Have Any of You Been Prescribed Casod... - Advanced Prostate...

Advanced Prostate Cancer

17,734 members21,828 posts

Have Any of You Been Prescribed Casodex to Increase PSMA Expression Prior to LU-177.

paige20180 profile image
30 Replies

Charlie is still hormone sensitive. I thought I had read that some clinics prescribe an ADT drug to cause PSMA expression to increase to enhance the treatment. My husband is getting his first treatment this Monday at Fortis Memorial Research Institute in Delhi, India.

For those of you having a difficult time traveling under Covid or not able to get in for treatment, we had to jump through many hurdles to be authorized to enter India under an emergency Visa. We will let you know how it goes.

30 Replies
KSK54 profile image
KSK54

Hello paige 20180,

Wishing you the best.

I am just 20 minutes away from this hospital. Please let me know if I can be of any help. It will be my good luck to help a fellow PC warrior.

Khatri

9999988309.

paige20180 profile image
paige20180 in reply to KSK54

Khatri,

How incredibly kind to you. We will definitely call if we have any issues. I wish we could take you to dinner. Maybe the next treatment when we aren't under such strict rules for our emergency travel Visa. Thank you again!

GP24 profile image
GP24

The drug these clinics use is Xtandi or Enzalutamide.

eurekalert.org/pub_releases...

You will not get a prescription for Xtandi while you are hormone-sensitive. Therefore I took Bicalutamide which is similar to Xtandi. I know another patient who observed an increase in PSMA expression when taking Bicalutamide. I was called a super-responder by my doctor but I cannot tell if Bicalutamide did the trick.

I would take Bicalutamide in the hope it increases the PSMA expression plus take it for six months after the PSMA treatment to delay a possible recurrence.

paige20180 profile image
paige20180 in reply to GP24

Thank you! Our doctor was thinking he’d put Charlie on Lupron a month after treatment. We was going to wait to see how the LU-177 did and then try to further give the cancer an extra punch. Would you suggest Bicalutamide instead of Lupron from your experience?

GP24 profile image
GP24 in reply to paige20180

If you want to give Bicalutamide a try then start today! It takes at least a few days to increase the PSMA expression. This has to be done before the infusion. Maybe you have left some Casodex pills from 2018 when Lupron was started.

After the PSMA infusion I think it makes no difference whether you use Lupron or Bicalutamide. I took bicalutamide plus 20 mg Tamoxifen because this has much lower side effects than Lupron.

There were trials which combined salvage radiation with ADT and showed a benefit for that for high-risk patients. This is the reason I took Bicalutamide for six months after the PSMA treatment. I would not just wait and see! A recurrence is likely and that will be a disappointment for you.

paige20180 profile image
paige20180 in reply to GP24

Really appreciate your thoughts. He’s done salvage radiation plus SBRT and his spine hasn’t responded well to the SBRT. I’ll be sure to share with our doctor what worked well for you.

GP24 profile image
GP24 in reply to paige20180

I mentioned salvage radiation just to provide a reason to start with ADT after the infusion. Doctors often do not want that because they want to see how well the Lu177 treatment worked.

nycrunner profile image
nycrunner in reply to GP24

Hi

I have been taking Bicalutamide for the past 6 weeks and I have noticed a soreness developing in my breasts.

You mention 20mg Tamoxifen. Does this help reduce the soreness in the breast ?

noahware profile image
noahware in reply to nycrunner

Yes, and can help prevent breast growth, too. I take 10 mg tamoxifen w/ my 150 mg dose of bicalutamide. Generally well-tolerated, but I believe they keep an eye on liver function the first month. No probs here, for me.

GP24 profile image
GP24 in reply to GP24

I started out with 150 mg Bicalutamide and 10 mg of Tamoxifen. Then I felt "something" in my breast and increased the dose to 20 mg. After a few weeks I reduced it to 10 mg again.

paige20180 profile image
paige20180 in reply to GP24

HI GP24. Were you hormone sensitive when you took Casodex prior to LU177? Thanks

GP24 profile image
GP24 in reply to paige20180

Yes, otherwise I would have got a prescription for Xtandi instead.

TJGuy profile image
TJGuy

Wishing best of luck to Charlie and you! Safe travels!!

Tall_Allen profile image
Tall_Allen

I don't know if Casodex will have the same effect on PSMA expression that the stronger hormonal agents do.

hansjd profile image
hansjd in reply to Tall_Allen

Allen, Do you know if Abiraterone has the same effect as Enzalutamide on increasing PSMA expression?

Tall_Allen profile image
Tall_Allen in reply to hansjd

Yes.

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

hansjd profile image
hansjd in reply to Tall_Allen

Thanks Allen I was pretty sure you’d know :)

paige20180 profile image
paige20180 in reply to hansjd

Hey. I think we need to be clear that there may be a big difference in men that are hormone sensitive versus resistant trying to get a better PSMA expression prior to treatment. My husband is doing Lu177 still ADT sensitive. Most men have had this treatment later in their treatment. The doctors we have seen think my husband is actually having this treatment at the best time possible with a low burden of 4 lesions, hormone sensitive and no chemo. Please read the studies and note whether the study is for hormone sensitive or resistant.

Shanti1 profile image
Shanti1

While PSMA "flair" is documented with 2nd line hormone therapy in castrate-resistant men, men who are hormone-sensitive may not demonstrate PSMA increase after ADT initiation. Below are links to studies demonstrating this. The first study, in particular, compares the immediate effect of ADT+Bicalutamide on PSMA expression in hormone-sensitive verses castrate-resistant men, demonstrating that 62% of the hormone-sensitive men had a decrease in PSMA expression at day 9. If Charlie's scans show him as very avid now, my thought is why do something that could change that. Maybe only if the response is not as ecpected. I would love to hear other thoughts, but I don't think there are any studies showing a flair for hormone sensitive men.

ncbi.nlm.nih.gov/pubmed/305...

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

charlesual profile image
charlesual in reply to Shanti1

Thank you so much Shanti!

Bodysculpture profile image
Bodysculpture

Praying for a good result

MateoBeach profile image
MateoBeach

Shanti1 is correct. Read that evidence carefully. I too am awaiting Lu-PSMA treatment and am HS. My strategy will be to have the first treatment without the drugs. Then repeat PSMA scan to assess response. If less than excellent response I would add enzalutamide (not bicalutamide) to prep for a subsequent round. This is being studied further in clinical trials.

But what I would really want, under compassionate care is Veyonda, idronoxil. Look up the LuPIN trial by Noxopharm. Sorry I do not have the link on my phone.

Good luck and travel safe.

paige20180 profile image
paige20180 in reply to MateoBeach

Thank you! Yes. Shanti has helped me so much. You too thanks.

Bangkok profile image
Bangkok

I recently discovered Bangkok is again accepting medical tourism. I had 3 treatments there from Mar to May. My PSA dropped from 990 to 0.14.

Bangkok profile image
Bangkok

I had 3 treatments in Bangkok last spring with no p vous

Bangkok profile image
Bangkok

No previous treatments only the radioligand. My PSA went from 990 to 0.14 and no Mets.

Bangkok profile image
Bangkok

I started my Radioligand (Lute 177) in Bangkok - cold turkey with no previous heavy duty drugs. After 3 treatments my PSA which was astronomical is now 0.10 and no mets in sight despite being lit up like a Chritmas tree after my gallium.

paige20180 profile image
paige20180 in reply to Bangkok

Wow. That’s just the best news. Thank you so much for sharing your experience. I’m so happy you are doing so great.

j-o-h-n profile image
j-o-h-n

Best wishes to you Charles.....

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 09/03/2020 6:36 PM DST

Patrick-Turner profile image
Patrick-Turner

I began Cosadex for 6 months in July 2016 when I had salvation SBRT to PG.

Once that failed in 6 months, it would not work again, and I had Zytiga, which worked for 8 months, all with ongoing ADT. I than had chemo which only increased Psa and didn't do anything, but docs said it would maybe make a second round of Zytiga work again, or make Xtandi work OK. But has 4 shots of Lu177, and after No3 shot I began Xtandi and Psa went from 25 before Lu177 to 0.32 one year later, probably because chemo at least had effect of making my Pca sensitive to Xtandi or Zytiga, but also Xtandi was favourite to increase PsMa expression. But since low Psa 0.32 last November 2019, it rose to 30 before 5th shot Lu177 on 24 July this year. It is thought Xtandi is not having anti hormone effect, but docs said I should keep taking it to make my Pca express more PsMa. I was also given compassionate course of 20 Veyonda suppositories two a day for 2 days before and 8 days after each Lu177 because it also boosts PsMa expression. Next Lu177 is in 2 weeks and I'll get Veyonda again.

I do not know if Cosadex would work as well to boost PsMa, and no doc has mentioned it.

Psa is now about 7, so maybe PsMa boosting is working OK.

Patrick Turner.

You may also like...