Lupron, Radiation and Opinions

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Lupron, radiation, and opinions

A recent post indicated that a urologist told a patient that

(paraphrasing) " you can avoid side effects of Lupron and shrink your

prostate with radiation. "

In my opinion, there are three roles in the use of ADT (Lupron,

etc.) in fighting prostate cancer. One is to shrink the prostate

gland to a size that permits or facilitates the proposed treatment

such as cryotherapy or brachytherapy. The second is for the purpose

described below: to assist in the overall attack against the disease

and possibly improve outcomes for those with more advanced disease.

The third is as the primary treatment in the case of those that have

advanced disease and are seeking to hold the beast in check.

As Larry indicated in a later post, there is evidence that a

neoadjuvant course of ADT before and during radiation treatment for

prostate cancer is beneficial. There is need of additional evidence

(see http://www.medscape.com/viewarticle/417010_4 ) but several well

respected institutions and physicians subscribe to this

thinking: " ScienceDaily (Jan. 2, 2008) — Researchers report that just

four months of hormonal therapy before and with standard external

beam radiation therapy slowed cancer growth by as much as eight years-

-especially the development of bone metastases--and increased

survival in older men with potentially aggressive prostate cancer.

This " neoadjuvant " hormonal therapy may allow men most at risk of

developing bone metastases avoid long-term hormonal therapy later on.

Furthermore, the short-term hormonal therapy did not increase the

risk of cardiovascular disease--a potential side effect of long-term

hormonal therapy. "

(see http://www.sciencedaily.com/releases/2008/01/080102222947.htm ).

There is also discussion regarding use of ADT prior to surgery

(see http://www.medscape.com/viewarticle/417010_3 ).

Now to my point: I am not sure that the patient is being well served

by a urologist that believes that radiation alone can shrink a

prostate gland that is large and thus more difficult to treat by

whatever modality. Yes radiation will shrink tumors, but it is not a

methodology used as the primary way to " shrink the prostate. "

According to most information that I have found, the shrinking role

is primarily by ADT. Furthermore, standard radiation use alone for a

large oversized gland might well subject surrounding body tissue and

organs at risk to unnecessary radiation and increase the possibility

of longer term negative side effects.

The treatment of prostate cancer is controversial. It seems that

regardless of the method of treatment we choose, there are patients

and doctors that disagree with that choice in favor of " their " own.

That is just the way it is, and is all the more reason to do the best

job of studying the disease and treatments that we can, including all

possible side effects, before we commit.

In my case, my gland was about double normal size and my initial uro

administered a four month Lupron shot " to shrink the prostate " so

that his recommended cryotherapy could be done. Although I hated the

side effects, I am now glad that I had the Lupron, because the

waiting period while the gland was " shrinking " gave me the

opportunity to do enough research to find the treatment that I

believed was " best " for me, proton beam therapy.

Now I know that the Lupron may have been beneficial in my overall

treatment. My doctor at Loma prescribed and additional one

month shot of Lupron to extend the effects of the ADT until the end

of the proton treatments. He was one of those who believed in the

beneficial effects of the neoadjuvant ADT during radiation treatment.

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