

Stronger treatments like Enzalutamide or Abiraterone may be worth considering if none of above work - if you can get access to them. Pre chemo Enzalutamide was rejected by PBS for second time a month or so ago. I understand Astellas is resubmitting in a month or so's time - maybe they will be successful then. I am getting Enzalutamide on a clinical trial. Oncologists may have other ways of accessing it. Obviously however the flushes are the main current problem.

Maybe there are alternatives to Androcur if it does not help with the flushes or is too difficult re depression etc

Tony Maxwell

[Charles (Chuck) Maack]

For those concerned about Hot Flashes/Flushes, please open and consider suggestions in this paper:

HOT FLASHES: http://tinyurl.com/mw8klaj  

[MBarry]

Hi, I was prescribed a low dose of Procur (Cyproterone Acetate) 2 months ago 1 x 50 mg daily for hot flushes and it has worked brilliantly. No side effects to report. I think Procur is NZ name for Androcur. 

[Darby]

1 hour ago, MBarry said:

Hi, I was prescribed a low dose of Procur (Cyproterone Acetate) 2 months ago 1 x 50 mg daily for hot flushes and it has worked brilliantly. No side effects to report. I think Procur is NZ name for Androcur. 

 

That's great news.  How long did it take to work?

[Darby]

1 hour ago, Charles (Chuck) Maack said:

For those concerned about Hot Flashes/Flushes, please open and consider suggestions in this paper:

HOT FLASHES: http://tinyurl.com/mw8klaj  

 

Thanks for the link.  I'll read that tonight/

[Darby]

One thing I did forget to mention (and I can't believe I missed it) is that I have lost all sense of smell and almost all taste (with come changes such as smooth Merlot now has a bitterish taste).  It takes hot chilli, lots of Vegemite etc to give me any sensation of taste.

 

My doc didn't have much to say on this, and I can't find any mention of the losses related Lucrin, but there is some association of it with Lupron.

 

By the way, my doc chose Lucrin because of the free exercise program (ManPlan) which I haven't availed myself of yet.

[MBarry]

re  Procur. It took about a week to 10 days to notice a really positive change.

 

[Darby]

1 hour ago, MBarry said:

re  Procur. It took about a week to 10 days to notice a really positive change.

 

 

Thank you.

[Darby]

On 21/05/2017 at 1:24 PM, Darby said:

...... I have lost all sense of smell and almost all taste (with some changes such as smooth Merlot now has a bitterish taste).  It takes hot chilli, lots of Vegemite etc to give me any sensation of taste....

 

Sorry to repost this, but I'm just wondering if anyone else has experienced this with ADT (Lucrin in my case)?

[tonymax]

No I have no taste effects            Tonymax

[Darby]

Just thought it was time to check in and report that the daily Androcur tablet has stopped the flashes which were driving me nuts.  It's a great relief.

Having the second Lucrin 3 monthly injection next Friday and I'm hoping that it doesn't cause a recurrence.

 

[Colin Glover]

Hi Darby I hope your doing much better. I felt I had to say something. I started on Lucrin a year ago today. My adverse reaction has been minimal. No hot flushes except maybe a little in bed sometimes. Psa has continued to drop 3.6 last time. However I took up the Manplan soon after and continue to do it at home.

 

It has been very beneficial and I'm sure its played a big part in my success so far. Very little weight gain, largely muscle. One thing that we have done for the last 6 and a half years, since my wife's brain tumor discovery, is make a juice of beetroot, carrot, celery, ginger and apples every second morning. I'm sure that has been of great benefit with other changes in our life style. Inspite of my  restricted bladder capacity etc my kidneys are first rate, constipation is not really too much of an issue  and BP is 120/60.

 

So following an exercise program has been positive for me.

 

Cheers

[Darby]

My apologies for not having visited this topic for awhile.  I find discussing PCa can be stressful leaving me down for a day or two.

 

Re: Androcur.  It did stop the flushes (I refer to them that way because they last way longer than flashes!) but due to breathlessness and tiredness my oncologist stopped prescribing it mid this year.  I tried Effexor which did help a bit with the flushes but the painful constipation despite a high fibre diet wasn't worth it.

 

My update:  began 3 monthly Lucrin Depot in March 2017 and had my quarterly shot yesterday.  Testosterone and PSA remain at <0.01 which is good news.  My weight is still the same as it was in March last year.  A bone density scan yesterday shows me to be in the normal range. A side effect which doesn't worry me is that I have no body hair these days below the neck although head hair and beard continue to grow albeit slower than normal. However the hot flushes are worse than ever:  last longer and the sweating is more intense. I really, really hate this. I keep my hair short with a #3 buzz cut because when I'm out and sweating, it's looks like I just got out of a pool.  I must look a desperate character to other people!    I find I have little energy and get exhausted within a short time with activities such as yard work which I used to be able to do all day prior to starting Lucrin, now 45 to 60 minutes tops.  Apart from these things all is well - heart, blood pressure and so on.  

[Charles (Chuck) Maack]

HOT FLASHES – Why? What to do?

Compiled by Charles (Chuck) Maack – Prostate Cancer continuing patient, advocate, activist, Mentor

www.theprostateadvocate.com

FIRST, MY DISCLAIMER:

Please recognize that I am not a Medical Doctor.  Rather, I do consider myself a medical detective. I have been an avid student researching and studying prostate cancer as a survivor and continuing patient since 1992. I have dedicated my retirement years to continued deep research and study in order to serve as an advocate for prostate cancer awareness, and, from an activist patient’s viewpoint, as a mentor to voluntarily help patients, caregivers, and others interested develop an understanding of this insidious men’s disease, its treatment options, and the treatment of the side effects that often accompany treatment.  There is absolutely no charge for my mentoring – I provide this free service as one who has been there and hoping to make their journey one with better understanding and knowledge than was available to me when I was diagnosed so many years ago.  IMPORTANTLY, readers of medical information I may provide are provided this “disclaimer” to make certain they understand that the comments or recommendations I make are not intended to be the procedure to blindly follow; rather, they are to be reviewed as MY OPINION, then used for further personal research, study, and subsequent discussion with the medical professional/physician providing their prostate cancer care.

 

We often hear prostate cancer patients recommending to other prostate cancer patients regarding hot flashes: get “MEGACE!” – NOT for prostate cancer patients, my friends!

 

Medical Oncologist Stephen B. Strum, M.D., FACP – renowned for his experience and expertise in the treatment of recurring and advanced prostate cancer:

 

“I am not a user of Megace in this setting since it is metabolized to DHEA and then to androstenedione and then to testosterone.  When the PSA is in good control and the testosterone is low, I use Depo Provera intramuscular injection 400mg ONCE and that usually eliminates hot flashes forever.”  The emphasis on “usually” added since there are rare cases wherein the hot flashes are not reduced/eliminated.

 

Therefore, a 400mg Depo Provera intramuscular injection just once would be what I would have done were I experiencing hot flashes. Make sure the prescribing/administering physician is providing Depo Provera and at the recommended dose, and not Provera.  Though both are Medroxyprogesterone, the difference is that Depo Provera is an addition of acetate.  There are physicians not familiar with that difference who prescribe Provera when the requirement is, specifically, Depo Provera.   HOWEVER, IMPORTANT TO NOTE:  Depo Provera has also been known to cause gastrointestinal bleeding – and a low hct percentage can also be attributed to loss of blood.  If you are experiencing fatigue and shortness of breath subsequent to Depo Provera, you may be experiencing a blood loss with this GI bleeding and don’t know it.  Be sure your physician keeps an eye on red blood counts (RBC) as well as hgb and hct levels.  With the administration of Depo Provera patients should follow-on having their Prolactin level checked to see if elevated (if earlier controlled), or in any event, to make sure that level is kept below 5ng/ml as explained in this paper http://tinyurl.com/7w5omeo.  

  The introducing of any new medications can temporarily cause a Prolactin rise, but once the medication is stopped, within a few days that elevation should return to normal.

 

Adding to NOT prescribing Megace is this commentary by Dr. A. Oliver Sartor: “"Megace® is used at times for patients who have hot flashes, and at times for patients to boost their appetite. But in prostate cancer, Megace may interact with the androgen receptor, particularly mutants, and cause excessive cancer growth. And you can actually get responses by withdrawing Megace. I do not prescribe the use of Megace in prostate cancer patients (even for hot flashes), because I don’t know who has a mutant and who doesn’t."

 

Men on ADT often ask “What is causing these hot flashes?”  Some attribute the cause simply to loss of testosterone.  I believe it is more complex than just this loss.  Consider that when men have surgical castration/orchiectomy and can no longer produce testicular testosterone, though they may experience hot flashes, they are found to be much more subdued than those experienced by men when chemical castration is prescribed.  As noted in one paper regarding LHRH agonists, “Hot flashes, similar to those which occur in women during menopause, are common and can often be more pronounced than those observed in patients who are treated by surgical orchiectomy.

 

Other past reports indicated “Hot flashes are thought to result from an alteration in the feedback mechanism to the hypothalamus due to the lack of testosterone. An increase in catecholamine secretion in response to decreased endogenous peptide secretion stimulates the nearby thermoregulatory center of the hypothalamus, resulting in the perception of increased heat.”  This would indicate that it is the effect from the LHRH agonist on the hypothalamus that brings about this “alteration.” 

 

Another cause can be attributed to LHRH agonist effect on lowering male estrogen levels, since low estrogen levels also bring about hot flashes.  Patients on transdermal estradiol (TDE) therapy did not experience hot flashes.

 

It's not really understood how reducing testosterone brings on hot flashes. However, it's true that hot flashes are a common side effect of LHRH agonist therapy. Hot flashes can range from annoying to debilitating. Sometimes hot flashes are associated with facial flushing, redness, and increased sweating and may cause nausea or interruption of sleep. Hot flashes can be brought on by stress or heat, or they may occur for no apparent reason at all. Studies have shown that the majority of the hot flashes that men experience as a side effect of ELIGARD therapy are typically mild.

 

Researchers analyzed patient characteristics and their DNA to determine which factors were associated with an increase in hot flashes. They discovered that men who were younger and had a lower body mass index experienced more hot flashes and felt more interference with their daily lives. The researchers also reported that the presence of certain genes involved in processes such as immune function, nerve impulse transmission, blood vessel constriction, and circadian rhythms were associated with an increased number of hot flashes.  

 

You might want to print this post then discuss with your family physician, your urologist, or your oncologist, particularly for those requiring a prescription.  On the other hand, you might just want to print it out, hang it on the wall, throw a dart at it, and give the result of the dart point a try.  If that doesn't work, throw another dart.  Hopefully, eventually the dart will connect with the one that will work for you.  In the meantime you will be enjoying yourself so much throwing darts that you'll forget about the hot flashes/flushes! 😊

Charles (Chuck) Maack - Prostate Cancer Patient/Activist/Mentor

(A mentor should be someone who offers courtesy, professionalism, respect, wisdom, knowledge, and support to help you achieve your goals; would that I succeed)

 

Email: maack1@cox.net

Website: www.theprostateadvocate.com

[Charles (Chuck) Maack]

On 5/19/2017 at 4:53 PM, Darby said:

 

Last Thursday my oncologist started me on daily doses of 100mg Androcur

I wanted to add that it is unlikely your testosterone level is "0."  The level of testosterone is usually measured in ng/dl and the aim is to get that level down to or below 20ng/dl with the prescribing/administering of LHRH agonists.  

[Charles (Chuck) Maack]

 

When anyone is prescribed Androcur the physician should be providing the patient information to understand this medication, its uses, AND its side effects.  With that in mind, please take the time to read info in this paper:

 

https://tinyurl.com/ycyyhpcn

[Darby]

45 minutes ago, Charles (Chuck) Maack said:

I wanted to add that it is unlikely your testosterone level is "0."  The level of testosterone is usually measured in ng/dl and the aim is to get that level down to or below 20ng/dl with the prescribing/administering of LHRH agonists.  

Hi Charles,

Thanks for your reply.

My latest PSA and Testosterone results taken from the pathology report from a week ago read <0.01 ug/L and <0.01 nmol/L respectively.