Adding biclutamide?

[Ayra1]

Should we add biclutamide on rising PSA values. Last psa .08. On adt for 3 years after having 1 met in femur along with sbrt. Rrp done in 2014 with clear margins. Thanks.

[Tall_Allen]

Why aren't you taking something stronger, like Zytiga, Xtandi or docetaxel?

[Magnus1964]

Your PSA is still low. Have you had a few rises in a row? If it's fluctuating at low levels it could be due to inflammation.

If you are experiencing rises casodex would be a next step.

[Ayra1 in reply to Magnus1964]

The rises has been from <.008 to .04-.06-.08. Thanks

[Ayra1 in reply to Magnus1964]

Thank you

[Ayra1]

Yes the lowest psa was <.008 which was there till nov 19. In 5 months it has risen to .04-.06-.08. Also at what psa level should we start biclutamide? Now or should wait till further rise?

[Magnus1964]

Don't know what other treatments you have had, but your femur met may need salvage radiation.

[MateoBeach]

So you can calculate your PSADT (See online PSA Doubling Time calculators). The addition of Casodex (bicalutamide), or the combination of Casodex with dutasteride which can an effective combo, could then be followed with serial PSAs to verify efficacy.

Yes, adding and advanced androgen receptor drug like Zytiga, or chemo like docetaxel are the most well established and clinically proven. So that must receive serious consideration.

But I can understand the personal reasons that may lead to trying a less onerous (cost and SE) regimen to see if it could delay progression for some time.

Casodex and dutasteride worked for me to delay evidence of progression for 4+ years, before it failed.

[Ayra1 in reply to MateoBeach]

Thank u

[herb1]

Ayra1: Sounds like you're in pretty good shape--except for that darn met. But before I'd rush into any changes with such low numbers, I'd want to be sure that the psa tests have all been done under the same rules, ideally by the same lab using the same method. For example, some labs no longer report values below some number (e.g., 0.01, others have different rules.

[Ayra1 in reply to herb1]

Yes all were done from same lab

[Ayra1]

Thank u