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Decapeptyl Injection Delayed

User
Posted 29 Dec 2020 at 11:48

Hi,


I’m not sure if i’ve posted this under the right section.  I was due to have my 3 monthly injection today but the surgery phoned to say that the nurse who was giving the injection was ill and there’s no one else available to do it.


I’ve been re-booked for next Tuesday - will that cause me a problem?


Thanks


Arthur

User
Posted 29 Dec 2020 at 12:44

Hi Arthur,


We had the same with my husband in November. Some surgeries seem very strict about the date it's given but we were told a week late wouldn't be a problem as testosterone would take around a year to recover after long term HT.


He had a PSA test around a month later in December and it was undetectable so no movement.


Best wishes

User
Posted 29 Dec 2020 at 13:11

Hi Arthur, I asked the same question last year because one was due right in the middle of the crap bit of my Chemo cycle (days 3 to 10 when immune system was at lowest ebb). I was told a couple of weeks either way wouldn't make any difference, as it takes quite a while for your  testosterone level  to start going back up?

Good luck to everyone coping with the insidious big C

User
Posted 29 Dec 2020 at 15:25
Hi Arthur funny thing is when I tried to delay one of mine last year by a couple of days they insisted it was crucial that it was done on the scheduled day but when they delay it isn't an issue.
Personally I can't see if you're on HT long term that it would cause a problem.
User
Posted 29 Dec 2020 at 17:44
It depends on the type of HT. I think you are still on decapeptyl which is a 3 monthly injection so assuming today was exactly 3 months after the last injection, a few days will be fine. However, next Tuesday is a bit of a stretch and I would be tempted to phone the surgery to say you would be much happier if the rearranged appointment was this week rather than next week.

The guidance is slightly different for Zoladex which should be given every 4 or 12 weeks rather than every month / 3 months and every effort should be made to avoid it being given more than a couple of days early or late.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 29 Dec 2020 at 19:27
I agree with Lynn I was on Zoladex and from the beginning was told it was really important to get the injections done, in my case, every 12 weeks. The nurses/gp giving the implant often said it's not so important with other treatments although at the time I think Zoladex was a lot more expensive, not so now, maybe that had something to do with letting me know. I remained on Zoladex for the 3yrs.
Peter
User
Posted 30 Dec 2020 at 11:26

The bottom line is no one had looked at this until recently, but they have now done so, and it does impact your testosterone level. The main problem is in the US, where insurance companies often delay permission to buy the hormone therapy drugs - it saves them a lot of money, given they cost 25x more in the US than elsewhere. When you delay a bit every time, your testosterone level is doubled. As a once-off, that's maybe not such an issue, but not something you want to do regularly or deliberately.


Delayed LHRH Agonist Dosing Doubles Castration Levels in Prostate Cancer


The other interesting thing the underlying paper mentions if I recall correctly (it was a while ago when I read it), is that Luprorelin (Prostap in the UK) was tested on the basis of 28 day months, not calendar months it tends to be prescribed in nowadays, and even those few days makes a difference to testosterone levels.


The paper doesn't go on to say if this change in testosterone level has any impact on the effectiveness of the hormone therapy treatment. That would be another level of research which hasn't happened as far as I know. I'm wondering if the PATCH trial (using Estradiol female hormone as the hormone therapy drug) might get some incidental data on this, since they are measuring testosterone levels during treatment.


EDIT: One thing you might consider is if you think you can do the injection yourself. I did this, and it removed a level of uncertainty of getting the appointment on the right date. I was on Zoladex, which may be the easiest to self-inject (no mixing anything up, and easy self-access injection site). If you want to do this, the thing to do is to ask if you can do it yourself at your next appointment while the nurse supervises. If it goes OK, then continue doing it yourself at home if you wish to do so. In the current climate, they are going to be much more willing to let you do it than in normal times.

Edited by member 30 Dec 2020 at 11:33  | Reason: Not specified

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User
Posted 29 Dec 2020 at 12:44

Hi Arthur,


We had the same with my husband in November. Some surgeries seem very strict about the date it's given but we were told a week late wouldn't be a problem as testosterone would take around a year to recover after long term HT.


He had a PSA test around a month later in December and it was undetectable so no movement.


Best wishes

User
Posted 29 Dec 2020 at 13:11

Hi Arthur, I asked the same question last year because one was due right in the middle of the crap bit of my Chemo cycle (days 3 to 10 when immune system was at lowest ebb). I was told a couple of weeks either way wouldn't make any difference, as it takes quite a while for your  testosterone level  to start going back up?

Good luck to everyone coping with the insidious big C

User
Posted 29 Dec 2020 at 15:25
Hi Arthur funny thing is when I tried to delay one of mine last year by a couple of days they insisted it was crucial that it was done on the scheduled day but when they delay it isn't an issue.
Personally I can't see if you're on HT long term that it would cause a problem.
User
Posted 29 Dec 2020 at 17:44
It depends on the type of HT. I think you are still on decapeptyl which is a 3 monthly injection so assuming today was exactly 3 months after the last injection, a few days will be fine. However, next Tuesday is a bit of a stretch and I would be tempted to phone the surgery to say you would be much happier if the rearranged appointment was this week rather than next week.

The guidance is slightly different for Zoladex which should be given every 4 or 12 weeks rather than every month / 3 months and every effort should be made to avoid it being given more than a couple of days early or late.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 29 Dec 2020 at 19:27
I agree with Lynn I was on Zoladex and from the beginning was told it was really important to get the injections done, in my case, every 12 weeks. The nurses/gp giving the implant often said it's not so important with other treatments although at the time I think Zoladex was a lot more expensive, not so now, maybe that had something to do with letting me know. I remained on Zoladex for the 3yrs.
Peter
User
Posted 30 Dec 2020 at 11:26

The bottom line is no one had looked at this until recently, but they have now done so, and it does impact your testosterone level. The main problem is in the US, where insurance companies often delay permission to buy the hormone therapy drugs - it saves them a lot of money, given they cost 25x more in the US than elsewhere. When you delay a bit every time, your testosterone level is doubled. As a once-off, that's maybe not such an issue, but not something you want to do regularly or deliberately.


Delayed LHRH Agonist Dosing Doubles Castration Levels in Prostate Cancer


The other interesting thing the underlying paper mentions if I recall correctly (it was a while ago when I read it), is that Luprorelin (Prostap in the UK) was tested on the basis of 28 day months, not calendar months it tends to be prescribed in nowadays, and even those few days makes a difference to testosterone levels.


The paper doesn't go on to say if this change in testosterone level has any impact on the effectiveness of the hormone therapy treatment. That would be another level of research which hasn't happened as far as I know. I'm wondering if the PATCH trial (using Estradiol female hormone as the hormone therapy drug) might get some incidental data on this, since they are measuring testosterone levels during treatment.


EDIT: One thing you might consider is if you think you can do the injection yourself. I did this, and it removed a level of uncertainty of getting the appointment on the right date. I was on Zoladex, which may be the easiest to self-inject (no mixing anything up, and easy self-access injection site). If you want to do this, the thing to do is to ask if you can do it yourself at your next appointment while the nurse supervises. If it goes OK, then continue doing it yourself at home if you wish to do so. In the current climate, they are going to be much more willing to let you do it than in normal times.

Edited by member 30 Dec 2020 at 11:33  | Reason: Not specified

User
Posted 30 Dec 2020 at 12:39
It is a matter of basic mathematics - a 28 day / 4 week / 12 week regime means 13 doses per year (or equivalent) while a 1 month / 3 month regime means 12 doses per year (or equivalent). If the drug is intended to be given 13 times each year, then every tiny slippage is contributing to getting less HT than you need to control the cancer.

I know that you have persuaded the medics to let you self-inject Andy but I think you are the teeny tiny exception rather than the rule ... in all the years I have been here, the only other person I can think of who self-injected was Alathays (once, because he refused to cancel his cruise and the nurse gave in under duress 😂).
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
 
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