Question For The Board

[gusgold]

Lupron has side effects like CVD, brain fog, and loss of sex drive because it wipes out T production. Also because of castrate T, DHT is usually not a problem. Casodex has fewer side effects because T is not lowered but DHT is still a problem. I just read a study where Casodex + Avodart was just as effective as Lupron in controlling PCa. So, why take Lupron when you can take Casodex + Avodart and lessen so many of the side effects of Lupron therapy.

[rococo]

Its called sequential androgen blockad. I have got 6 yrs+ from it. Some get. More some get less but some get an adverse effect with casodx feeding the cancec. No test l know of to predic. Goodluck

[pjoshea13]

Gus,

I already use Avodart, & I expect to ask for Casodex without Lupron when the time comes. Essentially, because my aim has always been to put off conventional ADT until I have no choice. (Primarily because of the short mean time to failure.)

I only learned in the past year that Casodex as 'monotherapy' is not uncommon in parts of Europe.

The question is - who does well on Casodex+Avodart without Lupron? Can you find a link to that study you mention? Thanks.

Presumably Xtandi+Avodart would be better - Xtandi does not become an AR agonist..

-Patrick

[gusgold in reply to pjoshea13]

Patrick...I think it would be better to use Casodex+Avodart then move on to Xtandi+Avodart when Casodex fails. Also, most insurance won't cover Xtandi until you fail Casodex...and at $10,000 a month you would need some kind of financial help with Xtandi without insurance

[BigRich in reply to pjoshea13]

Patrick,

I am doing this from memory. Dr. Parr discusses his study, which answers your question, in Urology Times.

Rich

[BigRich in reply to pjoshea13]

Patrick,

I am doing this from memory. Dr. Parr discusses his study, which answers your question, in Urology Times.

Rich

[Pguenette]

After discovering a met in bladder wall, and confirmed prostate cancer by needle biopsy, my Onc put me on double continuous ADT nearly 2 years ago with Eligard+Casodex. Minimal side effects, tolerable at least, and an undetectable PSA. Check and Eligard shot every 3 months.

[herb1]

Gusgold: Good question about mono therapy with Casodex. First, I believe the european protocol calls for 150 mg/day of Casodex. I suspect (do not know) that that would be more apt to lead to side effects than 50 Casodex+Lupron. Of course, varies by person. Casodex can cause liver problems, breast enlargement that I'm aware of.

But, in both cases the frequency of problems AND THEIR REVERSIBILITY are being ignored. With either you can stop pretty quickly but will the side effects diminish/vanish? Very subjective issue again. I do not believe the breast enlargement by Casodex reverses easily. Lupron side effects (e.g., hot flashes, brain fog, etc. ) do reverse, but often NOT quickly. Cardiovascular problems from Lupron? I'm not sure those are reversible IF they occur.

Herb s

[cfrees1 in reply to herb1]

I am in week 7 of 8 weeks of adjuvant radiation therapy. I am also on Lupron. In discussions with my Radiation Oncologist, the topic of reversal of side effects like breast enlargement (gynecomastia) came up and I was told that the breast issue would not reverse when i stopped taking Lupron. He suggested 3 radiation treatments to my chest to increase the likelihood that I would not suffer from gynecomastia. We'll do those in the next week. Has anyone else tried this? Did it work?

[PaulC2 in reply to cfrees1]

Yes.

In 2008, After surgery and a clinical trial had failed to stop my PSA increase, I signed up for radiation + ADT after thoroughly researching the benefits and drawbacks. Early in my treatment course, I underwent radiation to the nipple area bilaterally as a preventative measure.

I've experienced no gynecomastia and no increased tenderness/sensitivity during any of my multiple courses of ADT, unlike many men in my support groups who had ADT without prophylactic radiation to the breasts.

I understand That the radiation put me at increased risk for breast cancer, but that increased risk (from negligible to tiny) seemed a small cost to pay; and similarly with the temporary loss of chest hair surrounding the areolae.

[Hidden in reply to PaulC2]

I am only just starting on this journey. I insisted on, and am taking, casodex now in preparation for a 6 month eligard shot. When I raised this issue of gynecomastia and the idea of radiation of the breast area to prevent this my 2nd opinion urologists scoffed at my concerns. Easy for him to say -- no problem for him. It seems like a lot of urologists need some further education or enlightenment. Oh, and urologist #1 didn't want to prescribe casodex but urologist #2 recommended it. No surgery for me -- just ADT and radiation.

[herb1]

gusgold:

here's some more Casodex info I also provided in another response.

a. If you're concerned about Lupron side effects, look up Casodex-it ain't baby powder!

b. Since I just re-started Casodex yesterday in anticipation of my 4th Lupron cycle, I checked some aspects out:

Casodex shelf life: 5 yr!...half life 5.9 days. Does that mean I should be able to take it every other day...or even farther apart??? Reaches steady state plasma level of 9 ug/ml with daily dosing.

herb s

[PaulC2 in reply to herb1]

herb1:

a. The side effects of Casodex are certainly worth noticing, even though for most men they're much easier to tolerate than the side effects of Lupron.

b. Shelf life and half-life have almost nothing to do with each other. Example: The shelf life of a pint of water is almost indefinite, with proper storage -- it won't become any less wet after years and years of sitting on the shelf. But its half-life within the body is quite short; on a hot day, or during exercise, you might well respire, sweat, or pee out half that pint in only a few hours.

Some medications don't require a high constant minimum (and/or can be tolerated at a high dose), and with them, it's OK to allow your body to experience the high peaks and low troughs it would experience if, for example, you were to drink water only twice a day and go without for 11 hours between -- not the optimal level of hydration, but tolerable. But this is not true of other medications, and it is dangerously untrue of still others. To take a silly example: If you suffer from a bad headache once a month, taking two Tylenol just as the headache begins is just fine, whereas taking 24 Tylenol on January 1st not only won't prevent the twelve headaches you expect later that year, it will kill you.

Most medications have dosing regimens on their labeling that make very good sense for their physiologic effect on the body. Halving or doubling the amount or frequency is sometimes safe (and sometimes not), but a deviation by a factor of 2 usually makes the medication less effective.

[herb1 in reply to PaulC2]

paul C:

I never said there was any correlation between half life and shelf life.

I'm back on Casodex and needed to check the shelf life of my bottle. I'm sure the label says discard after 1 yr. It was only when the govt tested a large assortment did we learn that we are too conservative with many drugs.

As for 1/2 life, you may be right, but the only data I could find was that a steady state level of 9 ug/ml serum is obtained with daily dosing. But no info on what level is needed. Considering the relatively long 1/2 life, an acceptable steady state dose may be achieved with alternate day...or longer dosing.

herb

[PaulC2]

gusgold:

For most forms of PCa where ADT is worth considering, Casodex+Avodart will NOT be as effective as Lupron over the long run. I'd be fairly sure that the study you read has qualifications and circumstances that restrict its findings to a subgroup of PCa, perhaps only a small one, or limited to a short period of time.

That said, it is certainly true that, for most men, Casodex+Avodart is easier to tolerate than Lupron, and carries a far lower risk of metabolic syndrome (obesity, diabetes, heart problems) and of other problems like diminished bone density and increased risk of depression.

Therefore, for men whose PCa is unlikely to recur (e.g., when ADT is being given in conjunction with primary therapy in a low or intermediate-risk case), Casodex+Avodart might well be the better choice, since quality-of-life would probably be the more important consideration. I might also be the preferred "gateway" ADT for men whose PCa is likely to progress who aren't psychosocially prepared for full chemical castration.

But a very large contraindication, at least in my opinion, for men with advanced PCa who are in it for the long haul, is that, for many men, Casodex seems[*] to hasten the mutation of PCa from androgen sensitivity to castration resistance. I think this is what rococo was referring to when he wrote about the "adverse effect of Casodex feeding the cancer".

[*] -- Caveat: This finding is comparatively recent (within the past 10 years) and not universally agreed upon.

[gusgold in reply to PaulC2]

Paul if Casodex stops working why not move on to Xtandi + Avodart......Long time Lupron use is a greater killer than PCa....Dr. Myers says far more men with PCa die from the CVD caused by Lupron then from PCa itself.