Zytiga or Casodex: Hello all. My name... - Advanced Prostate...

Advanced Prostate Cancer
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Zytiga or Casodex

Hello all. My name is Jim. I was diagnosed with advanced pca with some lymph node invovlement two months ago. I just stumbled onto this forum a few weeks ago and have found the posts and replys to all post to be very interesting and informative. I am married and 68 yrs. old . I went to a urologist because of frequent urination especially at night. I would wake up several times at night. After a prostate biopsy, I was informed I had pca. The urologist suggested Lupron or Firmagon. I opted for Lupron. I also am on Casodex. My MO wants to put me on Zytiga with Prednisone. I like the Casodex and Lupron combo because I am tolerating them well. I am not so sure how I will tolerate Zytiga. My question is Zytiga with Lupron better than Casodex with Lupron in controlling the spread of pca.

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I chose Lupron with Casodex. Both drugs lower your testosterone and Lupron does it better over time. But when I started Lupron the doctor warned me that my T would spike, so I first took Casodex to stop the spike, then after a few weeks he took me off of Casodex because the Lupron lowers the T levels better over time. I used Lupron - generic (with 72 radiations) over 6 1/2 years and I am currently cancer free. I am on active surveillance now. I also got two opinions before I made a decision. So just keep on truckin'.

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Thanks for the comment Jim. I am exactly where you were. I took Casodex for 2 weeks before Lupron. Currently still taking Casodex. I haven't had my psa checked yet after starting this regimen. I am also at this point thinking about a 2nd opinion. I am also encouraged by your status now. God bless you. What is 72 radiation and where were you on the pc spectrum?

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Hello again, I had 42 radiation treatments in 2007 when they noticed I had PCa. Then in 2011 I had a bone scan and they found metastases. So I had 30 more radiations and started Casodex/Lupron. I used Lupron (Eligard - generic) for 6 1/2 years continuously with no breaks.

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Thanks.....what was your psa?

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In 2004 my PSA went from 23 to 72 in 3 months. Then my PSA has stayed at 0.006 for 7 years now. I stopped Lupron 6 months ago.

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Thanks

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Hi Jim

Can you tell me if your bone tumor was completely eliminated after your radiation treatment? I have a bone tumor now and starting proton beam on 6/11/19....my email is georgefrrr@gmail.com

Thank you and God bless you and all of us.

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After I had 72 radiations (over 4 years) my oncologist wanted to check my bone marrow. He did a bone marrow test (drill a hole in the bone) on my hip bone and found normal bone marrow. They used local anesthetic and after a couple days I no longer had pain from the procedure. It is better to know what is going on inside your bone than to just speculate. I wish you well.

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Thank you Jim for the info....I am happy to hear that....God bless u and all the best.

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Casodex and zitiga are 2 different animals i think. I know casodex is used to prevent psa flare where the lupron actually makes your psa spike for a week or so these days.

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I believe Casodex and Zytiga work to stop the production of T from the adrenal glands and areas other than the prostate

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I think Casodex is used to stop Testosterone flare ups, which can cause many unnecessary side effects when you begin treatment for ADT drugs. The PSA has to do with the cell division of prostate cells.

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The combination of Zytiga and ADT with lupron or similar drug offers a survival advantage which it has never been shown when comparing ADT vs ADT+ Casodex. You have hormone sensitive metastatic prostate cancer. The best 2 choices of treatment are ADT plus Zytiga and prednisone or ADT plus chemo.

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I am new to this process, but correct me if I am wrong but isn't Zytiga and Casodex chemo?

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No, casodex binds to the androgen receptor and does not allow testosterone to interact with the cells. Zytiga inhibits an enzyme that is essential to produce testosterone and other steroid hormones in the body. The testis, and the adrenals and may be the cancer cells will not be able to produce testosterone. The cancer is completely deprive of testosterone.

They have to add prednisone because the body will not be able to produce cortisol and to avoid an increase production of aldosterone by the adrenals.

Chemo use cytotoxic chemicals that cause cell death. Cytotoxic drugs work by interrupting cells at particular places in the growth cycle. Cytotoxic drugs are most likely to affect cells that are growing rapidly, mainly cancer cells, but also hair follicles, bone marrow and cells lining the stomach and intestines.

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Thanks tango65 for the info. I will be taking another look at Zytiga. As I mentioned before, I am a little apprehensive about starting Zytiga. Have you had Zytiga, and if so what were your experiences with you.

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I haven't taken Zytiga yet. The side effects are related to the lack of testosterone (fatigue, weight gain, depression, etc etc) and the overproduction of aldosterone (hypertension, edema, hypokalemia) which can be controlled by adjusting prednisone or using aldosterone blockers such as eplenerone.

rxlist.com/zytiga-drug.htm

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I took casodex for just over a month then they switched me to zytiga. I have tolerated both well. Other than some hot flashes, no noticeable problems

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Thanks for that info

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Thanks for that Michael. I hope if I switch to Zytiga, I will tolerate it as well as you have.

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I have been on Lupron for 7 years and Zytiga for 1 year. I am very fortunate to have little in the way of side effects...hot flashes and loss of strength/endurance is about it for me. I started on the normal dose of 4-250 mg Zytiga and my LFT spiked so I took 2 weeks off and started 3 tablets...the LFTs have been normal. My PSA was 150 Jan 2, 2018 and it has slowly dropped to 15 a week ago. All is well...

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Thank you

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Yes yes yes. Over a 40% better survival with those combinations.

Schwah

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I agree it’s saved my life

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"My question is Zytiga with Lupron better than Casodex with Lupron in controlling the spread of pca."

Yes. Definitely.

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Thanks.....what has been your experience (side effects) with Zytiga.

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Very occasional I called them heat flashes that’s it.

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Good morning Tall Allen and how are you?

My husband has been on the Lupron and Cassodex combo for 3 intermittent ADT treatments. Each one for 9 months.

For the first 2 treatments, the PSA went to undetectable in about 3 weeks and stayed there. For the THIRD treatment which started in Feb 2018, it took 7 months for the PSA to go to undetectable.

He is on BOTH Cassodex and Lupron.

In your opinion:

1) should he now be taking Zytiga/predisone OR Xtandi

2) his oncologist wants him on continuous Lupron and Cassodex as it took 7 mths for the PSA to go to undetectable.

3) Any opinion on what he should be doing now ref treatment.

My fear is that he is heading to Castrate Resistance.

Thank you so much and warm regards

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Please explain why this is the fear. It my understanding this is a normal outcome

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Good morning Tall Allen and how are you?

My husband has been on the Lupron and Cassodex combo for 3 intermittent ADT treatments. Each one for 9 months.

For the first 2 treatments, the PSA went to undetectable in about 3 weeks and stayed there. For the THIRD treatment which started in Feb 2018, it took 7 months for the PSA to go to undetectable.

He is on BOTH Cassodex and Lupron.

In your opinion:

1) should he now be taking Zytiga/predisone OR Xtandi

2) his oncologist wants him on continuous Lupron and Cassodex as it took 7 mths for the PSA to go to undetectable.

3) Any opinion on what he should be doing now ref treatment.

My fear is that he is heading to Castrate Resistance.

Thank you so much and warm regards

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1) Zytiga/Xtandi is certainly a stronger drug than Casodex. Sometimes the cancer learns how to feed on Casodex and withdrawing it makes the PSA go down - that hasn't happened yet. Zytiga/Xtandi increase survival more when used earlier rather than later. I don't know if insurance will cover the cost before castration resistance is documented and if he is not newly diagnosed.

2) Continuous makes sense if his response to ADT is slowing down - how much of a vacation can he hope for?

3) Castration resistance will occur no matter what he does.

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TA

What is definition of castrate resistance? If one has been on IADT (trelstar and casodex) and Psa rises when he goes on holiday and declines when he goes back on ADT, is he castrate resistant?

Bob

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No

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Thanks so much Tall Allen.

1) In your opinion, even though my husband's PSA is undetectable now, should he change to Zytiga or Xtandi now?

2) how long does taking Z or X prolonge life?

Thank you SO much.

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1) That's a judgment call - I've told you what I know

2) It extends overall survival by about 1-1/2 yrs when used among newly diagnosed men, about 4 months when used after metastatic castration-resistance as set in.

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Thank you so much Tall Allen. It's never easy is it!!

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I haven't taken it myself. Here are possible side effects (section 6):

janssenlabels.com/package-i...

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Casodex could afect the androgen receptor, which can develop splice variants such as AR V7. This may reduce the efficacy of the subsequent administration of Zytiga or enzalutamide.

cancerabcs.org/new-advanced...

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Big mistake and bad advise my friend. Recent studies have proven that thinking was very wrong. 40% less deaths with Zytega and Lupron vs lupron alone. Very few things in the PC works are no brainers. This is one.

Schwah.

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Recent trials, of a couple of years ago, and what has become STD of Care--I hate those words, does give the use of Zytiga with Prednisone, and a Leutinizing agent, like Lupron, ET AL and advantage in Overall survival.

In my case--though I was doing alternative medical things, with my aggressive Gleason 9. I did just the Vantas[Leutinizing Implant], and daily Casodex together as an ADT 2, with Avodart, Proscar, Arimidex, and DIM added---- as Casodex is an Androgen Blocker--And I am out 3 years--the last 32 months Undetectable--and the last of those 12 months on a drug vacation--for how long only GOD knows. But that is me---for yourself I would consider what shows to have a Medical Advantage as I mentioned above.

Nalakrats

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Hi Nal,

My MO (1st and 2nd) teams are having a debate, currently on Lupron (6 month dose), Daily doses: Casodex and Zytiga/Prednisone.

The debate is stopping Casodex, some think will promote AR-V7 splice mutation. Took Casodex 2 weeks before getting the 6 month shot of Lupron - Casodex reduced my tumors quickly, consequently, urine stream flow improved and burning sensation stopped!

So, any thoughts about continuing Casodex?

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I cannot prescribe--just in my case I took both Casodex[Daily], and had the Implant in the arm which avoided shots, and was good for 15 months, avoiding the necessity of shots. I am not a fan of 6 month shots--that is just my Opinion--I prefer Steady Eddie, as opposed to loading up at one time---others say there is no difference--my Uro&MO, disagree--but I made the final decision, on my ADT. I probably absorbed about 2 dozen papers at the time--but that was 3 years ago.

Every time I mention the Vantas Implant I get blow back--as men here ask their Doctors who plead innocence, or talk the patient into the Shot--because of whatever their reasons are--which some are they have not been schooled in it and cannot do the minor 4 minute procedure that leaves you with 3 stitches, you take out at home, after 3 days. Stopping the ADT agent in the implant is simple--just take the implant out--you do not have to wait months, if you plan a drug vacation.

Nalakrats

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Nalakrats:

You are always so helpful. I am having a hard time finding doctors that are aware of the Vantas Implant. I have had a great run on just Cassodex for the last 4 years with only now my PSA up to 1.5 for the last 4 months. Trying to decide the next step. I have a good run so far for the last 16 years when I had my RP and radiation. Any thoughts from anyone????

Tom

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They stay unaware--some play dumb, and others have not been trained in it by Detailers---only way I know how to find one in your area--is to call the company that makes it in the state of Penn. Ask for referral to Docs. that use it regularly--do not know if it is used outside the USA. Can Google Manufacturer Contact for the Vantas Implant.

Nalakrats

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Re: Zytiga side effects, I added Zytiga about 4 1/2 months after starting Lupron. I have not noticed any new side effects with the Zytiga. I have the typical hot flushes and fatigue, plus a bit of Lupron brain (minimal to mild, my wife says).

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Hi,

Your wife is on to something...

Regards,

Lupron Brain

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Thank you

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Casodex is an older, inexpensive drug that for many men works well..The usual progression is Lupron alone. When that starts to fail, (PSA starts climbing) Casodex is added which usually gives a good response. When THAT starts to fail, casodex is dropped and Zytiga or Xtandi is used to control the cancer...How long have you been on Lupron..?

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Hi there,

But, the LATITUDE and STAMPEDE trials, demonstrated all guns should be loaded up front. This may offer the best chance for treatment vacation time.

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Thank you Fairwind. I got my first Lupron shot on Oct. 24th 2018. Started Casodex two weeks before on 10/10/18. I haven't had my psa checked yet. Will see my urologist next month on 1/24/19 when I get my 2nd shot of Lupron.

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I would say that if Casodex is keeping your PSA down keep using it. It definitely comes with less side effects than Zytiga or Xtandi.

My husband had some luck with ADT/Casodex and probably should have stayed on it longer. He was taking three Casodex pills and some of the docs were nervous about that dose.

We moved and new MO insisted on experimenting by stopping Casodex abruptly and didn't get the results he predicted anyway. The new MO preferred Xtandi over Zytiga because you only had to take one drug with Xtandi. So far Xtandi at half dose is lowering the PSA in my old 75 yo guy. He was dx 2001 but probably had pCa for two years before that.

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Zytiga, Prednisone working for me. PSA 0.1 from first month of treatments along with 6 months Eligard injection.

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Hi Leo,

Same stuff here, Eligard-6 months, Zytiga/Prednisone and Casodex.

Init Dx PSA 1000+, now PSA 2.1, in 6 weeks of treatment. The idea is too shift PCa states of Hormone sensitivity and Hormone resistance continuously. Thus, Casodex and Xtandi are very important because it targets AR, I'm researching this deeply...

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I was changed from casodex to Zytiga after the mri found the tumor was out of the prostate. Psa was going down with both. No different side effects for me that I know of on Zytiga. The stampede trial is what the doc is using as a guide. Tumor has shrunk by over 1/2 and still going down. Zytiga is the preferred Med. My first dr. put me on casodex I guess because of cost. When I told him latter on that another dr. put me on Zytiga he said oh yeah that’s better. I stayed with the second one.

Good luck finding the right treatment.

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Thank you.... My MO has suggested Zytiga

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I would stay with casodex. If it stops working, then go to Zytiga. You still have xtandi and other ADT drugs. At your age these drugs may keep your PSA down for a long time.

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You asked:

"... is Zytiga with Lupron better than Casodex with Lupron in controlling the spread of pca."

Zytiga + Lupron does a better job of inhibiting androgen production than Lupron alone.

Casodex inhibits the binding of a androgens to the androgen receptor [AR]. It is not an alternative to Zytiga, & you could use them together with Lupron, IMO.

Xtandi is a more modern AR antagonist than Casodex, so perhaps a better question is:

"... is Zytiga with Lupron better than Xtandi with Lupron in controlling the spread of pca?"

-Patrick

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Just to add on here. I switched to Lupron + Zytiga + Pred a after nine months on Lupron + Casodex. No real evidence for doing that other than the MO said "why not try it for six more months and then stop". I asked about continuing the Casodex too and he said definitely not because that would be too much toxicity - especially for the liver.

I didn't notice any real difference in energy or side effects between the Casodex and Zytiga + Pred.

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Hi Jim, my husband is on Casodex daily along with Trelstar injections every six month he was diagnosed November of this year at age 45. The only thing the casodex will do is sometimes make him nauseous and a little constipated. He just started chemo this week and except for Monday has been feeling pretty good.

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Thank you.....I have had no noticeable side effects with Casodex and Lupon other than hot flashes

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