How long does it take before PSA drops on Casodex?

[Cateydid]

He's been on 2 weeks: PSA rising. I've read it can take 4-6 weeks for PSA to drop on Casodex, but then it will work for 14-22 months.

[Tall_Allen]

No one should be using Casodex only for advanced prostate cancer, except at the beginning of Lupron (or similar) therapy to prevent flare of metastases.

pubmed.ncbi.nlm.nih.gov/249...

Lupron (or similar) should be combined with other powerful hormonal therapies (Zytiga, Xtandi or Erleada) or docetaxel.

prostatecancer.news/2017/06...

[noahware]

Can you provide a little more background for us? (When diagnosed, PSA and Gleason score, extent of mets, age, any other treatments, etc.)

How much has the PSA risen? I am also curious why labs were done just two weeks into the therapy. It is more common to wait 4-6 weeks.

[Cateydid in reply to noahware]

Joe was diagnosed in November 2009.

PSA was 7 (I think), Gleason was 4+3=7.

Cancer found in 1 of 16 lymph nodes

Prostatectomy 12/09 PSA = 0

PSA rose again in a few months; radiation to pelvic floor, reduced again, but never back to 0

Watch and wait until November 2016. PSA nearly tripled in 3 months to 6 something.

Metastasized to lymph node at base of trachea, two other suspect lung spots

Docetaxel x 6 doses and started Lupron every 6 months.

Reduced lymph node by half, other spots seemed to fade

PSA every 3 months: continues to creep up slowly. 1 something in January; 6 something in March; 7 something early June.

Started Casodex: PSA 2 weeks later = almost 9

Suggested Zytiga, but I feel like Casodex hadn’t had a chance to work yet...

[DarkEnergy in reply to Cateydid]

"Suggested Zytiga, but I feel like Casodex hadn’t had a chance to work yet..."

This does not make sense, Zytiga is suggested because clinical trials has revealed it improves outcomes. Moreover, Docetaxel was administered, so why not complete the efficient cocktail of Lupron, Zytiga and Taxotere (Docetaxel)?

[noahware in reply to Cateydid]

Just to be clear, he has been on ADT (Lupron only) continuously for about four years now? And the Casodex was never used before, and just recently added to the Lupron?

This is an unusual sequencing. I guess the idea is this approach might help by interfering with the androgen receptor, even if the cancer has developed resistance to the low-T environment created by the Lupron treatment. I suppose it is possible. Was it recommended by an oncologist, as preferable to other alternatives?

I am taking Casodex as an initial treatment and got a good PSA response when I did my first labs, about 5 weeks in. I have no side effects. But two weeks may be too early to tell, both on PSA response and if the fatigue will subside.

Even if you do get an initial response to Casodex, I am not sure about any long term success using that alone... it is a weaker anti-androgen that does not have much of a track record for helping more advanced metastatic cancer. I would suggest you put all that historical info into your profile, and then post again, asking for suggestions on other possible ways to proceed after the apparent failure of Lupron a decade on from RP.

[Cateydid in reply to noahware]

He’s been on Lupron alone for 4 years. Started it after chemo. PSA had been inching up all along. Bone scans are clean; growths in chest have reappeared but are still very small.

Hoping Casodex will work first, knowing Zytiga or chemo may come next.

Thank you so much for your replies. I feel so supported when I get answers to my questions! It matters that you all take the time to respond.

[noahware in reply to Cateydid]

You're welcome! I think waiting a few weeks, to see what the further response is, should not be a problem. At that time you can re-post with the results, and get opinions on possibilities for alternatives.

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

Suggestion: Add copy/paste Joe's bio info (above) to his home page for his and for member's use. (Also add his location/treatment center(s)/doctor's name(s) too).

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 07/07/2020 10:20 PM DST

[Cateydid in reply to noahware]

BTW: has been on Lupron @ 6 months since 2016

[Cateydid in reply to noahware]

Sorry...forgot to mention he’s 66 1/2

VERY healthy otherwise; jogs, plays tennis....

Casodex is making him VERY sleepy. Will that level off over time?

[Schwah]

Tall Allen is 100% correct. It’s not theory or conjecture. There is clear Clinical and scientific evidence that early use of Lupron Combined with either Zytega or chemo reduce his deaths by over 40%. To do otherwise with all the evidence in place is a a mistake.

Schwah

[Cateydid in reply to Schwah]

Thanks for your reply.

[GP24]

I think his doctor just started with Bicalutamide and will give your husband an injection at the next appointment. This is the standard treatment. He will probably recommend a Chemo therapy after that.

[Cateydid in reply to GP24]

Thank you. Doc has said we can go the chemo route again if needed.

[GP24 in reply to Cateydid]

Please add the medical history in your reply to noahware to your profile if you plan to ask more question. This way one has this information when answering your questions.

As far as I understand now your husband had Docetaxel and then Lupron ever since. Now Casodex was added to Lupron, which he gets every six months still.

Casodex, when added to Lupron, has only a very small additional effect. I think this is too small for the situation your husband is in with lung metastases and a rising PSA value after Docetaxel.

The way to proceed would be a Chemo with Cabazitaxel and after that Zytiga. Studies show this provides the best survival now. Another chemo with Docetaxel will have a reduced effect compared to the first chemo.

pubmed.ncbi.nlm.nih.gov/295...

Conclusion: OS (overall survival) appeared to increase with the number of life-extending therapies, with a sequence including DOC(ETAXEL), CABA(ZITAXEL), and an ART(Zytiga/Enzalutamide) providing the greatest OS benefit.

[Cateydid in reply to GP24]

I did add all Joe’s info to my profile. I hope I did that right.

Thanks for the additional info. I just started reading about CABA yesterday and want to know more about that.

I’ll keep looking! Thanks ever so much for your help.

[GP24 in reply to Cateydid]

Cabacitaxel is a Chemo approved to be used after Docetaxel only. Patients report the side effects are not quite as high as a Chemo with Docetaxel.

[Cateydid in reply to GP24]

Good to know. I believe he got taxotere last time....but I’ll double check his file to be certain. Thank you again!

[Magnus1964]

At the beginning you can experience what is called the PSA bounce. When cancer cells die they give off PSA so your PSA may go up. But after that the PSA should go down. Give it a little time.

[Cateydid in reply to Magnus1964]

Thank you. We saw the doc yesterday. He wanted to switch Joe to Zytiga right away. I told him what I’d read about PSA spiking before dropping, and he agreed to wait and test PSA again after Joe has been on it Casodex for 6 weeks.

[Magnus1964 in reply to Cateydid]

👍

[j-o-h-n]

The answer is "a while" be patient.....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 07/07/2020 10:22 PM DST

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

Thank you.