Popular culture tells us that primary androgen deprivation therapy with leuprorelin acetate (Lupron) will not work for longer than two years! This is a significant and very problematic statement given that all of us with metastatic prostate cancer rely on delaying the move to any other treatments, especially given their cost to the quality of our life.
In an observational, retrospective study evaluating this statement as well as the efficacy and safety of the use of Lupron, 30 office-based urologists in Germany evaluated 647 men from 1992 to 2012. The study broke up the 647 men into three subgroups which were are described as: patients who received treatment for greater than 5 and less than 10 years (n=363), patients who received treatment for more than 10 years (n=173), a control group (with less than 5 years of urologic treatment, no cancer, only QoL assessment; n=111).
This study looked the efficacy of long term treatment with three depot formulations (1, 3, and 6 months) of leuprorelin in microcapsules in men with advanced prostate cancer for a period of >10 years.
More than 90% of the observed men showed a positive response for > 10 years of the treatment. Median testosterone level was suppressed considerably below castration level, PSA declined subsequently and remained low for all time points of observation up to 13 years.
They concluded that leuprorelin acetate (Lupron) in microcapsules is an effective long term treatment for men with advanced prostate cancer.
J Clin Oncol 32, 2014 (suppl; abstr e16077); Peter Hammerer, Manfred Wirth
Joel,
The key question may really be “WHEN was the Lupron started. We are seeing renewed interest in NOT starting Lupron right after primary treatment fails. Latest report I read was that it made no difference in long term survival. If that’s the case, then analyzing duration on Lupron may be false data. For example, I started 2 yrs after seeds/XBRT when PSA rose quickly to 10. Would I have had a different survival pattern if I (and my docs) waited another 2, 4, or 6 years, with psa presumably rising all that time. I am now 13 yrs on intermittent, but my doubling time is very short, 3.5 mo, suggesting that my psa would now, after 13 yrs, be astronomical without Lupron.
Herb S
Herb,
You are referring to the recent poster at ASCO where it was found that for men with a PSA only recurrence could wait before starting ADT without changing their survival potential (http://advancedprostatecancer.net/?p=4602). The efficacy study of long term ADT did not record the disease state of the subjects so we can not know what possible effect was mitigated by the lack of visualized or the existence of tumors. I would not call it false data, as it reported the state of the art at the time. The question will be if the PSA only study will alter the standard of care, I hope that it does. If it does, then maybe we can hope to see even longer survival with a better quality of life by delaying ADT. – Joel