I am on the generic for Casodex + the Lupron shot.
My question is: Since Casodex is the hormone receptor blocker and Lupron is the T killer, why not just take drugs that block T and skip the Lupron? If we get the T down and the PSA down, what if those results were from the hormones being blocked at the site rather than a lower T? Wouldn't it be better to take several "blockers" and make sure T can't influence the cancer cells, but still give the body its needed T results?
Because Lupron does a better job than Casodex. They used to give 150 mg daily Casodex before they had Lupron. Some still do - but I hope they get tamoxifen with it. Casodex is a weak anti-androgen relative to Xtandi. Could Xtandi be used as first line therapy? Maybe - but it is too expensive for that use. It is only given as a second line hormonal therapy when Lupron begins to fail. Nevertheless, Lupron is continued because the androgen receptor becomes exquisitely sensitive to even the smallest amount of T. BTW- Casodex makes your serum T level go up, not down, because the unused T hangs around.
"They used to give 150 mg daily Casodex before they had Lupron."?
Lupron was approved by the FDA on April 9, 1985, while Casodex was approved on 4 October 1995, at 50 mg/day in combination with a GnRH analogue.
-Patrick
That's true - thanks for correcting that - I should have said antiandrogens vs GnRH agonists. - flutamide (FDA approved in 1989) was the anti-androgen that was popular before Casodex came out. And goserelin (FDA approved in 1989) was the popular GnRH agonist before Lupron. GnRH agonists have proven to be much more effective than antiandrogens:
"Currently available evidence suggests that use of non-steroidal antiandrogen monotherapy compared with medical or surgical castration monotherapy for advanced prostate cancer is less effective in terms of overall survival, clinical progression, treatment failure and treatment discontinuation due to adverse events."
Casodex worked for my husband for awhile. When added to Lupron it dropped his PSA when Lupron seemed to stall.
He started at 50 mg per day. By the time he got up to 150 some of the docs were nervous about that dose. The urologist said it was fine as that was the dose used in Europe.
When we moved the new MO didn’t like Casodex and abruptly stopped it. He felt the PSA would drop from stopping Casodex but it went up instead. Then that MO started him on Xtandi.
Casodex is hard on the liver that's why
Is there a different ADT that is not hard on the liver?
I'd agree with the others who responded here. I am on 50mg Casodex and tri-monthly shots of Trelstar. I switched from Lupron due to very troublesome allergy RO it: hives and itching all over. Trelstar has begun to cause some allergy, but much less than Lupron or Zoladex. I'm also on Avodart, so the combination is referred to as "triple blockade."
Most experience fatigue, low energy, weakness, cognitive and memory impairment etc etc in degrees ranging from mild to severe and debilitating. Depression and irritability are common. I have experienced all of these. Thanks to advice from TallAllen, Nalakrats and others here, I pushed myself to engage in daily resistance (weight) training and aerobics, such as fast walking and cycling, especially when I have least felt like it, which has made it much more bearable. After my recent follow-up with my RA, since my testosterone and PSA are undetectable, color flow Doppler US and scans are good, I was told I can stop the Trelstar and Casodex and some of the supporting meds as of next week. Yay! Now we monitor metabolic and PSA blood work and go on. I am getting better at not waiting for the other shoe to drop. I was advised to stay on Avodart: the rationale being to try to maintain a body environment hostile to potential PCa metatstatic processes. I'll also stay tuned here to learn and share info about practical diagnostics, treatments and supplements.
Best wishes for your journey.
Thank you. I’m on a similar path and appreciate the update. Definitely interested in other diagnostics, treatments, and supplements. I will post likewise for the benefit of others as time goes on.
Josh
I was also on ADT3 for the second13 month stretch-this time from 5/17-6/18 - and stopped but I’m still on avodart., metformin, cabergoline D3, calcium , Crestor, celecoxib. Now Watchful waiting. I’m probably going to get PSMA Ga 68 ctpet when Psa rises to 1-2.
What is the reason you are still on Cabergoline? Are you on the Estradot patch?
I believe I was told it stops the adrenal gland from producing T and yes I’m still using the estradiol patches to fight hot flushes.
Sorry I was wrong. It reduces prolactin
Are you on meds which require that you reduce prolactin?
I wish to thank everyone who responded. It was very helpful. I see that the 2 drugs aim at T- one blocking it and the other knocking it down. So T seems to be their main culprit.
I will also be taking supplements that have anti-angiogenesis and apoptosis properties. T is not the only way to treat cancer.
Tall_Allen- you said BTW- Casodex makes your serum T level go up, not down, because the unused T hangs around." So if they are using your T to monitor your treatment results, but it goes up, then how accurate is their assessment?
Arete105,
That is an excellent question and discussion point. I am on 50 mg bicalutamide intermittent monotherapy and T doubles during the on period. What happens to T when bicalutamide is combined with Lupron - is T higher on 2ADT than Lupron monotherapy? Paradoxically, short term use of 50 mg bicalutamide is always prescribed when Lupron is first commenced to prevent the initial PSA flare because T rises before it falls on initial use of Lupron. Does T rise even more during the initial flare period because of the bicalutamide, but PSA falls because the anti-androgen effect of the bicalutamide offsets the higher T caused by the same bicalutamide? I would answer the last question as "yes" because with bicalutamide monotherapy, T doubles but PSA falls. And the answer to your initial question then should also be "yes" - T is higher on 2ADT, but the higher T is offset by the anti-androgen effect of the bicalutamide causing a net decline in PSA.
This might also explain the "anti-androgen withdrawal syndrome". After some time on bicalutamide and Lupron, PSA begins to rise and stopping the bicalutamide results in a decline in PSA. What is probably happening is that the increase in T caused by the bicalutamide is no longer offset by the diminishing anti-androgen effect of the same bicalutamide. By stopping the bicalutamide, T falls, and hence PSA falls too (usually only temporarily).
I started on Casodex June 7 this year, then Lupron a couple of weeks later when I also began radiation treatment. Took both for several weeks, until the medonc said the Lupron alone would do the job, and it would be better to save the Casodex for possible use later, versus “training” the cancer how to avoid it now. My 2 cents, we’re all different.
I was told the same thing Johnkelsey….I had the same regimen but casodex was dropped. So far so good.....undetectable PSA.....feel good.....I'm stage IV, 2 very small metastases to pubic region
While on Lupron and Casodex with undetectable PSA, my PSA began to rise. I switched from Casodex to Nilutamide and my PSA returned to undetectable in 4 months. I have now stopped Lupron, but remain on half doses of Nilutamide, Avodart and Cabergoline. My T has only recovered to 40, but the PSA remains undetectable. Good Luck!
I see that several have stated that they are on Avodart, among other drugs. But it has been shown to increase cancer. "Dutasteride is not approved for prevention of prostate cancer. It may slightly increase the risk of developing a very serious form of prostate cancer. Talk to your doctor about the benefits and risks."
Wouldn"t Flomax be a better choice for BPH?
I don't know about the best choice for BPH. I had a prostatectomy ten years ago, then the PCa recurred, had radiation , then the PCA recurred yet again. I then went on the ADT drugs in 2011. The Dutasteride helps stop any remaining Testosterone from converting to a deadlier form (Dihydrotestosterone). My favorite source of information is:
theprostateadvocate.com/obs...
Good Luck!
Stopping Casodex before stopping Lupron
lupron or casodex 
Rising Psa while on Lupron and Casodex
