My Intermittent Bicalutamide mono therapy - continued

[traveller64]

I'm still on drug holiday, it's been 13 months by now and PSA is slowly increasing. Recent PSA is 0.59. I had a PSMA PET in June which showed no mets. My MO wants to have another PSMA scan when PSA is in 0.7 - 0.8 range. If there are mets we will probably try to zap them and after that continue with bicalutamide mono therapy (50 mg/day).

Any thoughts on timing of PSMA scan (or any other scan) and when to resume therapy?

[traveller64]

Nalakrats, yes you're right, Casodex is not SOC. My MO, Dr H. Scher started me on Casodex 7 years ago when I had PSA recurrence. Since then the only cancer treatment was Casodex with varying doses. Since it is still working, we think it's better to continue with the same drug.

[Tall_Allen]

Sounds good! Are you still working with Dr Morris?

[traveller64 in reply to Tall_Allen]

No, I'm with Dr. Deaglan McHugh at MSK and also with Dr. Celestia Higano

[Tall_Allen in reply to traveller64]

Is Celestia Higano now at MSK? I heard she left SCCA, but I didn't know where she landed.

[traveller64 in reply to Tall_Allen]

No, she is not employed anywhere yet. She still lives in Seattle. We communicate via e mail and zoom.

[GP24]

I had several PSMA PET/CTs which showed nothing until the PSA value got above 3.0. Then small mets and a recurrence in the prostate bed could be detected. Therefore I would just wait for the PSA value to get above 2.0 for the next PSMA PET/CT. Also, I would take bicalutamide while getting the PSMA PET/CT. Xtandi increases the PSMA expression and bicalutamide will probably do so too to a lesser extend.

[TFBUNDY in reply to GP24]

Oh. My PSA post HIFU peaked at 3.2 from nadir 1. I had a Ga68 PSMA PET yesterday. Wish I had known about the bicalutamide trick. Why is it not standard practice?

[GP24 in reply to TFBUNDY]

It is an Xtandi trick but you will not get that drug while being hormone-sensitive. I take bicalutamide but I do not have a GP24-clone control group to see how well it works. Here is an article regarding Xtandi: eurekalert.org/news-release...

[Spyder54 in reply to GP24]

Great article. Saved. That is cool. I did not understand that Xtandi has a secondary advantage (even after castration resistance) of substantially making cells more PSMA Avid for better results from therapies like LU-177.

[traveller64]

Couldn’t find your post Nal. Do you remember the topic?

[TFBUNDY]

come on Nal. Write that Ebook. Put all of your great wisdom and experience in one place which is easy to access. It will save you from explaining yourself time after time. Consolidate.... Take care and best regards from London

[TFBUNDY]

Hurry up then before it gets smaller than your testicles...

[MateoBeach]

For many, after being well controlled on bicalutamide mono therapy for some time, it can start activating rather than blocking the androgen receptors. Since your PSA has been rising on it perhaps this is happening with you? Easy to find out: take a short term break from the bicalutamide and see if PSA drops rather than rising. One month can do it. Run it by Tia perhaps. Good luck.

[traveller64 in reply to MateoBeach]

MateoBeach, I’m on drug vacation for 13 months. PSA was 0.02 then, it is 0.59 now

[MateoBeach in reply to traveller64]

OK. So it is going up off bicalutamide not while on it. So it may still be effective for you. Good. How far will you let it go before resuming treatment? Hard decision I know!

[traveller64 in reply to MateoBeach]

I guess I’ll resume treatment before it hits 1. Difficult decision.