Is Casodex used primarily to avoid PSA flare when starting Lupron? If so how long does it need to be taken? If so would starting ADT with a degaralix injection instead and then transitioning to lupron after a month be equally or more effective?
Basic Question About Casodex - Advanced Prostate...
Basic Question About Casodex
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6357axbz
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There are many people right here on this forum who used casodex for over 5 years and did fine. I read many studies on pubmed from 1990s which concluded that casodex is as effective as Lupron for Advanced PCa.
After year 2002, the studies started badmouthing casodex and came up that it is inferior and should not be used long term. Lupron/Eligard lobby controlled the studies. After that comes Zytiga and became the King of all. Once Zytiga became generic...new LUTAMIDES (enza...Apa..Daro etc ) came and all spotlight is on them. They just cost @12000 a month or so. Casodex costs $10 a month. MY PSA dropped 70% within 15 days of casodex 50 mg a day and NOTHING ELSE.(from 830 to 248) Thats why I am impressed with Casodex.
Nobody is there to support poor generic casodex anymore. I believe in some people ,casodex can work for years....but not in everyone.
Is Casodex oral or injected
Casodex (bicalutamide) 50 mg tablets. 90 tabs with goodrx coupon at costco costs $32.
I was first given Casodex pills for a month before beginning ADT, Ie, Eligard 3 monthly sub-cutaneous injections. This ADT worked from 2010 to 2016, and Cosadex was added which extended Psa suppression by another 6 months, but after Cosadex failed I had Zytiga which gave 8 months Psa suppression, and I was not allowed to have Xtandi. I was given only one choice, to have Docetaxel chemo, and that failed badly in 15 weeks, then I went to Lu177 which worked well, and I was allowed to have Xtandi after my 3rd Lu177 shot to make Lu177 work better, and I am still taking Xtandi 8 months later but Psa is rising again so maybe Xtandi has failed. Its too early to say yet.
I have remained on ADT since 2010, apart from 2 brief pauses, now having monthly Lucrin shots
Not all men respond the same way to the range of hormone manipulating drugs. A friend died last year within 3 years after Dx. He had RP, with low Gleason and Psa. Psa went down then up so Pca continued on, then ADT failed after 3 months, Cosadex made his Psa rise from 7 to 40 in short time, then Docetaxel got Psa from 40 to 2 after 3 shots. He continued but Psa leveled, then was 40 after 10 shots. He wanted Lu177, but many more new mets turned up in his liver which did not show up in PsMa scan, so he had DNA of mets examined and he was also found to be Brca2 positive, so he had PARP inhibitors, and Psa went from 40 to 432, and he got so sick that he died in hospital, age 60. The best doctors just could not stop his Pca growing fast. He lasted less than 3 years after diagnosis. Its the worst case I saw myself, no doubt there are others. He was major breadwinner for family, lovely wife, 2 teenage boys, so they are doing it real tough now.
On the other hand I have known some men to last 26 years after Dx at 62. You could say they have a form of Pca best called weak, or a wussy, while others get the far more aggressive Pca that easily kills a man.
Pca teaches us that the only certainty is un-certainty.
Patrick Turner.
P T,
I agree that some PCas are very responsive to available meds whereas there are other PCas which do not respond well to availble treatments. Evryone's PCa is different.
But where would we be if us patients could not compare treatment outcomes?
I doubt anyone could fully rely on what doctors tell us. Discussions here reduce the uncertainty about enduring Pca progress and what to do about it.
One doctor told me not to go online to talk about Pca because it would make me anxious and confused. I replied that talking to doctors had the same effect.
Then I said both he and I had a lot to learn if we keep communicating, but of course the difference in position of doctor and I was that doc was in his game for the dough, and I was in my game for my life, and time = money, so docs have limit time to bare minimum. I happened to be the first patient in Australia in 2016 to get salvation radiation to PG after having had EBRT as the initial main treatment + ADT, which didn't work. This doc said the extra 31Grey he was giving my PG in addition to 70 Grey given in 2010 would definitely kill all Pca at PG which was never removed by RP. Later PsMa scans proved he was wrong about the prediction he made.
But afaik, Lu177 has killed all soft tissue mets so maybe all Pca in my PG have been killed but I can't be certain.
I heard on our ABC radio today that adding travel sickness drug Demathol to time when having chemo makes chemo 3+ times more effective.
Izzit BS? Hoo Noze?
Patrick Turner.
the only constant is change; gonna add yours now. thnx, pal. new stuff is on the way, since PCa is now getting more attention. keepin good thoughts out for ya, as usual
''Pca teaches us that the only certainty is uncertainty.''
I'm certain you can say that with certainly....
Good Luck, Good Health and Good Humor.
j-o-h-n Friday 03/06/2020 7:07 PM EST
Professor Stephen Hawking was reported to have said that "History is the story of human stupidity". I can't agree more, because so many were so certain, and then their plans failed and hopes turned to despair. It better to have Unkel Doubt sitting on your shoulder and whispering in your ear about how shit can happen.
Patrick Turner.
When In Doubt, Pinky Out...
Good Luck, Good Health and Good Humor.
j-o-h-n Friday 03/06/2020 7:44 PM EST
I do prefer to keep my pinky concealed, ( trousers up, zipper-checked) along with many thortz that the current social meedia ppl would love to burn me at at a stake for even thinking such thortz.
Ah, just wait until they get old enough to get Pca, they'll soon change their tune......
Patrick Turner.
Patrick. You may want to keep your eye on the forthcoming Veyonda DAART 2 trial. Veyonda is a produced by Noxopharm in Sydney. They are also involved with the LuPin trail at St V in Sydney (Lu177+ Veyonda).
If you are down in Sydney, I wouldn't mine catching up for a coffee. I'm on the ferry route (Cabarita).
Hi Alan, I don't visit Sydney unless I have to. I'm just too used to a nice small city like Canberra. The results of the trials you mention at St Vincents may be a benefit to me if it converts to therapy if I need more Lu177 in future. I'll look up what Veyonda actually is.
There was a trial for Lu177 + Xtandi at St Vincents that began soon after I finished 4 shots of Lu177. But at my 3rd shot of Lu177, I had Professor Louise Emmett supervise the Lu177 infusion.
Dr Emmett was awaiting the funding for Lu177 + Xtandi which happened. She believed that chemo that had failed would make Pca have higher PsMa expression when Xtandi or Zytiga was given to men after the chemo, and that the chemo make Pca re-sensitized to effects of the two drugs.
Thus she suspected adding Xtandi to the whole Lu177 treatment would attract more Lu177 to Pca met sites, thus make the Lu177 more effective. The basis for her ideas was founded in her ideas on molecular biology and anecdotal evidence from a lot of clinical practice. I don't know what if any conclusion has made yet after that trial, and maybe my Xtandi I am having now since last April is failing to have any effect at doing anything.
So what benefit would there be if Xtandi is not making the small amount of active Pca which I have more likely to express more PsMa and make a repeat dose of Lu177 effective? Only another PsMa scan might tell us the answer but I feel I am drifting into Dunno Land.
After lots of different treatment plans and inevitable treatment failures, a typical Pca patient ends up with less real options for beating Pca that finds yet more ways to beat all things that any doctor can do. This patient finds out even the smartest and most expensive option often does not work, even with the best analysis of his Pca and done in a timely manner.
Patrick Turner.
Hello,
I took casodex (bi-calutamide) at diagnosis in 2013 to reduce flare. It dropped my PSA somewhat but not really significantly. After a month I was put on monthly Zoladex (goserelin acetate) injections. This caused a significant drop in my PSA level. After four and a half years (2017) when my PSA started to climb, my oncologist tried casodex again. Some improvement but it wasnot really that significant. After that he suggested Firmagon (degarelix). Once again some improvement but not long lasting. I did not really like Firmagon because of swelling at the injection site and frequency (i.e. once a month as opposed to once every three months). The cancer clinic suggested I go back to Zoladex and Xtandi (enzalutamide) which has caused my PSA to drop to virtually undetectable. It has been two and a half years, so I am a happy camper! Hope that helps!
Using degarelix to start ADT most patients achieve castration levels of testosterone in 24 to 72 hours versus 2 or more weeks with Lupron. Then after a month, lupron or similar could be started or continue ADT with degarelix.
That’s what they say but I was on it for three years. Then I switched to estradiol and dropped casodex and Lupron ( actually trelstar- same garbage!) Best decision I ever made!
Yes, it is used primarily to prevent flare. About 2 weeks is all that is needed. Yes, starting with Firmagon accomplishes the same thing and may be more effective.
Thanks TA
When you say two weeks. When first beginning back in 2007 at UCSF it was 3 days. Then we did on an off injections and each time we needed casodex it was either 3 or 5 days.
This time it is 7 days, with another 2 weeks afterwards. My husband is in a different situation than the previous times except for the first when his psa was 234.
He's very sensitive to drugs in general. After one dose yesterday, he began with more pain in the trouble spots, also some stomach hurting.
Now we are about to do a second day and he's up to about 4 in pain out of 10.. where he can be at a 2 usually. I'm just preparing myself with information.
Depending how this goes, we get an injection on Friday which is 1 day less than a week away. Prior times we've been able to stop the casodex at the time of injection. Are there any safety issues/information lately that has to do with the flare..
It's a hard drug for him to take though necessary in this situation.
Any information on the latest thinking is helpful to know.. Thanks...
If he re-starts ADT with Firmagon, he won't need Casodex at all.
thank you... the problem we have with that is we know that zolodex has worked...
No problem. Just start with Firmagon for a month or two, and then switch to Zoladex.
Hi, would that mean after the firmagon injection, prior to switching to zolodex, he would then not need the casodex..to stop the flare? are you saying that normally the firmagon would stop a future flare? that would be an option.
I appreciate your knowledge.. I've lived for 13 years with what I call people trials that have helped me immensely... The wide range of experiences allows us to decide our next move along with our oncologists...
Also, being in the alternative health care for 45 years, I learned ways to help kidney and liver health. We had blood tests a few days ago that showed his numbers were good. What we do is use everything we have. I do a lot of light massage and acupressure, we use lemon water, and other older remedies. Parsley tea for kidneys etc.. There are no trials for these, they have no side effects, as in do no harm.
All of our decisions are based on risk reward. Because we are 13 years diagnosed stage iv, with a number of places showing mets at diagnosis, our docs are more inclined to listen to our philosophy. I'd say honestly, Tall_Allen, we are lucky in many ways, and we understand more of his body. For him, less is more...
We spoke to the doctor on call who said, I don't think the pain/ache intensity is coming from the Casodex. Well, after 7 hours, and years of dealing with this, and months of the steadiness of a certain amount of pain meds working and the type of ache/pain, there is no doubt this med has stirred something up.
Plus, I read many sites about the side effects it can cause, more ache/pain is listed in all of them besides a stomach ache which he also had last night, that he never has.
So, this is when we have to be our own doctors and I have to go seeking solutions I can bring to our docs. We love our guy- he's a great doctor. We respect and are grateful- yet it's also up to us to figure some things out if we are lucky, and with this site, we ARE lucky. I've seen you help many here and I thank you.
Yes, I am saying that starting with Firmagon prevents the testosterone flare one gets with Zoladex. Casodex is unnecessary.
Thank you... I will check with out doctor on Monday. The reaction that he is getting no coincidence 7 hours later is such intensified pain. I'm not quite understanding why the doctor on call said that Casodex wouldn't cause this and yet when I look side effects up.. there it is. I much appreciate this information. May you have strong health.. thank you...
He has likely become resistant to Casodex as often happens.
Please a question: We have only done Casodex the first 8 months in 2007. Then 3 more times for 3 days, no longer than 5 days. Can you say what your thinking is why he may be resistant. What might point to that in this current accelerated pain situation. Over the 13 years, he's probably in total done ADT drugs, excluding estrogen patches, honvan, no more than about 2 to 2 1/2 years on an off with the last time in 2014. I was much younger when this began with a better ability to retain this information. I knew his entire history and researched. I'm absolutely dedicated though it's harder to process as I've gotten older with a very watchful eye on him...
your thoughts please, thanks....
As the cancerous androgen receptor evolves, it mutates whether or not one uses anti-androgens. Some people mistakenly believe that if they hold off on the duration of hormonal therapies or use lighter versions they can avoid resistance. The opposite is true - the stronger anti-androgens prolong survival more than the weaker ones. Eventually the mutated androgen receptor will be able to feed on Casodex. At that point, there will be a surge of testosterone when he first starts Zoladex and Casodex will no longer prevent activation of the androgen receptor. This is what causes the pain flare.
Interestingly, in my 8 year journey with metastatic CRPCa I never once have been prescribed casodex. Not has it been discussed.
Yes, Casodex is used primarily to avoid PSA flare when starting Lupron, especially in the USA, where it was actually never approved by the FDA as monotherapy (as it was in other countries).
As I understand, it has potential side effects of 1) gynecomastia, and 2) liver problems. Not sure if those are only with the higher dose, longer term monotherapy.
Believe it or not, because of my intense fear of taking ADT..I remained on casodex for 2.5 months wherein my PSA dropped from 912 to .79..!!!!....insane. It was the easiest on me of all the T blockers I took....I’m told it should eventually be outflanked biochemically for most users in the AR complex so it has become ‘unfashionable’....I remain a big fan.
Regarding long-term use of Casodex, one must be aware that it can turn into an AR agonist:
"Under normal circumstances, bicalutamide has no capacity to activate the AR. However, in prostate cancer, mutations and overexpression of the AR can accumulate in prostate gland cells which can convert bicalutamide from an antagonist of the AR into an agonist. This can result in paradoxical stimulation of prostate cancer growth with bicalutamide and is responsible for the phenomenon of the antiandrogen withdrawal syndrome, where antiandrogen discontinuation paradoxically slows the rate of prostate cancer growth."
en.wikipedia.org/wiki/Bical...
When used as monotherapy, I would definitely use Avodart too.
-Patrick
wikiP is not considered a dependable source of info, open-sourced as it is, but in this case, the info matches my own research. i'm using finasteride, selective for non-cancerous but enlarged prostate tissue, whereas avodart (dutasteride) hits both cancerous and non-. I took this piece of info to my uro-onc (whose only desire in life is to cut people open and fool around with their gizzards) who Rxed avodart, which i substituted for the finasteride. noticed a marked difference in 'urgency', almost to the point of incontinence. Went right back to the finasteride. Was only last month, have a 90-day supply going to waste.
I have been on one 50 mg tablet of Casodex and one tablet of 10 mg of Tamoxifen since mid August 2019 when my PSA had risen to 65. My PSA dropped to 1.7 when tested in October 2019 and then to .3 when tested at the end of 2019. Fortunately I’ve experienced no side effects, and the tumor next to the wall of my rectum was reduced by40% when an Axumin Scan was done after being on Casodex for 40 days. My urologist says I’m one of the lucky ones who is hormonally sensitive.
Used it for treatment for 11 months. Started on Casodex alone after a 13 month adt vacation from Lupron. I wanted to try treatment with fewer side effects and the Casodex worked.
Back on Lupron now and my breast pain is gone, I guess that was an effect of monotherapy. We will remove the Casodex at some point, but my psa dropped by more than half in the first month of Lupron. I'll take it.
Sounds like a success
To answer your question I can only speak from personal experience. As A GS 9 @ diagnosis and many bony metastasis in 2013 where Degarelix loading dose was injected for 1 month followed by Lupron injections for 4 years . When PSA began to rise I was prescribed Bicalutamide 50mg and have been on it ever since with an undetectable PSA - so not just prescribed for initial prevention of testosterone flare ( degarelix loading dose is very efficient in reducing testosterone levels without a flare rapidly )
Impressive response to ADT!
do you still have your gland? or was the metastasis after RP?
I still have my prostate in one sense but in another no real functioning prostate after 45 IMRT treatments in 2015 . Metastatic at initial diagnosis in 1/2013
Better stated, Casodex should be given initially to prevent testosterone flare when starting Lupron, Eligard, etc. However, Casodex can be also given in combination with Lupron/Eligard, etc.; your Medical Oncologist will make that call. Interesting is a phenomenon called Casodex Withdrawal. Where by about 20% will experience an immediate drop in PSA values after a longer period of usage and stopped.
GD
Well, I had to twist my urologist's arm to prescribe casodex while waiting for eligard to become available. The darned insurance company dragged their feet approving it and I had to deal with a three week delay for what should have been a routine approval.
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