I have read hundreds of case histories of PCa because the best predictor of the future is to study the past. The usual scenario...BCR after primary therapy or mPCa at diagnosis. At this point you can do a PSMA scan or Choline 11 scan to locate the hot spots. If Oligo ( 5 or fewer) go after the PCa again with radiation, which almost always fails because radiation selects for the most aggressive 5% of cancer cells which survive and go on to form tumors....or scans reveal more than 5 hot spots so Lupron is started with or without taxotere and the PSA goes <.1. But, lupron fails after 3 cycles and now you have mCRPC. Time for Zytiga and Xtandi and both fail between 6-18 months. The DT keeps getting shorter so time for another dose of Chemo. The Chemo knocks the PSA down but just like with radiation selects for the 5% super aggressive cancer cells and stem cells which survive and go on to form a tumor which is resistant to all therapy. This leads to something far worse than mCRPC that only has one benefit...you no longer have that damn urge to go after the Ladies with LFIDS (little friend is dead syndrome). This condition is called SCDS (stone cold dead syndrome).
But check this out there may be another way...LIM (less is more) which also in 75% of the cases preserves muscle mass, cardio vascular health, no brain fog, and sexual fuction...what is this miracle...IADT with only 50mg of Casodex. Check this dude out...18 years and still ticking.
I can't believe that over all these years (casodex approved in '01, as noted), it has not been studied in depth. Until generic came along it also was pretty expensive. I agree there can be potential benefits but:
There are some potential side effects (always!!!); here's a quick! listing: flushing and sweating (hot flashes),
body aches and pains,
back pain, pelvic pain, joint or muscle pain, breast swelling/tenderness/pain, headache, dizziness, drowsiness, trouble sleeping, increased nighttime urination, weakness, hair loss, weight changes, constipation, diarrhea, stomach upset, gas, nausea, vomiting, loss of appetite, impotence, loss of interest in sex, trouble having an orgasm, sore throat, runny nose, or other cold symptoms.
.. serious side effects of Casodex including:
vision changes*, numbness or tingling of the hands or feet, swelling of the arms or legs, unusual or easy bleeding or bruising, changes in the amount of urine, painful urination, signs of infection (e.g., fever, chills, persistent sore throat), trouble breathing, persistent cough, or mental/mood changes (e.g., anxiety, depression).
Are those worse/better than the side effects of Lupron et al? Then there (now) is estradiol patches.
I continue to be amazed that I've experienced few side effects on IAD-3 over 15 yrs.
*Note: I pursued this and it apparently is a very questionable assignment.
Gus, no surprise. I think the vendor is required to document any side effect reported by anyone. I've had vision problems so I did chase that to the source of the statistics. It was a small, very small number of persons and probably had nothing to do with casodex.
a) As you know, bell curves have long tails which reveal only possibilities, not prognoses.
b) Every time I hear of such cases, my first assumption is that he didn't have cancer, that he just had the usual Gleason 6 bug and would have fared even better if he had never even discovered it.
Thanks for that post. I hope to get off ADT when my six month eligard shot wears off. Chemical castration isn't fun.
Gus," The intermittent approach failed in delaying castration resistance. There is also no overall survival benefit." Then why IADT? If monotheray, why not 150 mg. of Casodex ?
Big Rich: my understanding is that 150 mg/day of casodex can have real, big time side effects; I think liver. Plus, I don't think it's acceptable==legal protocol in USA. Gus's paper even notes that the German patient was tested regularly when he was on 150 mg.
My guess is estradiol patches are safer/easier/betterererer!
Many. Ways of applying this therapy. I started out to find the lowest dose to control the psa and titrated up to 50 mg per day, then finally toward the end of 7+ yrs 150 mg and stopped working. Now moving on to either xstandi again or save it and try nylutamide or any other reasonable options were fortunate to have. The best. Rocco
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What follows Lupron and Zytiga?
PSA rising…..Duke Champ? 
Treatment after Taxotere
