Stopping Avodart

[ewroge]

I was at my uro yesterday (8/26) an received a 3month injection of Lupron. I have been taking Avodart (now Dutasteride) for years, he said to stop taking it as it does no good. Is that an accurate assessment?

Ed Roge

[Dan59]

Ed,

I am under the impression that Avodart blocks a more potent form of testosterone not so much affected by the Lupron, that is called dihydrotestosterone or DHT. Some schools of thought believe high DHT is suspect to feed PCa. It is also used in cases of benign prostate hyperglasia or BPH (enlarged prostate) causing weak urine flow. It is a very benign drug< I have been on it for all 10 years of my stage 4 journey. DHT is a more powerful form of testosterone , perhaps a DHT blood test would be appropriate. then again it will be low while you are on dutasteride.

Dan

[Dan59]

I would also like to say that it is good to be followed by a medical oncologist specializing in Prostate Cancer while on Lupron, and if that is not possible just a good medical oncologist.

[Arrayscout]

I believe that if Lupron is suppressing your DHT to <5 nano per mil alone then the Avodart is not needed. Lupron is usually very effective at suppressing DHT as well as T. So you have to check your DHT to know this. Remember, Avodart has a long half life so you'll need to wait a while after you quit before you check your DHT. I'm not a doctor but I have been down this path. I take Avodart three times per week today but I'm not on Lupron. Best of luck.

[Spitzz]

Questions Beget Questions

1- You're looking for a short answer to a LONG QUESTION

2- Avodart handles several problems,

1) Urinary

2) Testosterone blocking characteristics

3) Who recommended the Avodart in the first place, an oncologist or the urologist?

There is what is called "Triple Hormone Therapy - Casodex, Lupron and Avodart"

For what purpose were you taking Avodart ??? (see link Below **)

BTW - I'm no doctor, but without any greater detail I have to ask, is your PC being treated by an Oncologist or a Urologist?

Also, when I started down this path in 2001 I was on Triple Hormone Therapy of

Casodex, Lupron and Avodart for 15 years.

Since then I've crossed over to Zytiga, Lupron and Avodart. When I transitioned to Zytiga I asked my Oncologist should still take Avodart, the answer was a DEFINITE "YES"

I leave you with these words, ASK YOUR ONCOLOGIST....

Best of Luck

**

ustoowichita.org/pdf/Triple...

[pjoshea13]

Ed,

When the FDA approved Dutasteride (Avodart), it was for BPH (benign prostatic hyperplasia). It has never been approved for PCa in the U.S..

When men are on Lupron, most doctors will assume that by getting testosterone (T) very low, they have also reduced dihydrotestosterone (DHT) to an insignificant level. The reasoning is that, since Avodart blocks conversion of T to DHT, it becomes increasingly irrelevant as T enters the castrate range.

Dr. Myers has spoken about this. Some men continue to produce significant levels of DHT while on Lupron. Myers is annoyed that DHT is rarely tested while men are on Lupron - after all, the purpose of Lupron, ultimately, is to prevent DHT-stimulated proliferation.

He tests for DHT & uses Avodart when necessary, but tailors the dose to get DHT below 5. Sometimes, one pill / week is enough.

But there is something else to consider. One of the routes to CRPC involves the generation of DHT via alternative pathways. Since this happens within the cancer cells, a DHT blood test might not be useful. My understanding is that Avodart continues to be effective in this scenario.

I wouldn't abandon Avodart.

-Patrick

[herb1]

Nalakrats:

I completely agree with all the answers provided-FROM THE TECHNICAL SIDE. BUT, we need to deal with the fact that some MD is the gatekeeper and must provide a script. I'm ok with a doc who shrugs and provides the script, but what to do with the doc who just says "NO!"? I know, change docs.

Herb S

[Dan59]

I bet he would agree to you having it if you suggest you have a bit of frequent urination and sometimes hard to get going,if not see Herb 1 comment on this thread

[JoelT]

All

Of the explanations are excellent and make a lot of biochemical sense, however there is no research evidence that I have read that shows that Avodart extends life or delays the onset of castrate resistance.

If it does not do either then why take it?

Like any other drug and despite it having been characterised as a benign drug it does have side effects and it does cost money.

Given these two factors I have decided not to take it despite the occassional flack I have received from others.

If anyone has any good studies that show that Avodart does extend life, improves the quality of lofe or delays the onset of castrate resistance please share the cotations.

Joel

[Annoos in reply to JoelT]

Hi, in 2009 or 2010 I started seeing symptoms of BPH and visited a Urology doctor and after he did all the tests he prescribed Avodart .5 mg and Xatral 10 mg to be taken daily 1 Avodart capsule in the morning and one Xatral in the evening. I have been taking them since then, however in 2015 I went to another doctor and he suggested that I reduce the dose to every other day for Avodart and every day Alfozusin 5 mg instead of 10 mg and every year I go and do the PSA test and other tests and the results have been very good.

Best of Luck to all

Anas

[herb1]

Nalakrats:

I've realized an interesting scenario is developing. When I went looking at replacement urologists, I realized that just about ALL of them now were part of one large group. The "group" seems to be more for administrative purposes but I'm not really sure. It may be difficult to get out from under their umbrella. I'm starting to ask myself whether this is becoming "restraint of trade".

herb

[herb1]

guys,

Avodart is now available as a generic right here in the USA--finally! I get mine from my Drug D plan, with Walmart as the mail order agent for my Cigna plan.

Herb

[JoelT]

Nalakrats,

Actually, Zytiga (abiriterone) does shut the adrenal gland and its production of T. I am not arguing that Avodart does benefit us and has a role in the production of T and DHT, but there is no evidence that it does.

I learned a long time ago that the human body is a mystery and what we think makes sense might not. Again and again I have been surprised when evidence ends up not supporting what seems to be so logical.

It does concern me when we make decisions on what is clearly logical, but ultimately does not come out in the wash.

Why aren't there studies supporting the use of Avodart, there are studies supporting the lowering of risk of developing PC, but none showing that it extends life of men with castrate resistant PC. Why not? We need to always ask these important questions, why not?

I do know that there are some very smart doctors who are major advocates for the use of Avodart, I do know that they are smarter than I am, but I still need to ask where is the evidence?

Avodart does not come without side effects, some that can be significant, like heart issues and of course painful breast growth.

My attitude is that we need to know that there are risks (this is not debatable) and there might be benefits, but again without seeing the evidence the use of Avodart might not add anything to out treatment efficacy.

Like all of our drugs, use it with your eyes wide open.

Joel

[BigRich in reply to JoelT]

Joel,

I agree with you. I understand the logic in using Advodart, but I think of the earlier recommendations for selenium and vitamin E.

Rich

[JoelT]

Thanks for the support. Historically I ave been a lone wolf when I share my thoughts on this item.

Joel

[BigRich in reply to JoelT]

Joel,

I am in the process of working with Vickie to secure an appointment with your urologist.

Rich

[Break60]

Very interesting thread which I stumbled on due to discovering a met in my femur after axumin scan as PSA was doubling monthly and reached 2.3 .

I was on dutasteride, finasteride, metformin, cabergoline after stopping Lupron and casodex last November. After finding the bone met, I'm back on ADT3 and researching SBRT to the bone metastasis. Based on what I'm reading here I'll stay on dutasteride but wonder if finasteride adds anything. I'll also stay on metformin and cabergoline and have been advised to start xgeva. I'll also go back on vitamin d3 and calcium.

Any thoughts?

Bob

[Hidden]

I have to take exception to this statement:

"Because DHT is a gourmet food source for prostate cancer cells. Yes sugar is another source"

Sugar and Testosterone play very different roles in the cell, and in cancer.

Sugar, glucose, is an energy source, yes. ATP in practice.

But testosterone is a signal. It causes a deformation in the AR, which deformation apparently allows the AR to move into the cell nucleus. I conjecture that the Ligand Binding Domain inhibits the entry of the AR into the nucleus, and the binding of an androgen to the LBD deforms the AR in such a way as to prevent the LBD from keeping the AR out of the cell nucleus.

But in any case, the comparison of testosterone to fuel seems to shed a very dim light on its role in the cell biology. Like the "seed and soil" image used to "explain" metastases, many of these simple models are outdated and long past useful. IMO.

[Hidden]

Why is it helpful to think of testosterone as "food"?

Actually, is it even consumed - do we even know that?

[Hidden]

While some cancers can be detected by their increased glucose uptake, that is by using glucose as contrast medium for imaging, that is not true for prostate cancer, except in late stage, sometimes after choline imaging has failed. Dr Kwon talks about this. I can probably find a reference if you like.

Prostate cancer cells rarely have increased glucose uptake that can be exploited for purposes of imaging contrast. Instead, other contrast agents are used.

[Hidden]

By model, I mean that "food" is an analogy. It is not food in the literal sense. It may be "like" food. "Like" in what way or ways? My question is what insight do you get from the analogy? How does it help you understand what is going on? What characteristics does testosterone share with food? Same complaint about "seed and soil".

[Hidden]

Neuro endocrine prostate cancer seems to be an increasing level of risk as a complication after abi or enza. (my general impression). The University of Iowa is studying a radiological treatment that has been used for many years in Europe. Its a targeted drug with a radioactive payload; beta rays rather than alpha rays.

Some places are counting CTCs using CellSearch (cellsearchctc.com/). This can only get more popular.

[leswell]

Thanks to everyone for this discussion. I must look up cabergoline, Bob, We are still hoping for Casodex, Avodart, and Proscar. AND VANTAS! Orchiectomy has been suggested, but we’re holding back to keep hope alive. Anyone wish to talk about that? 😔. (Reminder: Leswell has had 6 cycles of chemo and 14 Lupron injections + initial double Firmagon with no surgery or radiation due to lymphedema.) I say continue the Lupron until mCRPC. PSA is going down by leaps and bounds right now. Btw, he is on Metformin and DIM—but not BIRM yet. Broccoli and coleslaw daily. P.S. The Life Extension Foundation considers T a life extension agent—just not for Stage Four PCa. What a trap this disease is! Mrs. S

P.S. Happiness is the harvest—and 4 trapped voles. Mr. S just brought me one on a spade for photo identification. They ate the peanut butter, so they can’t be moles, right? One deer feasts nightly. Maybe if the voles were moles they would eat Japanese beetles?