Cassodex ONLY for ADT treatment

[mklc]

Is there any danger to using Cassodex ONLY as the ADT treatment?

This is after RP and radiation.

Not wanting to have the side effects from Zolodex & Lupron.

Thank you for any advise.

[Dan59]

Welcome to the group. Of course you will need to give your stats for anyone to comment on this. However casodex only blocks a small percentage of the testosterone , only those produced in the adrenal glands. Lupron, zolodex ,eligard and those type drugs block the main source of testosterone is the way I understand it. There are many ways to mitigate the side effects of lupron type drugs. And if you need adt ,the side effects of lupron are far better than the side effects of not taking Lupron, which of course is the ultimate side effect.

I wish you the best

Dan

[mklc in reply to Dan59]

Thank you Dan. I have posted my pc history and treatments. Your opinion on: 1) how long to be on ADT (9, 12, 18 months) 2) adding zytiga & predisone to ADT (per Stampede trial) 3) When to restart ADT (my present doubling is 3 months). Many thanks.

[Dan59 in reply to mklc]

Hi mklc,

First of all I am not a Doctor, I am just a fisherman fighting CRPC for 11 years The only stats I see are that you had RP in 2006 (congrats on kicking the bastard for 11 years) , and that you did adt twice once in 2009, and again in2015, I do not see Gleason score or wether you ever had confirmed metastatic disease, or what your psa was when starting adt, and if, and how long were you undetectable .In the past the thinking of some was that after 12 months of undetectable one could go intermittent. At any rate there seems to be a recent paradigm shift in APC, with the old being to take the least toxic drugs first, and to move to stronger drugs as the lesser failed, This is what I did , and I think what you are proposing. this left lots of drugs in the future . With the current Paradigm shift they seem to be hitting it harder earlier while the body is strong and cancer volume low for increased survival, ie the Stampede trial with zytiga and also doing early chemo with initial adt, basically hitting it hard early in hopes of durable remission. That is the proven new school of thought in APC. I do notice that when people posted their stats a month ago with how long ago they were dxed, there was only one that had similar stats to me from 11 years ago, and that Man, Gourd Dancer went through a heavy protocol with Dr Robert Amoto in Texas and is still undetectable after hitting it so hard early. You can search his name on here and see what it is that he did. I would also like to mention when I did xtandi, it reduced my testosterone to 0 making Lupron not needed.

wishing you the best whatever you do

Dan

[Ian2017 in reply to Dan59]

Have you done the ADT + early chemo option?

[Dan59 in reply to Ian2017]

When I was diagnosed that was not the standard as it is now, I wish I had , But I did not do early chemo with adt

[dockam]

Casodex competes with the receptors in prostate cancer for testosterone - it occupies the spot and doesn't allow testosterone to attach and will prevent cancer from its uptake. This could assist in preventing PCa growth. What are your stats? When were the RP and radiation?

Best to you - Randy

[mklc in reply to dockam]

Hi Randy, I have posted my treatments and history. Any opinions are appreciated. Many thanks.

[Notsdr]

Dockam is correct. Casodex (generic bicalutamide) is an antiandrogen. It does not lower testosterone. In fact, when a patient uses casodex, testosterone increases because the casodex is preventing the testosterone from entering the cells (thus more remains circulating in the blood to be measured - in my case, T increases from about 300 to 700). I have been on 50 mg. intermittent bicalutamide monotherapy for more than 2.5 years (post RRP, post IMRT, post BLPLND). Side effects are pain in breasts and gynecomastia. My PSA ranges from about 12 to 40, but the nadir is still about 12. After nine years post diagnosis (2008, PSA 136 pT3bNOMX), GS 4 +3 w/5), I am still hormone naive and have never used "standard" ADT (agonists or antagonists). Like MKLC, i wish to avoid the side effects of standard ADT for as long as possible, and stay hormone naive for as long as possible. I see no reason to keep PSA at ultra low levels provided growth of PCa is controlled. In other words, my PSA was about 12 in 2012, and it still is about 12 . The standard dose in Europe, which approves casodex for monotherapy, is 150 mg., but that dose can also adversely affect the liver.

[BigRich in reply to Notsdr]

What is BLPLND?

Rich

[Notsdr in reply to BigRich]

"Bilateral Pelvic Lymph Node Dissection". This was done at Mayo Clinic in Rochester in 2013 after a 11C Choline scan detected 5 positive lymph nodes.

[pjoshea13]

I was surprised to discover, a year or two ago, that Casodex monotherapy isn't uncommon is some parts of the world. It seems very attractive to me, since one avoids the morbidity of castration therapies.

Personally, I would couple Casodex with Avodart. Dihydrotestosterone [DHT] is the real target of androgen-related therapy. Avodart will limit the availability of DHT to the androgen receptor [AR], & Casodex will further limit access.

Over time, Casodex, which is an anti-androgen, i.e. an AR antagonist, can become an AR agonist. Regular PSA testing will indicate whether Casodex has stopped working.

-Patrick

[bldn10]

Casodex is not w/o its side effects either. If breast enlargement will be a problem for you, you need to address it before starting the Casodex.

[spinosa in reply to bldn10]

that's for sure...

[Hidden]

I don't see any reason not to use Casodex if it is working. I would keep a close eye on the liver enzymes though.

My AST and ALT spiked up after I started Casodex to deal with the T flare of Lupron. I'm not sure it was by caused Casodex but I was only on it for week. They went down to normal levels after I stopped using it.

I may end up trying it again later someday when I become castrate resistant. Hopefully, that will be a long time from now.

[Dan59 in reply to Hidden]

Important to note there are other aa in that class that may work when casodex does not. For me casodex spiked liver numbers,but nilandron did not And worked very well at stabilizing psa.since casodex no other drug spiked liver numbers,and I have tried them all. Though I always did them in combination with zolodex.

[Hidden in reply to Dan59]

Yes, I plan on going to Enzalutamide when I become castrate resistant. That is, of course if something better is not available. Enzalutamide is around 5 times more effective than Bicalutamide (Casodex).

[ewroge]

I have been on Lupron for about 4 years. It is very debilitating and causes numerous

side affects. I know of no way to reduce them. Sorry I could not be of more help. Maybe someone else has some thoughts on this problem.

Ed Roge

[Caring7 in reply to ewroge]

My husband has mostly bad hot flashes but they are manageable. He's contemplated estrogen to counteract but has not chose to do that. He has tried antidepressant for the moodiness, and that helped quite a bit. Some antidepressants are also supposed to help some men with the hot flashes.

He has body changes too but not too debilitating. Maybe try a nutritionist consult? Or seeing if you can extend time between Lupron shots? or some other options? The hot flashes are alone are pretty awesome to witness, and I'm sorry you are having so many side effects.

[Hidden]

Casodex in wikipedia en.wikipedia.org/wiki/Bical...

It seems to be used by itself in Europe (150 rather than 50), so it may not be that unusual.

It is not done that way in the USA.

Martin000

[DennisDworak in reply to Hidden]

Excuse me but I beg to differ. I had an RRP in 1995 & my PSA stayed very low for

over nine years. It than went up & in 2004 my Uro had me take 76 Gy of radiation to the Pelvic bed. That helped but it started going up again. So in Nov. of 2012 he sent

me to an Oncologist at the Vince Lombardi Cancer Clinic in Green Bay, WI. My PSA

at that time had risen to 13.1. She immediately put me on 150 Mg of Casodex daily.

(that's the max) On my next visit with her my PSA had fallen down to 0.84. I have been

on that dosage since than (over 5 yrs now) and my PSA has stayed low. At one time

it was down to 0.08. I go in for a check up (with Dr. Nancy Davis) every 4 months &

she watches my blood levels like a hawk & so far there has been no problem with my

liver or other blood readings. My PSA has krept up slightly over the years to 1.18 but

at my most recent checkup it had gone down a bit to 1.09. So she says we will just

be staying the course for now unless something changes. She has another patient

on Casodex (bicalutamide) only longer than me & she said he is still doing ok also.

So for now I am tolerating it ok & am glad to be around to enjoy my 5 grandchildrens

school & sports activities. Just to be sure there are some side effects to this.

I have a bit of gynecomastia and my genitals have shrunk up a bunch. And I am

not able to have an erection even with pills etc. but at my age 74 it does not concern

me. (and my wife is ok with that) I'm just glad to be reasonably healthy and am able

to work 2 part time jobs & also pass my school bus drivers physical and enjoy life.

My original Uro told me in 1995 that I would probably have 15 yrs max. Well I sure

fooled him. He was a tennis addict and retired to Fl. so he could play tennis every

day and a few years later I saw his obit in the paper. And the new Uro I had has

also been long retired. So that's my .02 cents worth and I guess every person

has to make up his own mind on all these issues. Just a note: It is with a sad

heart that I lost one of my good friends ( a buddy since Hi school) a few weeks

ago. He was 76 and seemed to be in good shape and was a hard worker

(physically) all his life. He had had a hip & knee replacement some years ago &

seemed to be doing ok. And had recently passed his bus driving physical.

Well he went out to pick & gather up apples from the tree in there yard and

fell over dead of a stroke/or heart attack. So U just never know when your

time is up.. Enjoy life while you can.!!!!

Dennis Dworak

Kewaunee, WI

.

.

[Hidden in reply to DennisDworak]

cool.

[roncyn in reply to DennisDworak]

97 for me GS 9 extra capsule penetration .. Doc then said 3 years will be 20 next month... Been on several protocols over the years and been through 4 uros .. Lots of urinary disfunction over the years from imrt...

Ron

[Hidden]

Oncologists believe there is a survival advantage in reducing testosterone produced by the testis to the lowest value possible, when compared with casodex only. The combination of lupron and casodex may be even more beneficial.

Lupron and similar takes care of 90 % or more of the body testosterone production. The testosterone produced by the adrenals can be blocked with casodex so theoretically it should be an advantage.

harvardprostateknowledge.or...

Casodex block the androgen receptor in whole body so the hypotalamus believes there is not testosterone available and secrets more LH and FSH and the testis produce more testosterone.

That is why testosterone increases when a patient is in casodex only. Even when there is casodex some testosterone is used by the body since not all the receptors are blocked.. The excess of testosterone is converted to estrogen and that is the reason why men in casodex only develop significant breast enlargement.

There is a competition between casodex and testosterone for the androgen receptor. The body by increasing the level of testosterone when in casodex only try to fool the action of the casodex . That is the reason for people in casodex only the dose is 3 times the one used when combined with lupron (150 vs 50 mg).

In a lecture I went recently, the oncologist said that combined or ADT (lupron, casodex and proscar) is ADT in steroids and that ADT by using only casodex is ADT lite.

Probably this is the message to take. If you are going to try to kill the cancer hit it with everything. The survival advantage statistically is probable small 2-3 % but for the ones it works it is 100%.

best

Raul

[mklc]

Hi Raul,

Thank you for the full explanation. The best one I have received.

I though/read/heard that possibly proscar or Avodart covers up the real PSA numbers and that possibly makes the cancer more aggressive (for men who have had an RP).

Thank you again and I so appreciate the explanations.

Best health to you.

[Magnus1964]

My rule is get PSA tested at least every three months. If you get three PSA increases greater than 1.0 in a row, something is going on. I went decades without anything showing on a bone or cat scan.

I started ADT drugs at age 57. I do have osteoporosis at age 75, but consider the alternative.

[mklc in reply to Magnus1964]

You are definately one of the lucky ones. good for you and long and a healthy life.