My urologist called yesterday with results of latest PSA and Axumin Scan. PSA fell from 65.7 to 1.7 after starting 50mg Casodex along with 10mg Tamoxifen. The scan showed the tumor next to the wall of the rectum had decreased from 5.4 SUV TO 3.5 SUV and showed no new occurrences of cancer.
I was diagnosed in 2007 - Gleason 7 and had proton beam radiation in 2008. PSA started rising in December 2016. My urologist recommended finding the cancer and not using hormones but the problem area was not found with a Ga-68 PSMA Scan and 2 Axumin scans until 18F DCFPyL Scan at NIH in March of this year. A CT guided Biopsy at OHSU in June confirmed malignancy but the location next to the wall of the rectum made surgery or SBRT too risky leaving hormone therapy the only option.
My health was and still is excellent having been on a Mediterranean diet since 2007 as well as being an avid hiker and golfer. I’ve experienced no side effects from the drugs except for decreased libido - interest is still there but erections are no longer automatic.
Has anyone had similar results from Casodex? How long can I expect this to work? Thank you for any imput.
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Are you doing Casodex as a monotherapy or are you on Lupron also ? Urologists seldom have to training to treat metastasized cancer. Maybe you should have a chat with a Medical Oncologist and a Radiation Oncologist. If your tumor is small and isolated, perhaps it can be treated with one of the newer spot radiation (SBRT - Cyberknife) techniques..
Yes I’m taking Casodex only - the urologist suggested 150mg daily but my medical oncologist from OHSU who specializes in prostate cancer suggested starting with one tablet a day. From the beginning I’ve told all doctors quality of life is more important to me then quantity. Because of tumors location,I did not qualify for NIH’s SBRT trail and Dr. Chris King from UCLA agreed it would be too risky.
I'm kind of interested in the mass against the rectum for a friend of mine. In his case, SpaceOAR may have been injected into a small ECE and protected the cancer from his (otherwise successful) radiotherapy. He had a biopsy, which showed it is not very hormone-responsive. It also does not have much PSA, and is not PSMA-avid, which is why it wasn't detected until it grew big enough to cause problems. It is interfering with his bowel movements and he is trying to shrink it with chemo. If that doesn't work, I have proposed ablating it with HIFU or HDR brachytherapy. Did your doctors talk about either of those, or did they feel any kind of focal treatment was too risky for the bowel?
Yes T A , Doctors at NIH, OHSU, and Doctor Chris King UCLA felt any radiation or surgery would be too risky because of tumors location. Reluctantly I started the daily Casodex and Tamoxifen on August 21 and was stunned by the PSA results as well as the reduction of the tumor size. I continue to walk 50 plus miles a week and today will be my 11th in a row chasing the little white ball. How long do you think this routine will work? Thanks for your reply
I don't know how long it will work, but there are many other hormonal agents that you will be able to try afterwards.
I may suggest that he get HIFU or some targeted hyperthermia combined with HDR brachy if it still needs shrinking. He's getting an MRI next week, so we'll know if the chemo is working.
If you suggest hifu, why not have him look into the Tulsa pro as well? It has active cooling of the rectal area (as well as the urethera) to prevent unintended harm.
After my treatment we reviewed the imaging with the doctor. He had taken the ablation right to the bitter edge of both urethra and rectum and I suffered no ill effects from it.
Hi 407ca- I was just looking at the Tulsa Pro- it looks like it is transurethral and just for ablation of the prostate galnd. Did you have it used for something other than prostate gland ablation? Thank you.
I have started believing that "old is Gold" This lovely entity called Casodex dropped my PSA from 830 to 240 just in first 25 days. But then, my MO switched me to Lupron and Zytiga which got PSA down to 0.9 in 3 months.
One of our fellow member ,Magnus remained in remission with Casodex for 5 1/2 years.
I've been on Casodex monotherapy for almost 6 months. Last PSA/CT/Bone Scan showed much improvement. PSA dropped from 950 to 60 in 3 months. Having all 3 again in 9 days. I will get back to you when I get the results. My MO would not give me tamoxifen or prophylactic radiation for the gynecomastia. Having occasional nipple pain.
Thanks for replying J- my urologist suggested radiation and also gave me a prescription for Tamoxifen. Started the radiation process in the middle of June but still wasn’t scheduled for treatment by middle of August so started the Tamoxifen which has a better record of preventing Gynaecomastia then radiation anyway. Seeing my M O Tuesday- will post what she has to say.
Saw M O today / very pleased. Continue same treatment and monitor PSA in 3 months. Wasn’t opposed to try Estradiol Patches if PSA went up in the future.
Consider adding Dutasteride to Casodex. It significantly lengthens my PSA doubling time (I have stopped it twice with less than half the doubling time during the off cycles. Check out compassionateoncology.org to read about Dr. Bob's approaches to hormone blockade. I have many abstracts that show some benefit from Dutasteride. Let me know how I can email them to you.
Something like 35 % of men on Dutasteride complain of longer time to orgasm. That seems reversible when stopping the drug.
Helps prevent male pattern baldness as well.
Casodex high dose 150 mg. has stronger influence on PSA compared to 50mg. Canada experience is 150 mg. for extended time (years) has some heart toxicity. As with all prostate cancer therapies and diets, take good are of your heart.
Some men on Casodex will eventually (typically years) have PSA rising. Stopping Casodex often results in PSA going back down for a time. (anti androgen withdrawal syndrome)
There is increasing evidence that SBRT (Cyberknife) radiation can put men into remission when they have a small number of mets (Oligometastatic disease). Consider consulting with an SBRT specialist to learn if the new techniques and hardware might be useful to you.
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