Advanced Prostate Cancer
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Bicalutamide (Casodex) plus Dutasteride (Avodart)

New Dutch study 1] below.

The rationale behind the combination of Casodex & Avodart was articulated in a 2009 paper [2]:

"Bicalutamide blocks androgen action in men with prostate cancer but has low affinity for the androgen receptor compared to dihydrotestosterone (DHT). Dutasteride, a dual 5-reductase inhibitor (5ARI), blocks the conversion of testosterone to DHT, reduces tumor volume and improves PSA in prostate cancer. Bicalutamide should be a more effective antiandrogen if it competes against intraprostatic testosterone, rather than DHT, for the androgen receptor."

Casodex with Avodart was used in a 2006 study [3], where a 3-month treatment prior to brachytherapy led to a substantial reduction in volume:

"The prostate gland and transition zone volume reductions after a 3-month course of neoadjuvant bicalutamide and dutasteride are comparable to previous reports of volume reduction using a luteinizing hormone-releasing hormone agonist with or without an antiandrogen."

Similar to [3], a 2016 Canadian paper [4] reported that:

"Dutasteride and Bicalutamide is a regimen of non-inferior efficacy to LHRH agonist based regimens for prostate volume reduction prior to permanent implant prostate brachytherapy."

In a 2025 study [5], "comparing the addition of bicalutamide with or without dutasteride to GnRH analogue therapy in men with non-metastatic castrate-resistant prostate cancer":

"The estimated median {time to disease progression} was 425 days ... in the bicalutamide/placebo group and 623 days ... in the bicalutamide/dutasteride group."

However: "In men with non-metastatic CRPC, adding dutasteride to bicalutamide did not significantly prolong {time to disease progression}."

In the new study [1]: "Bicalutamide monotherapy versus combined bicalutamide plus dutasteride therapy for patients with locally advanced or metastatic carcinoma of the prostate".

"At 3 years follow-up, PSA progression was found in 52 patients [65.8 % ...] in the monotherapy group compared to 38 patients (53.5 % ...) in the combined therapy group ...

"At the time of analysis 37 men (46.8 % ...) in the monotherapy group had died versus 30 men (42.3 % ...) in the combined therapy group. Median survival time was 5.4 and 5.8 years, respectively"

"... despite a trend toward higher efficacy of the combined therapy, progression-free survival and overall survival was not significantly different between the groups."







2 Replies

The classic "triple blockade" is Lupron (or Firmagon), Casodex and Avodart.

And Firmagon, while the injections are painful, doesn't have the characteristic "testosterone flare" of Lupron, when it's first administered. And I don't like the three-month injections of Lupron---it limits the options to change, if there are adverse effects. A one-month Lupron injection can be effective, and yet if the individual experiences bad side effects, he's not stuck with it.



Thank you for the information. I look forward to reading your posts.


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