Bicalutamide or not?

[Largell]

Hello all!

Quick summary: Diagnosed Nov. 2018, PSA 1036 (yes that's one THOUSAND thirty six!). Apparently only moved to lymph nodes(first thought bone mets-now looks like only voids in scan). Firmagon, then Lupron, then chemo, on going Lupron until Jan. 2020. Decided I'd try to quit the Lupron for a bit...

Well, the "Lupron vacation" is apparently over.

Last shot [3-month) was in Jan. PSA continued to drop. It went to .41 in June, .40 in August-shot up to 2.23 Sept. 3, then 5.38 Sept. 28.

I calculated velocity at 16ng/year.

I'm 61 years old. I'm down to 140 lbs.(on purpose). I quit the sugar and the carbs, taking Metformin and Febendazole. Muscles are back along with energy...feeling great!

Oncologist wants me to take bicalutamide when I get the Lupron. I'm reading in the journals and studies that it may just create side effects that would offset what appears to be a minimum benefit if I'm feeling no pain.

QUESTION-Bicalutamide or not? Looks like the "flare" will be short lived and the benefit not that great.

Oh, and I'm getting married in 11 days!

Thanks!

[Magnus1964]

You could go on casodex now or wait till your PSA rises and your off Lupon. Some doctors prescribe both at the same time.

[Hidden]

What side effects are you concerned about? You're only on Bicalutamide for a week.

Here's more inforamtion on the flare associated with Lupron.

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

[pjoshea13]

A study from Japan reports better time-to-treatment failure (TTTF) & time-to-disease progression (TTP), although not necessarily overall survival. [1]

The androgen receptor [AR] axis usually continues to be in play when PCa becomes resistant to Lupron. Bicalutamide [Casodex] targets the AR directly & protects against non-gonad androgen.

Another thing to consider, since dihydrotestosterone [DHT] is the primary target of ADT, is the use of Avodart to inhibit conversion of T to DHT.

-Patrick

[1] pubmed.ncbi.nlm.nih.gov/171...

[GP24 in reply to pjoshea13]

Here is another japanese study showing a benefit when adding Bicalutamide:

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

[Tall_Allen]

Congratulations on your marriage! The reason they give guys with metastases bicalutamide when they start or restart them on Lupron is that Lupron causes an initial surge in testosterone. That surge can make metastases grow rapidly. The bicalutamide blocks the androgen receptors so that the extra testosterone doesn't cause them to grow. It is only necessary for about 2 weeks. Alternatively, you can start with two monthly shots of Firmagon, and then switch to Lupron. That will also prevent the testosterone flare.

[LearnAll]

pubmed.ncbi.nih.gov/15151957/

Interesting study by Dana Farber Researchers.

[Largell]

Great! Thanks for the replies. I guess I was trying to get past the wedding Saturday after next (five hours from home) before I started anything new, Lupron included. But, the way this thing is doubling, do I dare wait two more weeks for the shot? And, on the same subject, 3-month Lupron or 6? Thanks.

[Hidden in reply to Largell]

I dont think it would be that big of a deal to wait another week or two, but that's my opinion.

As far as Lupron goes, your options might be limited based on the current shortage. You might want to find out what they have and maybe need to take 3 month Eligard instead. That's what I'm taking and it works just as well.

[Largell]

Oh, also getting a CT scan on Monday...

[ctarleton]

Congratulations on your marriage!

Yep, Casodex just before Lupron, to prevent any testosterone "flare".

Also, if your impending marriage may possibly lead to a lot of heterosexual, celebratory sexual "Whoopee", you might want to read Section 8.3 of this document about Casodex and reproductive precautions in males and females. If same-sex. enjoy!

accessdata.fda.gov/drugsatf...

Keep us posted. There is lots of experience here with the long term effects of Androgen Deprivation Therapy (ADT) on one's libido and secondary sexual bodily changes, and general learning/adapting/coping skills in that regard.

[Largell in reply to ctarleton]

Thanks! Yeah, never fully recovered the libido from the first round of Lupron, but it was improving. The learning/adapting/coping skills were/are developing and we've reached an age where kids aren't an option!

[doc1947g]

With Lupron, your are not going to have a great honeymoon nights.

I was on Casodex (50 mg/30 days) and Lupron Depot 22.5 mg/12 weeks. I am on my 17 weeks on ADT: NO Libido, NO erection, Lost of weight (10%), Weakness & Extreme fatigue.

Good luck and Happy Wedding.

[Largell in reply to doc1947g]

Yeah, I went through all of that too...just hate to do it again!

[j-o-h-n]

Let's see....... Honeymoon activities...... Chess? Checkers? Monopoly? Go fish...... enjoy the wedding and the honeymoon.....(take pictures).....Get a nuptual agreement....Check out your Mother-in-law cause that's your wife in 20 years....

** To watch video click on name of the top of the video **

youtube.com/watch?v=-hg4Qkq...(Not working as expected?)

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 09/30/2020 5:56 PM DST

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

Nice! Scrabble and Backgammon...thanks so much, I really needed that!

[Tommyj2 in reply to j-o-h-n]

Too many of these out there now..

[j-o-h-n in reply to Tommyj2]

To Tommyj2,

The divorces are even funnier....... guns, knives, arrows, baseball bats and etc......

(Three years older and deeper in debt)....

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 11/26/2023 3:43 PM DST

[Positive22]

Just started bicalutamide 3 days ago combined with 6 month Lupron shot. My PSA is now 1.5, petscan showed no uptake areas. I was told this supplemental drug is 50% effective for patients but worth the try to get PSA down. Thoughts? No side effects yet.