Hi, I am shipoo, I am new to this site. Very impressed with everyone’s knowledge.
I was just recently diagnosed with PC. Pet scan showed pelvic lymph node involvement and one mast on hip bone; G score 8; and PSA 6.
I would appreciate any knowledge you can share regarding which hormone therapy you found most helpful, agonist or antagonist,Lupron Or formagon, or any other preference you may have.
Also can Casodex be used alone. Thanks, much appreciated. Shipoo
Because Firmagon is not yet available as a multi-month injection, patients sometimes start with it (or casodex) to prevent an early testosterone flare that can cause bone pain and then transition to more convenient agonist shots.
Casodex (150 mg) can be used alone instead of a GnRH agonist, but it is not as powerful. Evidence is that early use of more powerful hormonal agents combined with a GnRH agonist increase survival more than Casodex.
Thanks for the info
Casodex can be used as monotherapy.
From 2018:
"Although there is no FDA indication for BIC {Bicalutamide} use as monotherapy, > 44% of patients in this study used BIC alone or as part of CAB {combined androgen blockade} followed by monotherapy. Further research is necessary to understand the outcomes of BIC utilization in these settings, particularly compared with newer second-generation anti-androgens."
ncbi.nlm.nih.gov/pubmed/299...
-Patrick
Firmagon (generic name "degarelix) is more effective than Lupron (generic name "leuprolide") in that it lowers the testosterone closer to zero and it has no "testosterone flare", i.e., a temporary 1-2 week increase in testosterone before the testes shut down. I don't know whether the side effects are different and, if so, better or worse. Maybe someone who has tried both can say - though maybe not because there are some side effects that seem stronger at the beginning and others later on. For most men Lupron seems to be adequate but I think I'd prefer Firmagon if I had a choice.
Casodex (generic name "bicalutamide") can be used alone and is commonly used that way in the UK and some other countries - perhaps because it's much cheaper. Casodex is sometimes prescribed at 50 mg per day and sometimes at 150 mg. The 50 mg dose is less powerful but has fewer side effects.
At one time, most doctors believed that we should start treatment with the mildest treatment that works (e.g., 50 mg Casodex), and only switch to more powerful drugs or higher doses if and when the mild treatment fails to control the cancer. Other doctors now believe that using very powerful treatments early (sometimes in combination) produces longer life than starting with weaker treatments and then graduating to more powerful ones as the weaker ones fail. Still others believe that sticking with weaker treatments while they work is the right approach for slow growing cancers and powerful treatments early are the right ones for aggressive cancer.
I don't know which of these approaches is the right one and I don't know if anyone does. I'm somewhat inclined towards the last view - mild treatment for mild cancer, aggressive treatment for aggressive cancer.
Since you've got a Gleason 8 and are already metastatic, I'm thinking you fall into the aggressive cancer group, in spite of your relatively low PSA. However I think each patient has to get the best medical advice that he can and make the most informed decision he can in light of his own priorities.
Best of luck.
Alan
Each ADT drug effects each person differently. Casodex is a nice older drug to start with. It's also cheaper.
Thank you
Adding this study to Patrick's for Casodex monotherapy:
researchgate.net/publicatio...
It says: "A post-hoc analysis of these studies indicated that bicalutamide 150 mg/day monotherapy may be of benefit to M1 patients with a prostate specific antigen (PSA) level </=400 ng/ml."
Above a PSA value of 400 ng/ml there is a benefit for Lupron. However, there are studies with different results.
Also to consider: there is mounting evidence that if one has a history of heart problems/high blood pressure, then the antagonist Firmagon is better (safer) than the agonist Lupron.
Good to know. Thanks
I have found this to be helpful: grandroundsinurology.com/po...
I have read the monographs above and can only tell of my experience. I am 73 years old and in 2007 I had an increasing PSA and my doctors recommended 42 radiations. Then in 2011 I had an MRI and they found metastases. They recommended 30 more radiations and I started Lupron every 3 months with 3 weeks of Casodex. Casodex is used to stop a testosterone flair. I still have my "junk". I stayed on Lupron (Eligard - generic) for 6 1/2 years. Lupron has many side effects. In Christmas Eve my doctor called and told me I no long have cancer. I have other health problems, but I am grateful for all the men who did studies on Lupron that saved my life. There were 2 Urologists in Orlando in 2006 who found out they had prostate cancer. One used radiation and Lupron, the other used surgery and Lupron. Both doctors had died 1 1/2 years later. They had waited too long to start therapy even though they knew everything about PCa. So ask a lot of questions and get a second opinion, but get started on something!
Thanks for sharing. So much to consider
Well, if you're not confused by now, I am. A distant bone met? My worthless contribution is throw the kitchen sink at it.
Greeting shipoo... Welcome to the Pca BIG FOOT society. Unlike the obscured Big Foot a/k/a Sasquatch of the Pacific Northwest we each have personal contact with the Pca Big Foot Monster. We fight the Pca Big Foot Monster with Scalpels, Radioactive Seeds, Radiation, Freezing, Medicines and Prayer. So if you wish to help us fight the Monster then please tell us your age, location, treatment center, doctor(s) names(s) and their expertise.
All information is voluntary and confidential. If you wish not to answer, then we give you a one way airline ticket to the Pacific Northwest.
Good Luck, Good Health and Good Humor.
J-o-h-n Thursday 02/21/2019 5:44 PM EST
Big Foot claims he's seen me, but nobody believes him.
hahahahahahahahahahaha (im writing that one down for when I'm in a nursing home, if i ever make it there) thanks....that hit the spot...
Good Luck, Good Health and Good Humor.
J-o-h-n Thursday 02/21/2019 8:41 PM EST
Already in hip. Hit it hard and hit it fast. Worked for me.
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