Casodex

[Jollyjill]

Hi Everyone: Just a brief heads-up on my SO who is oligometastatic with two involved lymph nodes. When he was rediagnosed in July ‘17, his PSA was 74. After various permutations to find the most effective therapy, he was put on Casodex 150/day. Today he discovered that his PSA has plummeted to 0.3. We feel very blessed & would be pleased to share information on any aspect of his journey that would be helpful. Keep fighting!!

[Tall_Allen]

Is he considering whole pelvic radiation?

[Jollyjill in reply to Tall_Allen]

It was suggested by his Radiation Oncologist & he did consider it, but his Dr. (who inherited several of Snuffy Myers’ patients) advised against it since he has been responding so well to Casodex monotherapy. He’ll be closely monitored & is open to exercising any further options that his Drs might offer. He’s also looking into Genome testing & scouring the literature for any advances in immunotherapy. Thanks for asking! I learn so much from you guys!

[Tall_Allen in reply to Jollyjill]

I don't know his details, but radiation might be curative, whereas the other therapies are not. If he has less than 10 years life expectancy due to other comorbidities, it may not matter.

[joeguy in reply to Tall_Allen]

I had PC in 2 out of the 5 pelvic lymph nodes that were removed during my RP in 2016. I have not had pelvic radiation for fear of frying things like the bladder and rectum, and have chosen the ADT route instead. I went castration resistant after 20 months of firmagon, eligard and casodex, so I have just recently started Xtandi, which seems to be working well. I keep wondering if it was a mistake to not go for radiation right away especially when I hear things like "it might be curative". I am curious however how irradiating the pelvic lymph nodes can be curative when the lymphatic system is so vast, with over 600 lymph nodes in the body? Isnt the cancer spread throughout the entire system once it invades a lymph node?

[Tall_Allen in reply to joeguy]

Lymph is different from blood. Blood circulates quickly, impelled by the heart and valves in veins. So a bone met, which had to get there via blood supply is an indicator that the cancer is incurable because it is systemic (everywhere).

When cancer cells travel in the lymph, they follow a known (more or less) drainage pattern through the pelvic lymph nodes. Lymphatics don't have valves or any other drivers. The lymph just sort of drifts, only affected by gravity or the body's motion. Also, unlike blood vessels, which are branched and converge, lymphatics are networked. The lymph nodes act as filters that can catch cancer cells, further slowing progression. So there may be an opportunity to get rid of ALL the cancer if it is still only confined to the pelvic LNs.

After cancer is located in other lymph nodes, say in the abdomen or the groin, it had to have gotten there through systemic transport because they are outside of the prostate lymph drainage array.

[joeguy in reply to Tall_Allen]

Thanks Allen, I don't know if its too late for the full pelvic radiation benefits to out weigh the risks of cooking things I would rather not have cooked at this point or not. I am a little over 2 yrs since RP, and Im thinking if I was going to do it, it should have been done 2 yrs ago. But that's just my gut feel, I am not a doctor, nor do I play one on TV.

[Tall_Allen in reply to joeguy]

When you use the term "cooked" I assume you are aware you are using the term metaphorically. Radiation is non-ablative (it doesn't cause necrotic tissue for the most part). It works because healthy cells can self-repair or replace themselves (through apoptosis), whereas cancer cells cannot. For pelvic LNs, the RO would typically use a low dose (around 50 Gy). If imaging reveals particularly enlarged pelvic LNs, they can be targeted with extra radiation.

[Break60 in reply to Jollyjill]

I think not radiating all pelvic lymph nodes is short sighted .

[Jollyjill]

Thank you for your positive & encouraging response!

[RICH22 in reply to Jollyjill]

i'm 72, been on casodex for the past 6 months, dropped my PSA from 14+ to <0.1 in the first month. like nalakratz, i've heard casodex can work for a good long time but my hemo-onc says i'd be very lucky if it goes over a year. I plan on going Intermittent and/or up the dosage, from the 50mg i'm on now. maybe add lupron, go vegetarian, whatever. Radiation is a last resort. good luck in your battle, fellow warrior.

[Jollyjill in reply to RICH22]

Thanks for weighing in! Agree that radiation is the last resort! My husband is more focused on managing the disease than on a cure. QOL is very important to him & radiation comes with a host of caveats that make it an unappealing option. He has decided to stick with the Casodex until & unless he becomes resistant & in the meantime there are other therapies on the horizon. Hope you continue doing well!

[RICH22 in reply to Jollyjill]

hopefully those txs on the horizon will be the result of genetic (incl. stem cell) and immunological research... maybe introducing cells that will "teach" newly-forming cancer cells to revert back to normal prostate cells? or improve the various types of cells that attack foreign substances and/or cancers (lymphocytes, granulocytes, monocytes, macrophages, etc) ? whatever the scientists studying genetics and pathogenesis come up with, all i can say is Godspeed, people, emphasis on speed!!

[407ca]

I am oligometastatic as well, with 2 lymph nodes and 1 sternum lesion, 1lesion on prostate. I begin SBRT to the sternum and LN next Friday. Following that I will be getting TULSA HIFU treatment to the prostate which already had radiation as primary treatment years ago.

Have to wonder why your SO does not get radiation to pelvis. It would seem very reasonable to do so in order to deliver a knockout punch while you can. Why wait until Casodex fails? The theory, as I understand it, is that oligometastatic cancer might still be cured even with a few mets.

[Jollyjill]

He had crysurgery when first diagnosed which means that he’s not a good candidate for pelvic radiation. Some fusion has occurred leaving insufficient space for inserting the gel which would offer some degree of protection. We go with the flow! Hope your treatments will yield excellent results and than for your interest!

[Tall_Allen in reply to Jollyjill]

Cryosurgery is often not effective. It can leave live cancer cells in the ablation zone. Has he had a PET scan or a biopsy showing whether he has a recurrence in is prostate? I don't think that SpaceOAR does much - what is really important is IGRT. Fortunately, he can still have fiducials placed for super-precise imaging. With a little help from anatomy and some extra visceral fat, his side effects should be minimal.

[Victorq1]

Hi All

What is the thinking on Proton Beam Therapy

and would it apply even after EBRT I had 9 years ago?

i know its expensive,

if not covered by insurance,

but i was recently in Prague Czech Republic and thy offer it there

for "reasonable" cost.

I hear the project was co-operative, with one in Great Britain

and they are speaking English.

what ever will be decided-

good luck

Victorq1