My PSA is rising in very small steps at the moment and although Zoladex is still doing the job, this will not always be the case. At my last clinic meeting (over the telephone, of course) an onco I had never spoken to before seemed surprised I was not taking Bicalutamide alongside the Zoladex. At the same time, he seemed quite pleased to hear this, and intimated that this was something to be held in reserve if the Zoladex continued to be less effective.
So, as my body builds up a resistance to Zoladex and my PSA continues to rise, will adding Bicalutamide bring about a noticeable improvement. If not, what would be the next obvious step? What would be the best choice to replace Zoladex? It won't happen just yet, but I like to plan ahead and be perpared.
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Dastardly
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If the cancer progresses the next step will be a new generation anti androgen, Zytiga, enzalutamide, or apalutamide. You will qualify for Provenge a vaccine which provides a survival advantage. Bicalutamide is not indicated, it is not the SOC.
You could consider Lu 177 PSMA treatment if there are mets expressing PSMA according to a PSMA PET/CT. There are clinical trials for Lu 177 PSMA therapy:
Thanks tango65. Thankfully, at the moment, my Pca appears to be under control, but I will certainly be looking at alternatives if and when I become castrate resistant. Here in the UK, I don't hear too much about Provenge, but I will certainly be looking into it
That's what I love about Pca - everybody has an opinion. The trick is to find out which are the right ones.
Why are you not on zytiga now..forget Casodex...that's mainly used during the T surge when starting ADT treatment. You want to be on ADT + Zytiga or Xtandi now. Earlier use is proven to be more effective.
Thanks TomTom1111. It's interesting to see everybody's opinion on this. My Onco thinks it is best to keep on with Zoladex until it begins to fail before making a change. If you throw all the big guns it too early, you become castrate resistant sooner than might have been expected, and then you are running short of ammunition
Bicalutamide is like a drop in a bucket compared to Zoladex. There are always new therapies. I'm surprised you aren't already taking Zytiga or Xtandi. There is no such thing as "planning ahead" and holding anything in reserve is certainly a bad idea.
I was started on Zoladex with Casodex at diagnosis. Casodex was used for the first month then discontinued. Once PSA numbers came down I was treated with chemotherapy and radiation. I have continued with Zoladex now since 2017 and PSA has remained at .02. (Except when I took a ill advised ADT holiday for 9 months). I have (mCSPC) and respond well to ADT. The SOC here in Canada is to wait until you become castrate resistant before adding Zytiga. Except recently my Oncologist has suggested possibly adding apalutamide.
My oncologist has a similar philosophy to yours. You and I seem to be following a similar path. I was diagnosed almost three years ago. PSA 103. Started with Firmagon and chemo. Switched to Zoladex and remain on that. PSA nadir was 0.17 after almost a year.
There was a very gradual increase in PSA to 0.7 over the course of 15 months. Oncologist said there was no concern at that point. Scans showed mets were stable or getting smaller. My monthly PSA jumped up in February from 0.7 to 1.0. My oncologist then added bicalutamide and my PSA dropped dramatically. This month it is 0.13, the lowest ever. This month I had scans done and none of my bone mets are visible any more. I am very happy about that.
I will be seeing my oncologist in a few weeks. Given Tall Allen's recent postings about the PEACE-1 trial results, I will be asking about adding abiraterone now.
Hi MarkBC. Yes, it looks like we are on a similar path. Two years ago, my PSA was 144. I was put on Zoladex straight away and, following 6 cycles of chemo, my PSA was undetectable. Then, just over a year ago, my PSA started to rise very slightly and it has become a trend. It was 0.25 earlier this month and I am not due another test for a couple of months. So, I am slightly 'edgy' about it, but it gives me comfort to see that adding Bicalutamide can be very effective. Sometimes it's best to be a tortoise rather than a hare.Many thanks
Bicalutamide is a good choice. It is one a number is ADT drugs and should bring your PSA down. If by chance is does not your next move might be to move on to Zytiga.
If I understand correctly, once your body had become resistant to a drug, it can never be used again? Adding Bicalutamide to Zoladex is designed to wring the last bit of use out of that drug before moving on to something else.
That is incorrect....zoladex stops T production which denies the pca the preferred fuel for growth. Casodex (bicalutimide binds to the AR on the actual pca thereby denying pca T. Casodex is a weak AR bind and there are others that work much better. Zytiga prevents Adrogen production from occurring in the adrenal glands and the pca...yes pca creates its own androgen.
You want to be on Zoladex and Zytiga right now otherwise when you become CR Zytiga will be much less effective and your next treatment will be chemo sooner than later.
I'm surprised your MO is using the single treatment to failure protocol. Since Stampede and Latitude RCTs, it is now SOC to use combination ADT + zytiga/xtandi/docetaxel early for superior outcomes.
If you become resistant to Casodex, you can take Niclosamine or Berberine, these two drugs might re-sensitize the use of Casodex and Zytiga. From now on you might totally change your Lifestyle and Diet, do Exercise everyday and take some Supplements.
Dastardy, I have been treated by bicalutamide mono therapy for the last 7 years since PSA recurrence. My MO was Dr. Scher, one of the best in US. Currently I am on a drug holiday for the last 8 months and my PSA is 0.26. You can check my Pca history in my profile. Please note that I am not recommending any treatment at all. Every patient is different, talk to your MO. I agree that bicalutamide is less potent as compared to newer drugs but this does not mean that it may not be used to treat advanced prostate cancer. It worked very well for me and it may work for others too. And don't forget that bicalutamide has fewer side effects.
Well, it has few side effects. Libido loss and gynecomastia. Tamoxifen fixed it. This medicine worked very well for me. I had a drug vacation for 19 months and after resuming Casodex, psa went down to undetectable again. However it may not work the same in other patients.
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