Advanced Prostate Cancer
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At what age can I stop Dutasteride?

What a wonderful forum! You folks seem to be most helpful about all the stress and anxiety of prostate concerns. It's nice to be here.

My background...

I'm 80. I've had 3 TURPs and after the last one, the doc took cell samples. One of the 50 tested samples came up positive for cancer at age 56. He told me watching and waiting was appropriate and put me on Dutasteride.

But I moved, and the next urologist got all freaky about the 1-of-50 report and said I needed immediate prostate removal. I said "no" so he sent me a letter saying if I didn't get it removed pronto, I could die in less than 3 months. That was over 15 years ago.

Meanwhile my PSA went down to 1.6 and held between 1.6 and 4.4 for a few years. I stopped the Dutasteride for a while and it went to 9.8 last July, so I went back on Dutasteride. Now, it's back to 8.0.

I have read conflicting recommendations, many saying that at my age, I shouldn't worry about PSA any more. Okay, but does that mean that I can ditch the expense of Dutasteride? I'm getting it from a Canadian producer, but still -- it's a lot of money I'd rather save.

Anyone who has tried eliminating Avodart/Dutasteride? What results?

Thanks in advance.

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wow - 24 years, no radical and still going...man, that is enviable. I'm not sure about eliminating the meds; my instinct, due to your results, would be to say keep doing what's working.

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Yes, of course, that's my inclination and you are echoing what my Primary Care physician says. I'm just trying to eliminate the cost. Buying Dutasteride is a drain.

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Is it not covered by medicare, Dutasteride is the generic form. Congrats on doing so well for so long.

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Yes and no. Medicare insists you first use Finasteride and then do more PSA testing and then have a urologist determine how the Finasteride worked. I did that and the urologist agreed with the testing lab that Finasteride didn't work well at all. He then issued a new Avodart Rx. It, too, was turned down. So he re-wrote the Rx to Dutasteride. Same rejection.

Medicare wants you to use Finasteride because it's cheaper. Too bad that it doesn't work as well.

So I get Dutasteride from Canada. The US government forces me to.

And that is why I'm looking for more info on when I can safely stop taking it. My current urologist wants me to continue with it, but I figure that at my age, I'll probably die from old age sooner than from prostate cancer.

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To our fellow “OF”,

It is, indeed, nice being here and also nice to meet you. My husband and I are now both 78 and very jealous of your 1 in 50 report. Your respondents here pretty much know that, unlike you, Leswell’s PCa is more likely to kill him than will old age, but we’re still hoping for a miracle and trusting in God, Nalakrats, Avodart, and Proscar in that order. As our miracle mentor writes, those drugs are relatively affordable insurance, not that the money doesn’t matter when you’re, which is to say we’re, living on one teacher’s retirement plus UCare (including Medicare) in the great state of MN. Abbreviating for once, “Oh yet we trust” that combined ADT will at least get him to generic Zytiga possibly this coming October especially if the Vantas isn’t effective or new symptoms develop.

I LOVE this forum especially after the Vikings’ ignominious loss last night. I gave up and went to bed which is why I’m awake now. Great fourth quarter, however, by the Patriots who will be in town in a couple of weeks. It really is time to move on from football. High school hockey anyone? We need distractions.

We’re hanging in there with the much more costly MCP 3x daily at $100 per month. (Not sure if the smell in the bathroom is Lotus soap or MCP, but it’s weird. I’d switch to one of a number of bodywashes if they didn’t have cancer-causing ingredients.)

Smile please, be careful, and keep advising us everybody. Above all, please keep writing. (Patrick, too.)

Best- Les and Jan

P.S. We have 100% chance of snow today somewhere between 8 and 16 inches. Let’s hope we can wrangle the snowblower out of the shed’s too small doorway. Promise not to send any pictures.

P.P.S. If you happen to be up late reading, dear JLS1, know that you and your husband are in our ♥️s and minds. Love from JLS#2

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Hi Jan...

You sound like a very warm lady in the land of snow and icy eaves. I hope that Les is faring well.

Maybe the two of you can do something special on this snowy day. Many moons ago, in MSP on a business trip, I took time out on a snowy Sunday and went to the Walker Art Gallery near Loring Park. The magnificent outdoor gallery had a huge statue of a rabbit sitting on its haunches in the snow. I sipped my hot cocoa as the snow fell and wondered what that giant rabbit would think if it was alive. Super memory you prompted me to recall. Thank you.

Be well.

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Thanks for your fond memory of the Walker. That must have been a different rabbit! I just looked up the “Hare on Bell”, which was no “Rabbit at Rest” (with sad memories of one of my favorite authors). My gardener’s thoughts about rabbits or hares are less pleasant but no less active.

Good Post, too, about when and if to eliminate dutasteride. Since Les has only been on CAB-5 (or 6 or 7) for a couple months, we are in a “wait and see” hibernation period. No appointment is yet scheduled in the new year for a CBC and PSA. It seems strange after a year and a half of monthly blood draws. Maybe it’s because we have been sent back to our urologist?

FYI, Les’s combined therapy includes Vantas, bicalutamide, dutasteride, finasteride, and DIM—plus metformin and modified citrus pectin. The combination is costly; Vantas was $672 for the year, but that is little more than monthly leuprolide injections which were becoming more painful on my husband’s slim frame. The dutasteride and finasteride with Medicare coverage cost us $12/mo which the urologist ordered for 90 days. Metformin we must pick up monthly, and the prescription is about to run out. I know our oncologist doesn’t want to continue ordering it, and we don’t want to start looking for a primary physician, the first prerequisite for whom would be a metformin prescription for each of us! Unfortunately, there isn’t a Charles ‘’Snuffy” Meyers or Mark Scholtz lying in wait under some Walker Art Center rabbit or cherry/spoon.

P.S. about a potential substitute or adjunct for metformin. AMPK activator is $24 for 30 days on sale at Life Extension; metformin is $3 per month at the local Cub pharmacy. See U of WI at Madison for promising results of metformin prescribed for non-diabetic veterans. Don’t know if any of that relates to you! Sincere congratulations on your 24 year survival. May it continue for at least another couple decades. My mom made it to one month before age 104. Why not us? Les says from his perch across the way, “or at least why not me”, meaning me of course since she was my mother. I said that was over the top. Not laughing. Go well. Jan

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Jan...

Metformin s/b free. Here in Florida, we have two competing grocery chains -- Publix & Winn-Dixie -- which both give you up to 2500mg of Metformin free monthly. I use 500mg at breakfast, 1000mg at lunch and 1000mg at dinner. Winn-Dixie Stores is a subsidiary of BI-LO Holding , which merged Winn-Dixie and South Carolina-based BI-LO -- maybe a store like them has similar deals up north.

I don't know how you get away with Dutasteride & Finasteride for just $12/month. What a steal! Medicare keeps denying Dutasteride for me, insisting that I use Finasteride, which doesn't help -- tried it twice for 6 months each attempt.

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Hello once again. Our snow is wet and heavy and around eight inches but possible to do with a couple shovels in the morning. While snowed in I’ve been reading our new drug formulary so as not to mislead you or anyone. Much has changed in 2018 in our UCare/Medicare Value Plus for Seniors plan. The deductible (which I neglected to mention, sorry) was $50 in 2016, $150 in 2017, and in 2018 is $250. Ouch! It appears that all Les’s drugs are now in Tier 1 instead of Tier 2. That includes your and our dutasteride (Avodart). After paying the deductible, it should be between $1.25 and $3.35 per drug. Somehow income is considered, but I haven’t done the taxes yet, so I can’t determine that. Ours will be very simple as we will take the standard deduction. Figuring out the estimated taxes I do by guess and by gosh and am not too far off usually. (TaxAct has worked fine to check my math.)

In short, if we ever get the deductible paid, dutasteride will be cheaper than ever.

I’m still in shock about FL’s free metformin. It’s a smart move as the drug is the best life extension agent ever according to the Life Extension Foundation. Keep those retirement dollars in the State by helping the residents live longer. Am I wrong? Good for you. If we must pay for a substitute such as AMPK Activator, I guess we could try that. Finding a preferred rather than standard retail pharmacy is my next job. That should reduce the copay of Tier 1 drugs to $1.00.

Must you have a prescription to get the free metformin and is that easy to get if you are not diabetic?

Thank you. Hope you are enjoying lots of sunshine. My grandparents always drove from Waukegan to Bradenton in winter. Jan and Les

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I'm 200 miles north of Bradenton. We get freezes here...but nothing like the Minnesota Wild parking lot tonight!

Yes, you need a prescription to get Metformin. I get that script from my regular G.P., but I know a podiatrist who prescribes it as a preventative med for old folks in danger of foot problems. You'll have to ask around. The maximum dosage is 2500mg per day, which is what I take. Even if Les needs only 500mg, if you find a free source get 2500mg with the script reading "take one with breakfast, two at lunch, and two at dinner". Then Les can decide about saving the extra pills for a time when our government finds something screwy to screw us out of Metformin.

Gotta go now. Don't freeze tonight.

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I use both the Generic of Proscar and Avodart. These interfere with 5-Alpha Reductase molecules which help convert Testosterone to DHT. DHT is gladly a substance, the AR receptor of a Pca cell wants to attach to. So My insurance Thur Medicare Part D, using the Walmart Humana Plan---my average cost for both is about 12 dollars a month. About 40 cents a day.

The famous Oncologist who he himself has Prostate Cancer now Retired--Dr. Snuffy Charles Meyers has a durable remission, and part of his program is Avodart every day. I think he is older than myself at 74---but I take both every day. I can afford the possible insurance policy of 40 cents a day---even if it is hogwash---which in IMO--it is not. You can change providers every year, on Medicare D. True the older you get the less Testosterone you make so there is less Hormone to be made into DHT---I know men past 90 still taking Avodart!

Nalakrats

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Thank you.

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If it works don't fix it.....

Good Luck and Good Health.

j-o-h-n Wednesday 01/18/2018 6:42 PM EST

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Dutasteride is usually prescribed for BPH to shrink your prostate. But it’s also used as an adjunct to Lupron and bicalutamide as a triple blockade hormone therapy for systemic prostate cancer. I see no great benefit to using it alone for prostate cancer.

If you’re in great health and believe you can live another ten years and are willing to put up with the side effects of HT or more radical treatments it’s an option to consider. 1 core out of 50 is very low volume . That was a long time ago but you’ve done well so you obviously had no or low grade cancer . A recent psa of 8-9 is high so a biopsy wouldn’t be a bad idea. Up to you my friend!

Bob

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j-o-h-n...thank you.

bob...many thanks for a thoughtful response. I think I'm a few years away from HT, and my worry has been that discontinuing Dutasteride might bring the necessity of HT closer. That's the reason I hesitate on ditching Dutasteride.

I am also trying to avoid the stress and perils of another biopsy. With only 1 in 50 years ago, my risk doesn't seem enormous, as you have indicated.

What did that wise, old sage say? "It's a crap shoot!"

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Congratulations on the last 15 years.. I would simply point out Dutasteride has a long half life, 30 plus days to clear half the medication from memory, and you may not need the full dosage (in fact I've read older people sometimes process drugs even a lot slower) . What I do is just cut back on my own, I take about 2 pills a week, and still notice a benefit of a smaller prostate. One last point related to this, taking a dosage consistently will help give accurate results from the psa test, which you want to monitor over time for any prostate cancer.

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What a sensible idea! Thanks, kanzan.

I think I'll wait 'til my PSA again gets down to around 4 or 5, and then trim the Dutasteride to Mon-Wed-Fri.

If it's still effective at that dosage, terrific!

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