Adding Casodex (Bicalutamide) a good idea ?

[hansjd]

I’d like to ask this community about the wisdom of adding Casodex to standard ADT.

Background: Dx Feb 2018, PSA 168; multiple mets to bones. Firmagon monthly Feb - Nov switched to 3 monthly Dipherelin in Nov. 6 rounds of Docetaxel Apr - Jul. PSA nadir 0.4 in Aug. rose slightly to 0.64 by Mar 2019. On Atorvastatin, Celebrex, Metformin and a number of supplements: Ca/Mg/D3, MCP, Melatonin, Vit E (Tocotrienols), Broccomax, 5-Loxin.

My MO didn’t suggest any additional treatment at this time, so I sought a second opinion from another MO. Basically he agreed the current treatment was fine but suggested that adding Bicalutamide could possibly reduce my PSA further.

My question is: is this a good idea? Is there any problem with adding Bicalutamide? I’ve read that it was a predecessor to Enzalutamide but not as effective as E. Would taking it now mean that Enzalutamide would be out as an option later? Would taking it reduce the effectiveness of Abiraterone?

Any wise thoughts from the experts in this community would be most appreciated. Thanks.

[Tall_Allen]

It might lower PSA, but as your androgen receptor begins to feed on it, it might then raise your PSA. Only way to know is to try it. When you become castration resistant, you can try the stronger stuff.

[hansjd in reply to Tall_Allen]

Thank you Tall Allen. I feel more confident now about adding it to my treatment plan.

[dbrooks_h]

Could Avodart help even if your prostate has been removed, and your your psa is still detectable, while on lupron.

[cesanon]

Casodex, Avodart and Lupron used to be part of a standard cocktail. Casodex and Avodart are generally pretty safe without much side effect.

[hansjd in reply to cesanon]

Thanks cesanon. It did seem from reading on this forum that lots of PC patients in the USA have it prescribed, so it seemed like it would be OK.

[hansjd]

Thanks Nalakrats. I appreciate you taking the time to answer.

[kaptank]

Casodex does not close off any options for the second line anti androgens like Enza or Abi. There is no cross resistance like there sometimes is between Enza and Abi themselves. It will go castrate resistant. Some onclogists might stop casodex before it goes castrate resistant and resume when PSA rises toward a baseline, trying an adaptive strategy to maintain PSA in a band below the baseline, delaying the development of castrate resistance. While nowhere near as potent as Enza or Abi, casodex is cheap, well tolerated and has been used a lot longer than they have so we know more about its long term effects.

[EchoII]

I would like to know more about the cross resistance between Enzalutimide and Abiterone. Anyone know?

[kaptank in reply to EchoII]

google enzalutamide abiraterone cross resistance. This is an explanation:

hematologyandoncology.net/a...

[hansjd]

Thanks so much kaptank. I find your response very reassuring. The MO who gave me the second opinion and suggested starting Bicalutamide as well as ADT is a PC specialist, so I guess I shouldn’t have had any doubts, but I thought it best to be careful.

[JimVanHorn]

They told me that Lupron injections can cause spike in Testosterone for a few weeks when starting the injections. For 2 weeks before the Lupron I took Casodex so I would not have T spikes or flairs. I continued Casodex for about 10 days and stopped it. My doctor told me that Casodex would not keep my PSA as low or as long as Lupron. Taking them both was like putting a band aid on top of a band aid. But follow your doctor's orders and just keep truckin'.