I’m 77 and first diagnosed in July 2018 as Stage 4 Gleason 8 PCa with widespread metastases. I had a great response to the standard care of Zoladex and 6 sessions of Docetaxel. Scans in May 2019 and showed a significant reduction in tumour volume, my PSA reduced from 152 at diagnosis to a nadir of 0.07 in May 2019 and then a statistically insignificant decline to 0.06 in February 2020. By September 2020 my PSA had increased to 0.2; still a great number but triple my nadir and the expert advice is I have progressed from hormone sensitive to castrate resistant. The other crappy news is that in the last few months I have developed mild cardiac arrhythmia. No sign yet that the arrhythmia is impacting my lifestyle but what can you do other than wait and see.
As I’m castrate resistant with PSA doubling every 3 months I started bicalutamide, an oldie but in some cases it still produces great results. With Stage 4 the only certainty is that the disease keeps on keeping on. The bottom line in this deadly business is how many, how large and where the tumours are. My scans and blood test in October were far better than I expected. After one month on bicalutamide my PSA dropped to 0.15, my scans showed no soft tissue tumours and none of my multitude of bone tumours show any activity. Presumably the tumours that remain are too small to be detected by the technology used in my scans. I remain symptom free, for Stage 4 that’s about as good as the news ever gets.
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Bjry
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You get more total mileage if you start with Zytiga or Xtandi. Men who used bicalutamide + ADT died much sooner than men who used Xtandi + ADT. Email these links to your oncologist:
I was pretty active before dx last year and have set my goal 600 miles higher for this year. Speed and distance has both increased and if nothing changes may be 1000 miles more than last year. It has been a big help for me mentally and physically. We have a few other riders on the forum PatrickTurner and addicted... to name but a few putting in big miles. They are both in their 70s but I am closer to your age at 57. Hope your doing well with your treatment.
Hi Tall Allen, I understand I am taking the bicaltumide to prevent tumour flare. I had to start taking them exactly 2 weeks before my zoladex injections. I was told to take them by my urologist but the enzalutamide was prescribed by my oncology team. I presume I will come off the bicaltumide at some point. Thanks for pointing out the contradiction. I will follow it up with my urologist. I have had some bad headaches since taking the enzalutamide. How's everyone else found them?
It sounds like you have too many cooks. You no longer need a urologist, do you? The bicalutamide prevents flare for about 2 weeks when starting Zoladex. It should have been discontinued then. You definitely should not be taking both - you are only compounding side effects.
I suggest you email them first. It is a courtesy to give your doctor time to review them in advance of meeting with you. I usually email the links with a short note : "I would like to discuss these with you at our next appointment."
What's your view on chemotherapy with docexetel? I'm in London UK. I've been told that they're not doing it because of Covid19 and I've been been put straight on enzalutamide. The oncologist says it's better than chemotherapy.
Too bad about the docetaxel. I know men who are getting infusions currently, but they are getting Neulasta with it. I don't think it's better, but it's not worse either. There was a trial in the UK that showed that docetaxel and Zytiga had equivalent results. Zytiga before enzalutamide seems to provide longer net use of hormonals. But alternating with chemo may help.
Glad to hear you are feeling good, Bjry. Not bad for 77 years old!
Anecdotally, several years ago when my initial ADT became less effective, and my PSA was increasing, my Oncologist also tried a re-challenge with Casodex (bicalutamide). It lowered my PSA a little bit, but only for a couple of months. I went on to other treatments soon afterwards. I'd agree with T_A, keep Zytiga or Xtandi in mind.
Also anecdotally, I started experiencing some occasional heart A-fib & rhythm issues a few years ago, too. I saw an "electrician" type of Cardiologist for a full work-up. Got several types of tests, and eventually settled on a couple of daily oral medications that seem to be keeping the episodes to a minimum, and generally "self-correcting" without other medical intervention.
I'm 73 and swear by bicalutamide. I was diagnosed in 2018, started bical. in June, i believe. By Aug. my PSA dropped from 16+ to 0.117, has been <0.1 ever since. Been on finasteride and tamsulosin with it, to shrink gland and improve flow. The only SE is flimsy erections and retrograde ejaculation... but orgasm is better than ever.
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I am considering going off Zytiga/Prednisone to determine if I am castrate resistant.
Hormone Therapy failing?
PSA Starting to Rise. 
Reaching Castrate Resistance? Increase in PSA,ALP.
