How long should you take Lupron for prostate cancer?
Key Points
- Patients treated with Lupron Depot (leuprolide acetate) for prostate cancer usually continue treatment, often with other medicines, upon development of castration-resistant prostate cancer, whether it has spread beyond the prostate (metastatic) or not.
- Castration-resistant prostate cancer is cancer that is able to grow even though initial treatments have lowered your testosterone levels.
- Your doctor will discuss with you of the length of time you should continue treatment, based on treatment effects and your personal preferences.
- Lupron Depot is a slow-release (depot) injection and must be administered in your doctor’s office each time you receive it.
Lupron Depot is a gonadotropin releasing hormone (GnRH) agonist hormone therapy approved by the FDA for the palliative treatment (to relieve pain and other symptoms) of advanced prostate cancer. Your doctor may recommend you use this medicine long-term.
GnRH agonists are often referred to as “androgen deprivation therapy” (ADT). These drugs work by reducing the amount of the male hormone called testosterone. Testosterone, an androgen hormone made in the testicles, can fuel prostate cancer growth.
After beginning treatment, testosterone levels will drop within 2 to 4 weeks and the manufacturer has noted that levels have been shown to remain at castrate levels for more than 5 years.
How often should I receive Lupron Depot?
Lupron Depot is given as an intramuscular (IM) 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:
- 7.5 mg (given every month)
- 22.5 mg (given every 3 months)
- 30 mg (given every 4 months)
- 45 mg (given every 6 months)
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.
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 (orchiectomy,) 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
- injection site pain
- injection site reactions
- other pain
- swelling
- testicle shrinkage
- trouble urinating
- fatigue or weakness
- headache
- problems with your joints, digestive tract or breathing.
Initially, testosterone levels may rise the first weeks of treatment after Lupron Depot injection, causing a flare of side effects, such as pain or urinary symptoms. Your doctor may prescribe antiandrogen agents like bicalutamide (Casodex) or flutamide (Eulexin) to help reduce this flare.
This is not a complete listing of side effects. If you experience side effects with Lupron Depot, speak with your healthcare provider about ways to manage them.
Learn more: Lupron Depot side effects (in more detail)
Can Lupron be used intermittently for prostate cancer?
The use of intermittent androgen deprivation therapy (intermittent ADT) for prostate cancer is controversial, and studies have found differing results. Some physicians may recommend intermittent ADT and stop treatment for a period of time to help reduce side effects for patients with early, localized prostate cancer, but this may not be recommended for patients advanced, metastatic disease.
- One study of intermittent versus continuous ADT in men with metastatic hormone-sensitive prostate cancer showed that intermittent ADT was not better than continuous therapy and might increase the risk of death.
- A large review of clinical studies (a meta-analysis) that compared intermittent and continuous ADT in patients with either metastatic or recurrent prostate cancer found that intermittent ADT improved some physical and sexual side effects and was not worse than continuous treatment with respect to overall survival.
- In addition, the best regimens, such as doses or length of time, for intermittent ADT are not well-defined. Speak with your doctor if you have questions about intermittent ADT for prostate cancer to learn about its risks and benefits for your situation.
This is not all the information you need to know about Lupron Depot (leuprolide acetate) for safe and effective use. Review the full Lupron Depot information here, and discuss this and any questions you have with your doctor or other health care provider.
References
- NCCN Guidelines for Patients Advanced Stage Prostate Cancer. 2020. Accessed Jan. 4, 2020 at https://www.nccn.org/patients/guidelines/content/PDF/prostate-advanced-patient.pdf
- Lupron Depot. Package Insert Information. Abbvie. North Chicago, IL. Accessed Jan. 4, 2020 at https://www.rxabbvie.com/pdf/lupronuro_pi.pdf
- Dawson et al. Overview of the treatment of disseminated castration-sensitive prostate cancer. Up to Date. Accessed Jan. 4, 2020 at https://www.uptodate.com/contents/overview-of-the-treatment-of-disseminated-castration-sensitive-prostate-cancer
- Hormone Therapy for Prostate Cancer. What is intermittent ADT? National Cancer Institute. Accessed Jan. 4, 2020 at https://www.cancer.gov/types/prostate/prostate-hormone-therapy-fact-sheet#what-is-intermittent-adt
- Hussain M, Tangen CM, Berry DL, et al. Intermittent versus continuous androgen deprivation in prostate cancer. N Engl J Med. 2013 Apr 4;368(14):1314-25. doi: PMID: 23550669; PMCID: PMC3682658.
- Crook JM, O'Callaghan CJ, Duncan G, et al. Intermittent androgen suppression for rising PSA level after radiotherapy. N Engl J Med. 2012 Sep 6;367(10):895-903. doi: 10.1056/NEJMoa1201546. Erratum in: N Engl J Med. 2012 Dec 6;367(23):2262. PMID: 22931259; PMCID: PMC3521033.
- Magnan S, Zarychanski R, Pilote L, et al. Intermittent vs continuous androgen deprivation therapy for prostate cancer: A systematic review and meta-analysis. JAMA Oncology 2015; 1(9):1261-1269.
- Perera, M., Roberts, M.J., Klotz, L. et al. Intermittent versus continuous androgen deprivation therapy for advanced prostate cancer. Nat Rev Urol 17, 469–481 (2020). https://doi.org/10.1038/s41585-020-0335-7
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