Zytiga vs Casodex with Eligard for intermediate risk stage T3a, PSMA negative cancer, post RP (5/21) initial PSA 0.4, currently 0.79

[inhaleexhalerepeat]

I am curious as to why MO is choosing zytiga over casodex even though there is no evidence of metastasis at this time? He is recommending 24 months of ADT and possibly radiation. My father has been reluctant to initiate further treatment but will likely be starting soon.

[noahware]

I suspect the MO is choosing zytiga over casodex because the former is FAR superior to the latter.... and even though there is no CLINICAL evidence of metastasis at this time, there is a strong likelihood that mets on some level DO already exist (that they can still escape detection does not mean they are not there... and it makes sense to nip them in the bud).

I was reluctant to do ADT and chose bicalutamide, and it failed with a matter of months. I am now on Zytiga and tolerating it far better then expected, with a sharp drop in PSA and ALP... in the short term, the only downside for me has been hot flashes.

BOTH of these meds resulted in a loss of libido for me, so there was no benefit to Casodex in that respect. (I am still able, with very low T, to achieve erection and dry orgasm, but there is no INTERNAL drive for such achievement.... rather than a complete loss of ability, the bigger problem is a complete loss of interest! And when you lose interest in something, you don't really miss its absence. The "problem" then is inherently not so much mine as it is my wife's... which of course means it is MY problem, too!)

[Magnus1964]

From the history in your profile, I would choose eligard plus casodex. Your Father has a low gleason score and could benefit from this treatment. If and when necessary can move on to zytiga.

[Tall_Allen]

T3a is not intermediate risk, it is high risk. The high persistent PSA also puts him at high risk. He should be getting whole pelvic salvage radiation. The negative PSMA with the high PSA is actually not a good sign. It tells you that the cancer may be widespread with tumors too small to see at this time (called "occult"). If possible, try to get a Decipher test on his prostate tissue - it may suggest longer and stronger hormone therapy.

Definitely Zytiga. Don't waste time with Casodex.

[Justfor_]

30 months after RP, my PSA reached 0.17. Wanted to keep it low until this 4th Covid wave passed, so started Bicalutamide. 10 days at 50mg/day reduced it to 0.09. I lowered the dose to 4x50mg/week and 11 days later PSA went down to 0.06. Currently, a second dose reduction to 4x25mg/week and counting. My goal is to find the minimal Bicalutamide dose that will keep my PSA in the 0.04-0.05 range until I decided what to do next.

[Chrisbaird]

On zytiga 3x months 100gm deduced PSA from 25 to 0.06 but started to have liver toxicity so reduced to 50gm for last 9 months and PSA 0.01 for 6months also on hormone therapy last year only side effect hot flushes in summer period where bad

[MateoBeach]

Most important priority now should be salvage radiation therapy to the prostate bed with full pelvic lymph node fields. Possible chance for actual cure. ADT in a supporting role to maximize effects of radiation on killing remaining cancer.