Nerd type question - very tiny niggle - probably not a problem

Good Morning mstev2 

Having been called Alwayshope's apprentice nerd  on another thread this morning I will give you my humble opinion for what it's worth!!

The official guide lines from Prostate Cancer UK says "2/3 days late will be fine - 2/3 weeks isn't".

So this is where Mr Nerd starts getting pedantic. Your monthly injection is for 28 days - 4 weeks - so is your 3 monthly one 3 months or 12 weeks (I bet it's 12 weeks).

I was on 6 monthly Decapeptyl injections for 3 years and my GP made me stick to 26 weeks cycles.

As my old teacher said "the ball's in your court discuss whilst I nip out for a ciggy"

It's a bit like saying "how do you know it's a full pint of evaporated milk" (think about it!!).

Have a great day - Brian. 

A day or 2 is unlikely to make a difference. 

Yes every one cares.

You are likely to be overthinking things here.

When I was having my HT injections the nurse would make the appointment for me usually it was 28 days and then 12 weeks to the day unless that day happened to be a Saturday or Sunday when the surgery would not be open.

What are the details of your diagnosis?  PSA, Gleeson score, and staging etc?  This will give everyone here more idea of how to help you.

Has your surgery also booked a PSA/Testosterone test before the next HT injection to see if the injection is having the desired effect?  They usually booked me one at least 7 days prior to the next HT injection so that the nurse would have the results when I went for my HT injection.  It is something to ask about as not sure all surgeies do this without being asked.  My PSA didn't go down by much on the HT but thankfully after Radiotherapy it went down and is still down after 8+ years.

Diagnosed with PSA 13, Gleeson Score 7(3+4) Staging T2 N0 M0 but after MRI T3 disease could not be ruled out as the tumour was pushing out on the prostate edge and therefore it was thought that some miniscule cancer cells could have escaped to the local area so Radiotherapy suggested as best way to treat as it would treat the whole area - it did.

My details are in my profile, but this will help, I hope.

Staging T3b N1 M0, PSA at diagnosis 7.39, to be treated by Hormone Therapy and Radical Radiotherapy. Hormone Therapy for 6 months before 37 Fractions of Radiotherapy (74 Grays) and carrying on with HT for at least 2 years.

I'm not really concerned about this - I just thought about it whilst calculating interest for someone on a car loan, and then found it bouncing around inside my head. 

My treatment appears to be similar to yours. The Oncologist was pretty positive, and the "N1" part is literally that - one lymph node adjacent to the turmour.

It's not really overthinking so much as conditioning.

Working for the bank, and then with Citizens Advice, I have always booked things in advance and known exactly what I was doing. It is very hard to esacpe, but this is a minor thing.

The only person to discuss additional PSA tests with me is the Oncologist, who wants one for my next discussion with her in two months time (no date for that yet, but I do have the form). She told me to expect it to be significantly reduced.

Thank you for responding.

Chief nerd here (perhaps I should have chosen a different avatar name). 

As someone who was also trained into the minutiae of things I can understand your need for detail. Firstly, I wouldn't plan your diary at the moment because you will probably be moved on to the 3 monthly - but in reality 12 weeks injection for Zoladex. The 28 day one is normally to see how you react to the drug and whether it is doing its job in reducing the testosterone. If you are to remain on the 28 day cycle then the nerd in me says that as your last injection was on a Friday then I would aim to have your next one also on the Friday otherwise you are going to start having to move the cycle every so often because of hitting into the weekends if you have it on the 29th day. If you were put on something like Prostap then the drug companies recommendation is every 3 months but some doctors have interpreted this as every 12 weeks just to add to the confusion. This got the nerd in me wondering if this 1 week variation mattered and there is some evidence that moving to 12 weeks long term had the unexpected effect of increasing the testosterone levels so I double checked with the Urologist and we did a little experiment for a couple of cycles by opting for the 12 weeks and sure enough hubby's testosterone increased. When he went back to 3 monthly it came back down. Not really scientific, but interesting.

Hi

I'm an exb-banker too and I totally get where you are coming from.

I tied myself up in knots, counting days, and posing questions such as what happens in 31 day months etc. Although, I most definitely didn't set up a spreadsheet!

Anyway, I agree with the other guys, a couple of days either way won't make any difference.

However, because of my 'banking  brain' I used to have my Prostap injection early rather than late, if it was possible. Couldn't help myself!

Remember there are no stupid or irrelevant questions!

 Regards

Stuart

I was on Prostap for 3 years, starting with two 4-week injections to check tolerance and then moving on to 3-month injections. They were all done at the GP practice and the nurse always told me it should be 12 weeks and not three months interval. That does make it easier to plan on the calendar. She also told me that a week either way would be fine if holidays or something else intervened, but I should get back to the correct timing for the follow injection. We marked the calendar for the three years and planned holidays etc to avoid the injection dates which were always on a Thursday. That day suited as I was often rowing on Saturdays and Friday was the "sore bum" day in between.

Interesting,  when I started on Zoladex my surgery insisted it was a 3 monthly jab.  I read up about Zoladex and it clearly stated 12 weeks and after a short debate my practice changed their policy.  AH, I found your little ‘unscientific’ experiment interesting and wonder if anyone has researched delaying the jabs by longer than a week.  If the object is to reduce the PSA score, could altering the dosage (either by having a reduced dosage quantity or longer timeframe) actually be beneficial?  I wonder what research was initially undertaken to validate the strength and timescale to the manufacturers?  Is this even contributing to the PCa resistance over time?  My mind is going overtime.  No such thing as a silly question. David  

Hi David. You have to go back a long time when the drugs were first developed to get to how the most effective dose eg.  in 1999 for Leuprorelin there were trials with 7.5 mg per month. Initial trials are often done in mice and then extrapolated up for humans. The drugs then have to go through phase I, II and III trials which usually refines the dose and records the side effects. Once peer reviewed it then has to get government approval before it can be used by the general public. I can't find the paper at the moment which did the analysis I based hubbys informal trial on but seem to remember that it was related to the the time until biochemical recurrence. I think it was also to do with research into intermittent hormone therapy which can also extend the time to biochemical recurrence so yes, trials have been done in this area.

Thank you, as always.

I'm taking Zoladex and my next injection will move over to the 3 month interval.

I checked with the manufacturers information and they say "12 weeks (approximately 84 days)" - although for my money there is no approximate about it - 12 weeks is 84 days.

The initial 28 days injection has left me with no side effects so far, so I foresee a conversation that goes:

"How are you?"

"OK."

"Anything fallen off?"

"No".

"Ok. Here's the big brother".

I suspect that there will be side effects down the line because I can only imagine that they kick in once the testosterone has fallen to a low level. I can't find any information on this yet, though I haven't looked hard.

I have been too busy playing silly whatsits wondering about how the calculations are actually carried out.

My intention is to use the 12 weeks measurement because I can then make sure that it doesn't clash with either Christmas 2024 or Easter 2025.

I will also try and avoid some of the rabbit holes I have been falling down.

When you're planning ahead, if you find that there's a clash of dates you can always ask for a 4-week injection to move the schedule a bit.