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Posted 3/7/2011 7:41 PM (GMT -5)
On 11/26/10, I had my first shot of 4 months lupron.  I did not have the flare so frequently mentioned eventhough I did not receive any meds prior to the injection to prevent it, which in retrospect I am wondering why because I read that the flare can be quite dangerous and debilitating.

At 60 days after injection, psa was 0.11 and testosterone was 14 so I guess the HT is working.  Next Lupron shot is later this month.

My question is what % of men do have the flare if no meds given to prevent it and what does no flare mean, if anything in the Pca battle?

The Old Sailor 

Posted 3/7/2011 10:32 PM (GMT -5)
"Flare" is something to be avoided in men with advanced PC, cancer that has metastasized.. The testosterone spike can greatly aggravate the condition..Now, it seems, most ADT patients are given Casodex for a couple of weeks before to suppress the "flare" brought on by Lupron and its clones..But like you, my Eligard was started without any Casodex to suppress the 'flare". When I questioned my urologist before the shot, he simply said don't worry about it..The experts on this board sure worried about it, predicting dire consequences..My "T" is now 6 and my PSA is 0.0
Posted 3/7/2011 10:49 PM (GMT -5)
Fairwind, super on your psa and T levels.  Sure is nice to hear from some of the brother Gleason 9s  that some good things are happening.  Did you have any noticeable flare?  Only thing I experienced was a sore butt for a couple of days where I received the injection. Loss of libido seems to be only side effect I have so far but at age 69, it might not be that strong anyway!!   The Old Sailor

Posted 3/7/2011 10:51 PM (GMT -5)
I have often heard the term "flare" used here, but asked once before, and wasn't really given a complete answer to what it is, what causes it, and how it abates. Would like to learn what it really means.

David
Posted 3/8/2011 12:06 AM (GMT -5)
Old Sailor:

Yea on the sore butt!

First Lupron shot was just another shot in the butt. Second and third ones were so bad I could not get out of bed the first morning after.

Took about three days to get really mobile again.

This is strange because it seems to only affect a few of us.

Don K.

Posted 3/8/2011 4:42 AM (GMT -5)
When it is first administered the various hormone suppressing injections begin their task of steadily suppressing testosterone production but also have the immediate effect of stimulating (at least in the first 1-2 weeks) the pituitary gland to increase the production of Luteinizing Hormone (LH). Levels of LH govern the amount of testosterone produced by a particular group of cells in the testes. It also (in conjunction with other hormones) governs such things as ovulation in women). So a surge in LH initially results in a flare of testosterone level. If a patient had serious problems with mets in their spine a flare stimulating tumour growth in the bone could threaten spinal stability or even in extreme cases paralysis. Casodex seems to prevent the increase in LH and thus flare. I see mention that DES can do the same. I would guess that if a patient was in danger from increased pain or worse from possible flare then the doc would err on the side of caution.

"Why is flare prevention important?"
In patients with advanced disease with subclinical spinal cord compression, flare can precipitate full cord compression and paralysis. If there is PC growing close to a nerve root then flare could result in pain in the distribution of that nerve. In patients with PC involving lymph nodes close to the ureters, flare could increase nodal disease and cause early compression of the ureter(s). Obstruction of both ureters could lead to kidney failure. Increasing disease in bony sites often leads to bone pain during times of flare

There's a bit of reading here:

www.prostate-cancer.org/education/andeprv/hormone.html


www.labtestsonline.org/understanding/analytes/lh/sample.html

Bill
Posted 3/8/2011 8:41 AM (GMT -5)
The "flare" is a spike in tesosterone after the injection.  It begins almost immediately and causes a mans testosterone to spike approximately 65% above your normal level.  If your level was 400 it would rise to approximately 650 in theroy causing your PCa to worsen.  The big reason for the Casodex is for guys with advanced PCa, mets and such, to not cause the disease to worsen.  The spike itself lasts approximately 5-7 days and begins to receed.  Most individual's tesosterone is back to normal in 14 days and headed down to a nadir which occurs anywhere from 28-65 days after injection.

The interesting thing was the PSA didn't follow the testosterone spike, I guess because it was for such a short time the PSA couldn't catch up before the tesosterone started down again.

For guys with little to no disease to begin with some Doc's don't believe it necessary, I went ahead and did the Casodex thing because it was easy and took any chance of "flare" out of the equation.

Fairwind, I don't believe there are any experts on this board just guys with experience they would like to pass on.

I received this information from a study that I have tried to post here a few times but for some reason it won't allow me to do it.  I'm not the most computer literate guy.

David 

Posted 3/8/2011 1:02 PM (GMT -5)
Sailor, I don't know if I had a flare or not..No "T" tests were done during the period it might have occurred and I had no increased feelings of masculinity..I had the Eligard shot (in the stomach fat) about 3 months ago and the symptoms have been hot flashes and complete loss of libido/ability..With surgery, you get ED..With ADT you get ED but now you don't care! I'm not sure whether I'll continue with the HT for the prescribed two years..I need to learn some more about this....My wife, as you can imagine, is dead set against it..
Posted 3/8/2011 1:43 PM (GMT -5)
thanks billy and david for a much clearer explanation of "flare", both were good answers.

david in sc
Posted 3/8/2011 1:49 PM (GMT -5)
For those that were discussing the injection pain in the butt, a wise nurse told me how to avoid the problem. Lift your foot on the injection side of your body, in order to take the weight off your foot. It relaxes muscles and helps eliminate the after effects. There may be one exception. A nurse with PMS that particular day.
Posted 3/8/2011 2:34 PM (GMT -5)
Putt:

Thanks for that advise. If/when I go back on Lupron I will be sure to do that.

Don

Posted 3/8/2011 3:42 PM (GMT -5)
Fairwind, I recall that Dr. Snuffy Myers said something like this concerning libido on one of his videos - while on HT, he would see a beautiful topless woman on the beach and compare it with a beautiful sunset, mountain range etc. You get the message.   All things are relevant.  I guess I would compare it to a beautiful sunset at sea!!  Old Sailor

Posted 3/9/2011 8:48 AM (GMT -5)
Old Sailor best to you....just for the record on this you did receive 'Flare' you just didn't have clinical flare issues! As pointed out by some of the brothern above that is how LHRH drugs work in everyone, as pointed on in Dr. Strum's book of wisdom...'nobody should be subjected to flare'. You can analyze and decide the issue for yourselves.

Page number 138- A Primer on PCa (Dr. Strum)  2 types of flare biochemical and clinical flare.  Glad you and I didn't had clinical flare shown.

Post Edited (zufus) : 3/9/2011 12:19:32 PM (GMT-7)

Posted 3/10/2011 4:29 PM (GMT -5)
Zufus - I read page 138 of Strum - does he mean that no awareness of the flare is good because he says that would represent low volume of Pca?  Thank you for your thoughts.  The Old Sailor

Posted 3/10/2011 7:23 PM (GMT -5)
Sort of, he does state if the flare that can be felt or is exhasterbated to clinical significance(bone pain, bone displacement/movement, blockage maybe of uters etc.) is the huge concern and something a patient should not be subjected too. With low volume of PCa likely nothing is felt on flare in patients...and many docs don't give casodex probably cause they don't correlate a significant issue being noticed..and have not seen issues with clinical flare vs. T flare or chemical flare which happens when using it for everyone, so they figure it is no big deal. But, as in Strum's book one guy died of complications related to clinical flare and his was preventable (nice lawsuit would ensue). I think that makes his point relevant. (lol)
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