Advanced Prostate Cancer
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Asking Local MO to add Avodart and Metformin to Xtandi

Asking Local MO to add Avodart and Metformin to Xtandi

I am trying to bone up for a local MO second opinion next week. Supposedly, this MO believes in scans and may not pawn us off on the nurse like the other local MO has been doing.

My husband takes Xtandi and recently they added Casodex again.

Because so many here have mentioned adding Avodart and/or Metformin to Xtandi, I need some tips to convince the MO. She doesn't specialize in PCa. I also want to double check why Casodex was added.

Thanks in advance.

Mary

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I do not know either---you would expect Lupron to go with Xtandi---as it does with Casodex.

Xtandi is the next level up from Casodex. From the little I can tell you need a MO who specializes in Pca at a center of excellence. Suggest you post where you live and ask for MO recommendations from the group here.

Nalakrats

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Casodex is like Mighty Mouse , whereas Xtandi is like Superman - Casodex is superfluous after Xtandi (both are anti-androgens). It should be taken with Lupron or orchiectomy, of course. Avodart doesn't add anything - so there is no benefit to taking yet another pill. Metformin has had equivocal results in trials so far - nothing at all definitive - but at low doses it might not do any harm and may make a small contribution, so why not? If he is taking Zometa for bone mineral density, adding Celebrex to it may improve survival.

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He is taking nothing for bone health except Vitamin D so that is something to ask about along with mentioning Metformin. Thank you for the common sense ideas for approaching the MO. After all, I don't want to scare her with overload.

Mary

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you are wrong, as in fact Avodart does it at the leftover test not hammered by L and C, so worth adding. It is also something one can do on its own in between IHT cycles-there is no downside to this.

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There were some early retrospective data that suggested Avodart might be beneficial in that setting, but when your hypothesis was actually subjected to a prospective randomized clinical trial (by Klotz - one of the proponents of that theory), it was disproved. They found that there was "no benefit to the addition of dutasteride to an intermittent androgen deprivation regimen." In fact, the median time off treatment was SHORTER for dutasteride-treated patients (19.8 vs. 21.3 months). The authors conjecture that the use of 5ARis may select 5ARI-resistant cancer cells that put out more PSA. So it may make the cancer more virulent. Here, read it for yourself:

ncbi.nlm.nih.gov/pmc/articl...

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Interesting. This is just looking at localized. Any studies on non-localized disease? No reason to think results would be any different, but there are so many variables.

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These were men with recurrent and incurable PC who are the best candidates for intermittent ADT (iADT). iADT is controversial in men with detected metastases. Because we've learned that early use of advanced hormonals (Zytiga, and presumably Xtandi and others), a 5ARi would be superfluous.

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"I don't want to scare her with overload."??? What? Scare the shxt out of her. Tell her it's your husband's life not hers. Look for a new (good) oncologist that specializes in Pca asap.

Nice pic. is that your husband or your boyfriend? Keep smiling like you do and tell the guy to smile also.

Good Luck and Good Health.

j-o-h-n Monday 05/14/2018 10:19 PM EDT

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I again hate to preach but the reality is we are all very sick guys with a very limited future and there is point in hiding this fact from anyone, including yourself. In my view it helps to deal with this up front, then plan, make your bucket list and live large, as long as you can. Spending too much time on bits and pieces does little to enhance one's life as it will NOT change things very much, no matter what treatment you end up taking, or not. Your best days are those right in front of you, not some dream that all will be good, when that is not the case for the vast majority of us. I am now in year 19 so think I have some basis to make these statements. My pals who spent the remaining days jumping from doc to doc, etc.lost that valuable time of perhaps living and getting the most out of life that remained to them. If you have money, spend it on doing things that make you and your family happy, DO IT TODAY, do not wait or linger.

Lastly, do not blame docs, none of them have the magic cure because there is NONE, some are certainly better than others, have better resources etc. as well, but please respect the sad fact that any medical practitioner in this field, has a very very tough time in watching all of their patients die before their eyes-try that for an extended period. So, hug them, thank them and take it upon yourself to get up to speed, make the call on your treatment and again, get out of the house and rock on!!!!!

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Couldn't agree more. Well said

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Believe me that in almost 18 years since diagnosis and being asymptomatic my husband has frequently opined that he is tired of all this treatment bulls*it. It's me, ever hopeful, that drags him to doctors who find more and more to practice on him. All he ever wanted in life was to go off to work each day and provide.

I am happy that we traveled when we were younger and interested in exploring worldwide. Now we don't even want to do medical travel as we enjoy staying put and like where we are.

I know what a tough job the MOs have as I have witnessed the calls from hospice for more pain medications. Hearing that gave me respect for what they do and a look at our future.

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