Advanced Prostate Cancer

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Had robot assisted RP on 3/31/2017. Pathology Report indicated 40% of prostate involved, lymphovascular invasion (2 lymph nodes each metastasis less than 0.1 cm in diameter) confined to lymph nodes, Gleason Score 9, tumor pT3a. First post PSA of .09 on 6/6/2017. Second post PSA of .155 on 9/21/2017. Started radiation therapy on 2/6/2018 in conjunction with 50 mg dose of Bicalutamide daily. Finished week 5 (of 8) weeks of RT today. As of 3/4 weeks ago, gynecomastia began to manifest despite 3 radiation treatments to chest to prevent. Radiation oncologist doctor suggested switching from Bicalutamide to Lupron, and also, at my suggestion, he will also go along with Tamoxifen to attempt to reverse the gynecomastia. Doctor will not make a recommendation as to what is best for me. Instead, he leaves either decision up to me. I seek the advice of this illustrious group. Any like experience? Any recommendations? Thank you very much! Joe

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Glad that you are having radiation. If you are switching to Lupron to avoid gynecomastia it may not work. I have been on Lupron since June of 2016 and I definitely have man boobs. Mine are to well endowed for radiation. I am not crazy about taking additional pills. For me surgery is out of the question as the only reason I have any bladder control is do to scar tissue. (Surgery will require the use of a catheter.)

If your are on Lupron you should ask if you can also be on Zytiga (with prednisone). They have shown wonderful synergistic effects when taken together.

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Thank you very much for your suggestion! Good luck!

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If you are taking tamoxifen to REVERSE gynecomastia that has already appeared, you should be taking 20 mg daily. To prevent it, take 10 mg daily. I didn't think anyone still did chest X-rays for prevention - clearly inferior. Lupron is much better than Casodex, but if you are susceptible it too can cause it. Apart from the gynecomastia, Lupron is probably better at radiosensitizing and killing off the nasties. When taken by itself, Casodex is usually prescribed at 150 mg/day; combined with Lupron, it is usually 50 mg/day. Some of Lupron's side effects may be worse than Casodex (eg, hot flashes, loss of libido, loss of lean body mass, gain of fat).

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Good info! Thx!

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Did you have radiation to the chest before you started Casodex?

Rich

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A few days after. Doc said did not matter

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