Advanced Prostate Cancer
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Dr. Myers "Aging With Prostate Cancer"

Latest vblog post by Dr. Myers.

A couple of interesting points to me:

a) the concept of drug clearance & dose adjustments. Myers is speaking in the context of clearance mechanisms becoming less efficient with age. Levels of a drug in the circulation can be much higher than intended. Side effects in some may not be due to being over-sensitive, & lowering a dose may not reduce efficacy, if clearance is sluggish.

I had my first & last colonoscopy about 5 years ago. I was warned that, owing to my drinking habits, one of the three drugs in the sedative might not work. A few minutes into the procedure, I was becoming very uncomfortable. I saw the technician nod to the nurse, & she gave me more of the sedative. It made no difference at all & the procedure was quickly halted.

My wife - the designated driver - was expecting to drive me home to bed, but I suggested a nearby Thai restaurant. Ignoring her frowns, I had a couple glasses of red wine with the meal. Was alert for the remainder of the day.

It seems that my liver is a bit hyper & quickly metabolizes some drugs, including alcohol. This is the opposite problem to the one that Myers mentions. Presumably, some drugs are ineffective for me at the standard dose?

Perhaps there will be a test one day, to determine a dose adjustment factor. Is weight & height ever taken into account?

b) Myers speak of using 'Castration-Lite" on some patients - of wanting to preserve testosterone levels. I wonder how many other oncologists give that a try?

Myers' Castration-Lite is Avodart + Casodex. i.e. no Lupron, etc. I was surprised that some do very well on it long-term. I remember reading that Casodex was approved as monotherapy in Germany, & thinking that was odd. In 1995, it was approved as an add-on to Lupron (or similar drug) in the U.S..

The antiandrogen Casodex is outclassed by Xtandi these days, I suppose.


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Chemical castration and physical castration haven't brought my testosterone levels down below the 20-or-less therapeutic level....... My current testosterone level is 44.20---and that is after having an orchiectomy last November 18, almost six months ago. It's even popped up as high as 98 a month ago.


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Besides castration not effectively lowering my testosterone level, I've been aging at an estimated rate of 10 years for every year of treatment. I feel that my physiological age is now 90 instead of my chronological age of 67.




Casodex at 150 mg without any other ADT drug (as opposed to 50/mg with other ADT drugs in the U.S.) is one standard of care in parts of Europe. I do have a few guys who have elected not to go on to traditional ADT when they have been faced with progressing disease and instead have used Casodex as a monotherapy.

Generally, they have been able to do this for a decent period of time before they have decided to move on and add additional drugs. I can report that during their Casodex only periods they had a better quality of life then when they did add other drugs.



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