Would it work when we go back to the old treatment again? Your input would be appreciated.

[markoch26]

I am asking this question as I am curious as to whether or not the old treatment is workable after you have used up all other treatments. For example, Lupron and Casodex (frontline) were used at first diagnosis. After all other treatments like zytiga, xstandi, etc. are castration-resistant, would it work when go back to lupron and casodex again? Thanks.

[doklam2017]

Hi,

I am not a specialist in this but this is how my team of doctors explained it to me -

They started on hormone therapy on me - Abiraterone and Prednisone ,

once it losses effect , i.e. from Hormone sensitive I transit to being Hormone Resistant : they plan to introduce, some days break and then start with Docetexel . Once that is ineffective then , Hormone again, BUT , Enzulamatide this time. After that fails , then to the last round of chemo i.e. Cabazitexel . After that...........................either some new medicine which is clinically proven ................or palliative care.

So while ADT is a continuous process , it is hormone, chemo, hormone , chemo, palliative or some new med.

Hope that answers please.

YOU please need to validate this with your team of doctors. This is 'a' process not 'the 'process pls.

😀

[LearnAll]

Markoch26,

This is a very very important question you asked. My mind frequently thinks about it. I have heard from doctors that once a treatment loses effect , we have to switch to new treatment.

I doubt that this is entirely true. In case of medicines acting on human brain. They tend to lose effect with time. ( e.g. "prozac poop out") But , when that medicine is stopped for a few months and then restarted, the effect returns.

I really would love to find out if that is the case even in Prostate cancer medicines.

My own experience with bicalutamide is causing me to raise this possibility . I was prescribed Bicalutamide 50 mg a day when I was diagnosed 18 months ago. Bicalutamide alone caused a drop in my PSA (from 830 to 99) a whopping 89% drop in one month.. My Onco stopped it and started me on Lupron and Abiraterone. This combo took PSA down to 0.2 in next 10 months. I stopped all ADT meds for 8 months and about six weeks ago when my PSA rose back up from 0.2 to 3.1, I decided to first try Bicalutamide and finasteride because I hate side effects of Lupron and Abi.

I watched PSA every 15 days ..to my pleasant surprise ,my PSA kept dropping from 3.1 to 1.2 to 0.6 to 0.4 .(a drop of 87%) Note that this is second time use of Bicalutamide.

I am not suggesting that any one should try using meds which failed again after a length of time...But this is something I am very interested to find out . Hope some other members have experience of re use of med and its outcome.

[GP24]

Even when you are castration-resistant, you will continue with ADT/e.g. Lupron as the backbone therapy. Doctors assume that not all cancer cells will be resistant and therefore ADT will continue to work against the remaining sensitive cells. You add Abiraterone, Enzalutamide, Apalutamide to ADT/Lupron because these drugs are FDA approved in combination with ADT.

When you start to become castration-resistant, you can use bipolar androgen therapy or radiation of the mets to destroy enough resistant cells so you remain hormone sensitive for some time. But this is experimental. There are case reports that this did work.

[Magnus1964]

Usually going back on drugs that you were on does not work.it didn't for me. However, there is evidence for some ADT drug working again after chemotherapy. There is also some evidence for adding other drugs to ADT drugs to extend their efficacy.

[GP24 in reply to Magnus1964]

Yes, the sequence Abiraterone-Docetaxel-Cabazitaxel-Enzalutamide will work well.

pubmed.ncbi.nlm.nih.gov/263...

[LearnAll in reply to Magnus1964]

I was inspired to try bicalutamide again by you ..when you told us that this med by itself worked for 5 1/2 years. I do not remember the name of another member who wrote that Bicalutamide worked for 8 years for him.

As of now, I do not regret the decision to refuse Lupron and Zytiga . Thank you for the info you provided.

Please tell us more what other meds have you tried after stopping them for a few months ( Re-Used ) and what was the outcome. With 28+ years under your belt with mPCa , your opinion is highly valued by me. I am sure you have been doing something right.

[GP24 in reply to LearnAll]

Magnus wrote five years ago (I hope it is ok to cite him):

I had surgery then radiation a few years later. After my PSA started going up again I went on casodex. The casodex worked for 5 year with no side affects. When casodex stopped working I went on nilandron but had problems with my lungs so I had to stop it. I then went on flutamide but the side affects were truly awlful and I had to stop that. Both of these drugs lowered my PSA by the side affects were to great.

This next part gets a little tricky. I found a drug on the Internet called (DCA) sodium dichloroaceatate. I acquired some and went on a six week treatment. That worked for 4 years. The FDA ban its use but I think you can still get it. I only side affect from DCA was peripheral neuropathy in my feet which I still have.

I then entered into a study with aboratorone (Zytaga). I was on this drug for 3 1/2 years with little side affects. My ankles swelled up.

For the first time since my diagnosis spots showed up in lung. I went on a 6 week treatment of Provenge and the spots disappeared.

I just finshed a second course of radiation for a spot on my hip bone. The jury is still out on the results. But in the meantime I am going on a second study with xtandi plus another drug.

I think surgery and radiation were an important factor that caused the drugs to work for such a long time.

[LearnAll in reply to GP24]

Magnus was able to buy 4 years of remission with Sodium Dichloroacetate (DCA) Interesting ! Will anyone share his/her knowledge about this substance and why It was banned ? Thanks in advance.

[GP24 in reply to LearnAll]

Here is a Wikipedia article about DCA en.wikipedia.org/wiki/Dichl... It mentions neuropathy as a side effect.

I do not trust drugs that claim to work against any cancer.

[LearnAll in reply to GP24]

Thanks for the link. Yes .GP24, it is possible that a molecule or substance CAN work against all cancerous cells. Cancer cells are inherently weaker and more fragile than normal cells. That is why fear of death (extinction) drives them to multiply as rapidly as possible. (self preservation instinct)

As an example, Betel leaves inhibit or even kill cancer cells...There are studies from eastern part of World about betel leaves and their anticancer properties. .The recent one I read is about 2-3 months old from Malaysia (do not read the studies which were done with quid. Read ones which used ONLY betel leaves)

where the researchers found that the chemical in betel leaves disrupt the microtubules of cancer cells , makes them spindle shaped and that leads to cell death (apoptosis)

I have a number of betel vines in my backyard and have been chewing 4 to 6 leaves along with saffron and sugary rose petals. for over a year. Hence, my interest in constantly watching research in this area.

Another example is Mebendazole or Fenbendazole which kill cancer cells by same mechanism ,that is disrupting microtubule architecture of cancer cells. Remember Joe Tippens Story. All I am saying is that if we can find a molecule which has least side effects and can disrupt metabolism of cancer cells ,in general...that can potentially cure every type of cancer.

[GP24 in reply to GP24]

Just read this study: sciencedirect.com/science/a...

If you have lymph node mets at diagnosis and get surgery plus LND plus ADT, you have a 59% chance of cancer specific survival for 20 years after diagnosis. So Magnus seems to belong to these 59%.

[Magnus1964]

How did you respond to the bicalutimide restart? After the 51/2 years on it my PSA started to rise. In the interim I moved to upstate NY. My new Uro wanted to try bicalutimide again after being off it for 6 months. It did not work.

I have been on xtandi on for 4 1/2 years in spite of a high PSA. So I added niacinamide and my PSA took a big nose dive from 78.86 to 71.90. I have only the one PSA test so I don't know if my next test will be lower or not.

I plan to keep everyone informed of my progress.

[LearnAll in reply to Magnus1964]

Magnus, Is this question for me ? If yes...I responded spectacularly with retry of Casodex to my surprise. My PSA went down from3.1 to 0.4 in six weeks ...almost no side effects. T came back close to 250. I am keeping close watch on PSA and other biomarkers...Lets see how much time I can buy with Bicalutamide plus Finasteride. I love this combo.. feel almost normal.. Praying to God to keep this remission going for few years.

I will be in New Delhi India in Summer and will get PSMA Ga68 scan as well as FDG scan to see if my PCa cells are still hiding in some corner. MRI and CT are clear.

[Tall_Allen]

You are still using Lupron (I hope) so there is no such thing as going back to it. After the cancer learns to feed on Casodex, it will cause harm to go back to it. Once the cancer becomes resistant to chemo, it is pointless to use it again. However, it may be worthwhile to rechallenge the advanced hormonals after chemo. The radiopharmaceuticals can be used multiple times if the cancer is not resistant.

[markoch26 in reply to Tall_Allen]

Hi Allen,

Yes, I have been on Lupron for 4 years now. Lupron will be the only main treatment for life, I assume. Recently added Casodex. I am just curious as to whether or not we can play this type of game with this beast. Thanks.

By the way, thank you, guys, for all your replies. We would like to hear more positively from others if you have this kind of experience. So, keep your replies coming in so that others can learn from this experience, and in that way, we can all extend our lives by leaps and bounds.

Thanks from Taiwan

[Tall_Allen in reply to markoch26]

Going back on Casodex after resistance is dangerous. It will speed progression. Don't play ill-advised games with your life.

[immunity1]

It is a good question and I suspect the answer will vary depending on our individual sequence of treatments which are unlikely ever to be repeated in a clinical trial. For example, myself having stopped bicalutamide in 2016 and hammered my PC with the kitchen sink (Docetaxel, EBRTx3, lutetiumx6 etc) and always on goserelen I am tempted to retry bicalutamide (or better still Enzalutamide which is bloody expensive in my locale). I do think there is logic in retreatment after sufficient time having kiled off other resistant clones of cancer cells with other treatments.