Lucrin after orchidectomy

Hi all, I am a new person to this forum, lucky I found it. I am from Vietnam and I would like to tell about my dad’s case to get your advice / experience sharing.

When my dad knew he got prostate cancer (Jun 2018), it was already bond metastasis (stage 4) with Gleason score of 8 (4 + 4). He took the surgery to remove the testicles (orchidectomy) in Jul 2018 then took Casodex from Feb 2019 when PSA started rising again. In Dec 2019, he stopped using Casodex when PSA arose again and injected Lucrin in Feb 2020 because his doctor believed that his T level was higher than the threshold of 20 nmol/L. In the most recent test (Apr 2020), his T level dropped dramatically to 0.08 nmol/L but his PSA continues increasing (2.83 mg/nL). His doctor said Lucrin was worked and my dad should monitor his PSA for further 2 months. Since my dad’s PSA level has increased quickly, we are quite nervous. Could you who have experience or went / go through the same treatment approach share your advice? Below are key milestones of my dad’s treatment.

- Jun 2018: got biopsy and the result is prostate cancer, Gleason: 4 + 4;

- Jul 2018: took the surgery to remove the testicles (orchidectomy), PSA at that time was 73 mg/nL;

- Oct 2018: PSA decreased to 0.218 mg/nL

- Feb 2019: PSA increased to PSA: 0.336 mg/nL and started taking Casodex

- May 2019: PSA reduced to 0.162 mg/nL

- Dec 2019: PSA arose to 0.38 mg/nL then stopped taking Casodex

- Feb 2020: PSA rose to 0.75 mg/nL then injected Lucrin

- Apr 2020: PSA increased to 2.83 mg/nL

Looking forward to receiving your sharing.

Thank you in advance

[Magnus1964]

Those Last few PSA readings were fairly small. I don't think I would have stopped casodex. You could just as well added Lupron to the casodex. I am assuming that the removal of the prostate was not advisable. The next step might be radiation to the prostate.

[LearnAll in reply to Magnus1964]

I agree with what Magnus is saying. Restarting Lucrin PLUS casodex andmay be increasing casodex dose upto 100 mg a day can control his PSA better. Keep monitoring PSA closely but do not give up on medicines whcih have worked so well before. just an opinion.

Good luck...caring son of a lucky father !

[Hidden in reply to LearnAll]

Thanks Magnus1964 and LearnAll for your feedback! My dad stopped Casodex based on the advice from his doctor who shared the same thought of castration resistance with Tall_Allen. Please continue share your thought with us.

[Tall_Allen]

This is a condition called castration resistance. Casodex sometimes feeds the cancer, so you were right to eliminate it. He has to keep taking Lucrin, though. I don't know what is available in Vietnam, but there are some stronger hormonal medicines that he can try (abiraterone or enzalutamide). Docetaxel would be a good choice too.

[LearnAll in reply to Tall_Allen]

You said :"casodex SOMETIMES feeds the cancer"

Can you give me atleast one or two clinical trials which has concluded this .?

If people monitor PSA closely, will they not know if Casodex is feeding cancer...SOMETIMES.

[Tall_Allen in reply to LearnAll]

It's a well-established (my earliest case reports were in 1993) phenomenon called "anti-androgen withdrawal syndrome," because PSA goes down when anti-androgens are stopped. It occurs as the anti-androgen comes to activate the androgen receptor.

auajournals.org/doi/10.1016...

goldjournal.net/article/009...

ncbi.nlm.nih.gov/pubmed/753...

karger.com/Article/Abstract...

amjmed.com/article/S0002-93...

ncbi.nlm.nih.gov/pubmed/911...

acsjournals.onlinelibrary.w...

goldjournal.net/article/S00...

ascopubs.org/doi/10.1200/JC...

karger.com/Article/Abstract...

ncbi.nlm.nih.gov/pmc/articl...

link.springer.com/article/1...

The SOC in patients on Combined Androgen Blockade (CAB or ADT2) with a first-generation anti-androgen and a GnRH agonist is to stop the anti-androgen to see if PSA goes down. CAB is outmoded since the approval of more powerful hormonal therapies.

[LearnAll in reply to Tall_Allen]

Thanks. Does that mean just like BicaLUTAMIDE, all other lutamides such as Enzalutamide, Apalutamide,Darolutamide will have the same effects as they are in the same class as Bicalutamide.

[Tall_Allen in reply to LearnAll]

Anti-androgens all have that effect.

[LearnAll in reply to Tall_Allen]

What do you think about starting Anti Androgen for a few months ..then discontinue and enjoy low PSA .....and then..after few months..repeat the cycle.

Right now, I am not on any medicine for last 3 months and all biomarker are very good. Just thinking ahead.

[Tall_Allen in reply to LearnAll]

Reading your profile, it seems that you were on Lupron+Zytiga for mHSPC, but you decided to use iADT. I have never heard of iADT with Zytiga - I would be worried about selecting for Zytiga-resistant clones. When you write, " ...starting Anti Androgen for a few months..." which anti-androgen are you talking about? If you mean enzalutamide as a monotherapy, maybe; there is just no data to recommend it as a monotherapy. If you mean bicalutamide (150 mg/day), it does not have the same oncological benefit as Lupron, or of Lupron+enzalutamide, of course, but if the side effects of the stronger therapies are intolerable to you, I can understand why you might do that.

[Hidden in reply to Tall_Allen]

Thank you, Tall_Allen, for your sharing. We think the doctor provides us an economic treatment plan. In Vietnam, chemotherapy and abiraterone are only applied for castration resistant patients and social insurance will pay 30% of the cost of abiraterone and 100% of chemotherapy. Enzalutamide is not coved by insurance. Hope to you more!

[j-o-h-n in reply to Hidden]

Hello Dawn,

How old is your Father?

Other than his Pca Is in good shape?

Are you male or female?

Are you in the medical field?

All information is voluntary. Thank you for being such a wonderful offspring...

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 04/23/2020 6:47 PM DST

[Hidden in reply to j-o-h-n]

Thank you for your asking. I am not in the medical field. My dad is 69 years old. In Oct 2017, he went through an emergency operation relating to aortic dissection, before that his health was quite good. Sometimes, I thought his Pca was a side effect of that event.

[j-o-h-n in reply to Hidden]

Hello Dawn, thank you for your reply. You may want to add your Father's bio to your home page. This way it's there for you to reference and for others members to view.

Hopefully you have other family members to help you manage your Father's situation. Keep on posting here for information. There are many knowledgeable members who know about Pca (I'm not among them, I'm into humor)....

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 04/24/2020 2:23 PM DST

[Hidden in reply to j-o-h-n]

Thanks for your advice.

[Rafithussain in reply to Tall_Allen]

My condition is almost similar to dawn 80 my current psa is it 0.972 from 0.08 in jan 2020 and it was 0.01 in sep 2019..I wanted to know does resistance occurs in all prostate ca patients within 18 to 24 months

[Tall_Allen in reply to Rafithussain]

No - it can take longer or shorter.

[Rafithussain in reply to Tall_Allen]

I have developed it after 22 months..how do u Analyize this is it too early

[Patrick-Turner]

All those Psa figures are quite low, except the last one at 2.83, indicating a fast rise.

After removing balls or having ADT with Lupron, Lucrin,Zolades et all, Psa may go low then rise after months or years. Normal treatment is to add Zytiga or Xtandi, which may suppress Psa for another year, and then maybe have Docetaxl chemo which might give 18 months reduction of Pca, and lower Psa, but many will still have rising Psa no matter what they add to normal ADT or after having balls removed.

When Psa reaches 5, it is good idea to have PsMa Ga68 PET/CT scan to give best idea of Pca status of what is at PG and at mets. After ADT + Cosadex then Zytiga failed I had chemo, which failed after 4 shots.

Then I had Lu177 Psa went from 25 to 0.32 in 12 months but Psa is rising again, maybe 5 now, so I'll get more Lu177 if possible, but I feel very well.

I was diagnosed with Gleason 9 and inoperable in 2009. Psa has been been up and for 10 years.

Maybe Pca kills me next year. I really don't know my future, and nor does anyone else.

I witnessed a friend who had Casodex after RP failed to keep Psa low, followed by 70Grey EBRT. The Casodex made Psa rise rapidly. Its not common, but in some cases it happens, and my friend had Chemo, and after 3 shots, Psa went from 40 to 2, then up after another 7 shots to 40, and Xtandi didn't work, and he was Brca-II positive and had PARP inhibitors and Psa went rapidly to 432, with many new mets in his liver. PsMa scan showed the new mets would not respond to Lu177, so he just got so sick and weak in hospital he just died, 3 years after diagnosis, under 60yo. His case was unusual, but some Pca kills real fast.

My friend should have had Lu177 after 5 shots of chemo when Lu177 may have worked before Pca mutated at went to his liver.

Patrick Turner.

[Hidden]

Since last month, my dad had difficulty in passing urine, especially at night. Do anyone meet the same situation? Does it relate to Lucrin? Is it normal or the signal of something?