What Happens If I Stop Lupron Depot
If Lupron treatment is stopped, testosterone levels can rise and your cancer may worsen. Do not discontinue Lupron Depot unless your doctor tells you to stop treatment.
In men, testosterone is reduced to castrate concentrations with Lupron Depot treatment. This is called medical castration, as opposed to surgical castration when the testicles are removed surgically. The testicles make most of the testosterone in a man, about 95%. The adrenal glands above the kidney also produce a small amount of testosterone.
In patients with advanced prostate cancer, you may also receive other medicines along with Lupron Depot. These may include chemotherapy drugs, immunotherapy or targeted drug treatments, or corticosteroids depending upon your stage of cancer.
You may experience side effects with Lupron Depot treatment such as:
- hot flashes or sweats
Hormone Therapy For Prostate Cancer
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Hormone therapy is also called androgen suppression therapy. The goal of this treatment is to reduce levels of male hormones, called androgens, in the body, or to stop them from fueling prostate cancer cell growth.
Androgens stimulate prostate cancer cells to grow. The main androgens in the body are testosterone and dihydrotestosterone . Most androgens are made by the testicles, but the adrenal glands as well as the prostate cancer cells themselves, can also make androgens.
Lowering androgen levels or stopping them from getting into prostate cancer cells often makes prostate cancers shrink or grow more slowly for a time. But hormone therapy alone does not cure prostate cancer.
How Often Should I Receive Lupron Depot
Lupron Depot is given as an intramuscular injection into the muscle in your upper arm, buttock or thigh. Lupron Depot is available as single dose kits that contain a prefilled injection syringe of:
Depot formulations continuously release medicine into your body over a certain period of time after injection. This means you may not need to get a shot every day, or even every month. Your healthcare provider will give you Lupron Depot injection, and together you can decide which treatment dose and schedule might work best for you.
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Physical Emotional And Social Effects Of Cancer
Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.
Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.
Prostap Injections And Abnormal Heart Rhythm
You may be more likely to experience an abnormal heart rhythm while you’re having Prostap injections if you take certain other medicines, including:
- medicines to treat abnormal heart rhythms , eg amiodarone, procainamide, quinidine, disopyramide, dronedarone
- certain antidepressants, eg clomipramine, citalopram, escitalopram
- certain antimalarials, eg halofantrine, chloroquine, quinine, Riamet, mefloquine
- certain antimicrobials, eg erythromycin given by injection, telithromycin, levofloxacin, moxifloxacin, voriconazole or pentamidine
- certain antipsychotics, eg amisulpride, thioridazine, chlorpromazine, sertindole, haloperidol, pimozide, zuclopenthixol, sulpiride
- arsenic trioxide
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How Do Prostap Injections Work
Prostap injections contain the active ingredient leuprorelin acetate, which is a type of medicine known as a gonadorelin analogue. It’s similar to a natural hormone called gonadotropin releasing hormone . GnRH acts on the pituitary gland in the brain, causing production of testosterone in men and oestrogen in women.
Leuprorelin acts on the pituitary gland in the same way as natural GnRH. It initially increases the production of testosterone and oestrogen, but with continued treatment it desensitises the pituitary gland. This stops the production of testosterone in men and oestrogen in women.
The growth of most prostate cancers is stimulated by testosterone. Leuprorelin deprives the tumour of testosterone, causing it to stop growing or shrink.
Endometriosis and fibroids
The growth of endometriotic tissue and uterine fibroids is stimulated by oestrogen. By stopping oestrogen production, leuprorelin brings on a temporary menopause that deprives these tissues of oestrogen and causes them to stop growing or shrink.
Because of its effect on body hormones, leuprorelin can be used to treat hormone responsive early stage breast cancer in pre and perimenopausal women at higher risk of recurrence, and hormone responsive advanced breast cancer in pre and perimenopausal women.
Hormone Therapy With Radiotherapy
You have this if:
- your cancer hasnt spread to other parts of the body but is at a high risk of coming back, eg the cancer has grown through the covering of your prostate
- you have a very high prostatic specific antigen level
- you have a high Gleason score
You might have hormone therapy before, during and after radiotherapy. Doctors usually recommend that you have the treatment for between 3 months and 3 years. How long depends on the risk of your cancer coming back and how many side effects you get.
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Who Can And Can’t Have Prostap Injections
Most people can have Prostap injections, however they are not suitable for:
- Women who are pregnant. If you could get pregnant you’ll need to use a non-hormonal method of contraception, eg condoms or diaphragm, while you’re having Prostap injections and for a few months after your last injection. Ask your doctor for further advice.
- Women who are breastfeeding.
- Women with vaginal bleeding where the cause is not known.
Your doctor will need to weigh up the risks and benefits of having Prostap injections and may need to do some extra monitoring if you have:
- osteoporosis or a risk of developing it, for example due to a family history, anorexia or bulimia, smoking, excessive alcohol consumption, low body mass index , or long-term treatment with corticosteroid or anticonvulsant medicines
- liver problems.
The Future Of Hormone Therapy For Prostate Cancer
Some experts aren’t sure how much further we can improve hormone therapy for prostate cancer.
“I’m not saying that we’ve reached the end of what we can do with hormonal therapy,” Thrasher tells WebMD, “but there are only so many ways to shut down the hormonal effects. The cancer will still eventually escape.”
Brooks argues that, overall, prostate cancer is only moderately affected by hormones. “You can only do so much manipulating the levels of hormones,” says Brooks. “We have to find better ways to fight the basis of the cancer cells.”
Thrasher and Brooks have more hope that the next breakthroughs will come with different approaches, like chemotherapy or vaccines.
But Holden remains optimistic about the future of hormone therapy for prostate cancer.
“Cancer cells eventually figure out how to survive, how to overcome a specific hormone therapy,” he says. “But if we have enough types of drugs and can keep changing the hormone therapy, we might be able to keep the cancer cells in a state of confusion. We could change therapies before they have a chance to adapt.”
“It’s like an endless chess game,” he says. “You may not ever win, but you might be able to prolong the game indefinitely. I think that hormone therapy still has a lot of promise. We just need to develop better anti-androgens, and more varieties of them.”
Currently Available Leuprorelin Formulations
In 1971, GnRH was first isolated and characterized in the laboratory.24 Leuprorelin, a synthetic analogue of GnRH, was first synthesized for clinical use in 1974.25 Leuprorelin has a longer half-life and is 80 times more potent than naturally occurring GnRH, because of its enhanced binding affinity and increased resistance to degradation by peptidases.26 Alterations in the chemical structure, including substitution of a D-amino acid for glycine at position 6 and deletion of glycine at position 10 with the insertion of ethylamide, are responsible for these properties.27
The clinical benefits of GnRH analogues in prostate cancer patients were first described by Tolis et al in 1982. Ten patients with locally advanced or metastatic prostate cancer were treated with leuprorelin given as daily subcutaneous injections or twice daily intranasal applications for a period of 6 weeks to 12 months. During the treatment period, those patients with urinary obstruction noted improvement in urine flow, and those with osseous metastases reported decreased bone pain.28
Technological advances have fostered the development of multiple long-acting depot formulations of GnRH in order to improve convenience of use, quality of life, and patient compliance. The first long-acting formulation was a monthly injection approved by the FDA in 1989 for treatment of advanced prostate cancer.30 In the US, leuprorelin is now available in monthly , 3-monthly , 4-monthly , and 6-monthly dosages.
Hormone Therapy With Radiation
Hormone therapy is often given together with radiation therapy for localized disease .
Hormone therapy usually consists of a shot that lowers your testosterone, given every 1 to 6 months, depending on the formulation. Sometimes, it is prescribed as a daily pill that blocks testosterone from reaching the cancer cells. Clinical trials show a benefit in patients who receive hormonal treatment in combination with external beam radiation. Hormone therapy has been shown to improve cure rates of prostate cancer for men receiving radiation therapy and is part of the standard of care for men with certain types of intermediate-risk prostate cancer and nearly all high-risk prostate cancer. It is often given for intermediate-risk cancer for 4 to 6 months , and for 2 to 3 years in men with high-risk localized prostate cancer, although some doctors may recommend as little as 18 months of hormone therapy.
Hormone therapy should not be given to men with low-risk prostate cancer and is not a standalone treatment for localized prostate cancer in any risk category.
Want more information about a prostate cancer diagnosis and treatment options? Download or order a print copy of the Prostate Cancer Patient Guide.
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Degarelix Injection May Cause Side Effects Tell Your Doctor If Any Of These Symptoms Are Severe Or Do Not Go Away:
- pain, redness, swelling, hardness, or itching in the place where the medication was injected
- excessive sweating or night sweats
- difficulty falling asleep or staying asleep
- enlargement of the breasts
- painful, frequent, or difficult urination
- fever or chills
Degarelix injection may cause your bones to become weaker and more brittle than they were at the beginning of your treatment. Talk to your doctor about the risks of taking this medication.
Degarelix injection may cause other side effects. Call your doctor if you have any unusual problems while receiving this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s MedWatch Adverse Event Reporting program online or by phone .
What Other Drugs Will Affect Eligard
Eligard can cause a serious heart problem. Your risk may be higher if you also use certain other medicines for infections, asthma, heart problems, high blood pressure, depression, mental illness, cancer, malaria, or HIV.
Other drugs may interact with leuprolide, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all your current medicines and any medicine you start or stop using.
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Treatment To Lower Androgen Levels From Other Parts Of The Body
LHRH agonists and antagonists can stop the testicles from making androgens, but cells in other parts of the body, such as the adrenal glands, and prostate cancer cells themselves, can still make male hormones, which can fuel cancer growth. Some drugs can block the formation of androgens made by these cells.
Abiraterone blocks an enzyme called CYP17, which helps stop these cells from making androgens.
Abiraterone can be used in men with advanced prostate cancer that is either:
This drug is taken as pills every day. It doesnt stop the testicles from making testosterone, so men who havent had an orchiectomy need to continue treatment with an LHRH agonist or antagonist. Because abiraterone also lowers the level of some other hormones in the body, prednisone needs to be taken during treatment as well to avoid certain side effects.
Ketoconazole , first used for treating fungal infections, also blocks production of androgens made in the adrenal glands, much like abiraterone. It’s most often used to treat men just diagnosed with advanced prostate cancer who have a lot of cancer in the body, as it offers a quick way to lower testosterone levels. It can also be tried if other forms of hormone therapy are no longer working.
Ketoconazole also can block the production of cortisol, an important steroid hormone in the body, so men treated with this drug often need to take a corticosteroid .
Before Receiving Degarelix Injection
- tell your doctor and pharmacist if you are allergic to degarelix injection, any other medications, or any of the ingredients in degarelix injection. Ask your pharmacist or check the patient information for a list of the ingredients.
- tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: amiodarone , disopyramide , quinidine, procainamide, or sotalol . Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor if you have or have ever had long QT syndrome high or low levels of calcium, potassium, magnesium, or sodium in your blood or heart, liver, or kidney disease.
- women who are or who may become pregnant should not receive degarelix injection. Degarelix injection may harm the fetus. If you receive degarelix injection while you are pregnant, call your doctor immediately. If you are breastfeeding, talk to your doctor before you receive degarelix injection.
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Surgery To Remove The Testicles
Surgery to remove your testicles isnt a common way of lowering the amount of testosterone you produce.
You usually only have surgery to remove your testicles if you need your testosterone reduced urgently. For example if your cancer has spread to your bones and is pressing on your spinal cord, your doctors might want to reduce the amount of testosterone quickly.
Your doctors might also suggest surgery as an option if you don’t want to have injections or tablets.
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Early Versus Delayed Treatment
For men who need hormone therapy, such as men whose PSA levels are rising after surgery or radiation or men with advanced prostate cancer who dont yet have symptoms, its not always clear when it is best to start hormone treatment. Some doctors think that hormone therapy works better if its started as soon as possible, even if a man feels well and is not having any symptoms. Some studies have shown that hormone treatment may slow the disease down and perhaps even help men live longer.
But not all doctors agree with this approach. Some are waiting for more evidence of benefit. They feel that because of the side effects of hormone therapy and the chance that the cancer could become resistant to therapy sooner, treatment shouldnt be started until a man has symptoms from the cancer. This issue is being studied.
How Does Hormone Therapy Work Against Prostate Cancer
Early in their development, prostate cancers need androgens to grow. Hormone therapies, which are treatments that decrease androgen levels or block androgen action, can inhibit the growth of such prostate cancers, which are therefore called castration sensitive, androgen dependent, or androgen sensitive.
Most prostate cancers eventually stop responding to hormone therapy and become castration resistant. That is, they continue to grow even when androgen levels in the body are extremely low or undetectable. In the past, these tumors were also called hormone resistant, androgen independent, or hormone refractory however, these terms are rarely used now because the tumors are not truly independent of androgens for their growth. In fact, some newer hormone therapies have become available that can be used to treat tumors that have become castration resistant.
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