Lupron ONLY or Lupron AND Cassodex??

[mklc]

Lupron ONLY or Lupron AND CASSODEX?

PSA is doubling every 2 months. Oncologist says to do Lupron ONLY

(after taking Cassodex for a month to stop flare).

Oncologist says that there is possibility that Cassodex taken for the entire ADT treatment MAY prevent Zytiga from being effective later on.

HAS ANYONE HEARD OF SUCH A THING???

Previous 2 ADTs were with Zolodex/Lupron AND CASSODEX. So to go with just one drug makes me very nervous especially now that combo drugs are used early whilst still hormone sensitive.

Many thanks for your opinions.

This is a fantastic forum with so much knowledge.

[Dr_WHO]

Could not find any literature saying that there will be an issue with Zytiga. Please know that this comes from a fellow warrior not a MD. I only have access to open literature. Sorry that I could not be of more help.

[mklc in reply to Dr_WHO]

Thank you so much Dr. Who.

If you don't mind me asking...which is more effective for ADT treatment

1) Lupron only

OR

2) Lupron AND CASSODEX?

I respect this is an opinion.

Thank you

[Dr_WHO in reply to mklc]

As they work by different mechanisms I would go with the combo. You want to hit cancer with both your left and right fists.

Seriously think about a second opinion.

Walt, a retired chemist not a MD

[mklc in reply to Dr_WHO]

Thank you Walt.

I am onto booking for a 2nd opinion.

I agree with taking both Lupron and Cassodex which is what I will do.

Many thanks and appreciation.

[herb1 in reply to Dr_WHO]

hI dR. Who: Where'd you get your ph.d in chem (which?)? Do you scare your MDs as much as I seem to when I wheel out facts?

[Dr_WHO in reply to herb1]

Got it a North Dakota State University. Yes, most of my medical team are not happy when I come with questions/comments for them.

[herb1 in reply to Dr_WHO]

For the record: Penn State, 1961, Physical Organic Chemistry.

[Dr_WHO in reply to herb1]

Welcome brother! Inorganic chemistry. My thesis was in organometallic synthesis so I could of gotten it instead in organic.

[Dan59]

I have not heard of such a thing, I did many similar drugs before zytiga. IMO you should get a second opinion at a major learning Hospital with a Medical Oncologist who specializes in Prostate Cancer, I also think avodart /dutasteride should be added to make what used to be called adt3. PJOshea recently posted to the group a study on avodart. How long has it been since diagnosis? You mention you have been on adt twice before. Where are you located aproximately? Lupron blocks the testosterone produced in the testicles, casodex being an antiandrogen blocks the small amount of t produced by the adrenal, and avodart dutasteride ,prevents T from being converted to the much more lethal dihydrotestosterone. I am posting a 10 year old video on adt3 by Dr. Strum, who is a expert medical oncologist specializing in prostate cancer youtube.com/watch?v=FMWDAJK...(Not working as expected?)

Dan

[mklc in reply to Dan59]

Thank you Dan. I agree with what you say which is why what may oncologist said made my head spin.

Time to get a 2nd opinion and move to another oncologist.

Best wishes for your health.

[Cmdrdata]

I’ve been that road of Lupron and Casodex (and prior to that chemo consisting of doxetaxel, doxorubicin, Adryamycin, and ketoconazole). I am near or already mCRPC (rising PSA, however current scan technology have not been able to zero in the source). Insofar as Zytiga and Xtandi, I think you need to have your genetic traced for AR-v7. There have been studies saying that the reason these two doesn’t work for everyone is because of that genetic trait.

Julius

[mklc in reply to Cmdrdata]

Thank you so much Julius.

This information helps a lot.

Wishing you good health and best wishes.

[herb1]

Hi MKLC: It is fascinating that while many (some?) 'skilled' oncologists/urologists use/recommend ADT 2 or 3 or even 4 (metformin), most? working oncologists do not seem to. Both my urologist and my oncologist smile, write the script but don't think they do anything. PS. I've been on and off IAD3 for 16+ years...but now may be losing the edge.

[mklc in reply to herb1]

Hi Herb1,

I find these differing opinions very stressful because then who do you listen to?

If you don't mind me asking, what drugs have you been on

and are you continuous or intermittent?

Many thanks and here's to your continued good health

[herb1 in reply to mklc]

Hi, I've been on triple intermittent adt since 2001. that's lupron + casodex + Avodart. I can't get anyone to prescribe metformin at this time. Note that IAD stands for intermittent androgen depletion, and the "3" means lupron+casodex+avodart---usually.

The truth at this time is there is no "proven right answer" I don't even know of studies of Lupron vs Lupron+Casodex. With Avodart I usually suggest that guys get a dihydrotestosterone (DHT) test when started on Lupron. If DHT is <5 or so (and T is also down at castrate, >20, or 40 or 50, depending (again!) on doc!), then avodart may not help...much!

There have been some accusations against avodart as either increasing the GS score of a prostate cancer or some other suspicion.

Yes, all quite iffy!

[mklc in reply to herb1]

Hi Herb,

What are the problem / issues with Avodart?

Warm regards.

[herb1 in reply to mklc]

Good question. I don't know of any and don't feel I've experienced any over ~15 yrs, but I'm sure the insert in the package lists a whole range of side effects! Look it up online, but don't get nervous. It is sold to help enlarged prostate, and appears to help that issue, maybe by reducing prostate size. It is claimed that it reduces psa by up to 50%--but is that good or not.

[Hidden]

I heard that Casodex used along with lupron or similar seems to offer a survival advantage in patients with hormone sensitive _____metastatic____ PC.

Patients with biochemical recurrence only (without metastasis) seem no to benefit by adding Casodex to the ADT.

Since it is obvious that using the "old" diagnostic techniques (bone scan and CT with contrast) many patients with "biochemical recurrence only" do have metastatic disease. Most studies have been done with mixed populations of BCR only and metastatic disease.

Until new studies are done differentiating these populations correctly using the new PET/CT studies, this controversy will continue.

I do not understand why using casodex will jeopardize treatment with abiraterone. The mechanisms of action are completely different for one drug and the other. Anyway I do not have any scientific information to answer this question one way or the other.

Best

Raul

PS: Ask your doctor for data about his opinion that bicalutamide will affect the action of abiraterone.

[mklc in reply to Hidden]

Thank you so much Raul.

I really appreciate your opinion and makes me feel so much better.

How is your health?

[Hidden in reply to mklc]

i am stable. Trying to get a second opinion on how to proceed with my ADT, stop it or intensify it. We'll see.

Thanks, best

[wolf2gang120]

My doctor took me off of the casodex after 3 months....but didn't tell me why. The casodex was making my stomach turn and the Lupron was doing fine. Radiation is what saved me,but my psa is on the rise again......gl