Quick history, 3 months of Zoladex prior to robotic RP, Sept 2013.
3 months Zoladex during salvage radiation. Oct 2015
Steady rise from 2015 to 6.6 PSA January 2019 Doc wanted me back on medicine so 150 Bicalutimide a day hopefully to keep strength up.
Found 3 bone Mets in April so May 2019 went on Zoladex thinking it was better against Mets then Bicalutimide.
On December went back to Bicalutimide because of continuing losing strength.Doctor wants me to go back to Zoladex (the loss of strength was from IBM disease) My question is this any thought does Bicalutimide treat bone Mets to same degree as Zoladex.
I find my PSA going down while only on Bicalutimide to .012 from .025 in 3 months from Dec 2019 to March 2020 pretty positive.
As I have posted before I like the theory of riding one medicine as long as you can then sequencing to something else.
I don’t think a lot of guys here have done 150 Bicalutimide mono therapy but those that did what was lowest PSA went, how long did it work, and anyone here thoughts on bone Mets (had them SABR in summer no scan since), does Bicalutimide work as well as Zolodex on keeping Mets down.
Thanks for your help.
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Canuck53
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You can't go by what it did in the past, and that decline was microscopic, anyway. No, Casodex is not as powerful as Zoladex, and while Zoladex will always work, Casodex will not. In fact, the cancer will learn how to feed on Casodex eventually.
Thanks, I know you believe in combination treatments citing solid studies, I just think PSA pretty low so do I go with it to buy more time hopefully, finally go on Zolodex and or combination therapy.
You have many answers if I ride this does it affect the effectiveness of Zolodex later.
If you are worried about castration resistance, your logic is all wrong. It will happen no matter what you use. You are not buying more time, you are assuring less time. Life expectancy is longer with stronger rather than weaker ADT.
Thanks again I accept you have the expertise I struggle to get my head around buying time with Bicalutimide then going to stronger stuff lowers survival time.
Yes We have many guys here on this forum who did well on Bicalutamide monotherapy for over 5 years. One such person is Magnus who believes in riding out treatments one at a time. He is going into his 23 years of PCa.
As for Bone Mets, any thing which lowers your PSA and ALP will melt away your mets. PSA generally .. is an indicator of how many cancer cells are alive inside you and ALP is indicator of how your bone mets are....both indicators going lower means cancer cells are dying.
Again, does not matter what treatment you are using as long as PSA and ALP is on constatnt decline...we are achieving our goal.
I am over 25 yrs with PC.. Had an RP in 1995, than RT in 2004, than went on Bicalutamide 150 mono therapy & got over 6 yrs out of it with low PSA.. PSA Started creeping up again in 2018 so just a year ago I had an Orchiectomy instead of going on Lupron for life.. I'm now 76 yrs old & feel good & not currently taking any meds & MO says to live as healthy as I can & we will keep a close eye on it.. Sounds good to me... Very best of Luck to you....
Hello HamGuy at Denny's..... Nice to see you finally came out of the woodwork.... Keep Posting here we need guys like you. If you want to you can give us more about your bio... it's all voluntary but it helps us help you and helps us too. Thank you! (25 years - way to go)
Hi John, I always browse these posts & find many interesting... I think I was kind of lucky as my original PSA at time of my RP was only 7.6 and my Gleason was 6 or 7.. My currant MO said that with that kind of reading they wouldn't even do an operation on me.. Geez Thanks a lot.. But back than it was different.. Over the years I've gone thru
7 Dr.'s.. First two retired & have already passed.. Next one retired, and the Radiologist is still working.. My first & best Onco who I had for a few years & I thought very highly of her, went & moved to Nashville to teach/research at Vanderbilt U. I sure miss her.. Then I got a new lady Onco fresh out of school.. Was ok for a couple of years but we really got into it at the end of the year & I had to Fire her.. She was green & not up to the job.. So found myself a new male Onco who was tops in his med class & worked at Mayo for awhile...So far we are getting along nicely.. He recently made the statement to me that big Pharma & the medical industry has a lot of people over medicated & many would do just as well & live just as long & be much happier with just trying to live a healthy life...
All the other nitty gritty details of my case have mostly escaped my memory bank.. Sorry
And I LOVE your humor.. Here's one I may have gotten from U but maybe not..
Doc says to his patient; Sam I have bad news for U & even worse news for U..
Sam says boy that sounds bad.. Give me the bad news; Doc says well I got your test results back today & U have only a day to live... Sam says boy thats bad but Doc what
could be worse... Doc says well I was supposed to call U yesterday....
And keep the Good Humor coming there J-o-h-n... Lots of us like it...
its not really a question of stronger or weaker medicine, as Nalakrats indicates, their action is different. There is evidence that the combination of a GNRH agonist plus an androgen receptor antagonist is more effective than either alone or in sequence, which is logical. I was on both for 3 years until my PSA elevated at which time I discontinued bicalutamide. I am sure you are aware that second generation agents exist that may be worth exploring; abiraterone (lowering testosterone production) and enzalutamide (as another AR antagonist).
I know there is better stuff (Xtandi) I just get stuck on the thought of using what is working then switch to next. I believe Xtandi might work after Bicalutimide.
Out of curiosity what was lowest your PSA went under casodex. Funny I was quite happy I went from actually .032 to .012 tall Allen correctly pointed out this is a small drop, popped my balloon. Did you go to .00 from.0
Cutting your psa IN HALF is not insignificant. Just as doubling is not insignificant. stick with the casodex, brother. see my profile for my history. good luck, STAY POSITIVE.
TA is good at balloon popping. I would put that drop of PSA clearly in the "WIN" column and enjoy the good results. Keep on doing what you are doing and be well, Josh
Generally speaking and not directed at anybody in particular.. just because somebody knows a lot, does not necessarily mean they are always right.
I don’t know if TA is right in this case or not. Your PSA is low, small numbers for sure, but the decrease, relatively speaking, is significant.
The important thing here, is that it is low! My MO at DFCI only tests down to 0.02. He considers that undetectable. So you are doing very well in my opinion.
What can be asserted without evidence can be dismissed without evidence. Hitchen’s razor.
Our first introduction to Casodex was when my husband was diagnosed in 2007 with a psa of 234 and bone mets. He was on Casodex for 10 days then tested again the day of his first Lupron shot. The Casodex alone had dropped his psa from 234 to 90. Then we did Lupron and it further dropped it to 0.01. That lasted for 8 months with psa beginning to rise. We were at UCSF when they advised us to stop the Casodex because they said sometimes this happens that a rise begins to occur.
From that point we were on Lupron for a full year from the start of diagnosis. He then went off completely for another year while he had a much needed hip replacement. This worked out fine.
We had been on intermittent Lupron for no longer than another year. We did different things like Estrogen patches, some DES, and off again for another long while. When his PSA kept rising we decided to try Zolodex. We were in trouble because through a color doplar it showed the tumors in his prostate were getting close to the rectal and bladder wall.
We did zolodex for about 6 months. The tumor load dropped by 50% but also had pretty bad muscle loss, more than with Lupron.
We went back to estrogen and also used cannabis after that. It is 13 year later and now we are going back on Casodex tomorrow for 3 weeks with a Zolodex planned for about 3 months hoping it will work again.
We've made some risky moves, by switching because in those days intermittent was iffy. We decided to take the risk and glad we did for us 'personally'.. It is all very personal.
So good luck and wish us luck that we get stabilization once again so we can switch things up as we have in the past.
It's a commitment and obstacles that we continue to jump over. We stay positive as we take meds, not just taking them but consciously taking them, meaning with intention, as is our philosophy instead of just taking something without thought. We use qigong, meditation, diet, walking, intention and prayer. We are grateful. It's all very personal as I've been on Advanced Cancer Group with my heroes sharing their stories helping us to make decisions in keeping with our personal philosophy. Blessings and LOVE we find powerful...
To ALL strong health are our wishes...
BTW casodex was difficult for my husband. It wasn't an easy drug for him personally. This is why we are using it just to deter a flare.
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Enzalutamide (Xtandi) or not
Bicalutimide + Finasteride: latest labs
PSA rising while on ADT mono therapy 
Climbing PSA
Lu177 + PSMA617
