9 days on Casodex. PSA tested lower. Meaningful, or not?

[Skipper238]

Good morning,

I get my first Eligard shot on Friday, but I did start taking my 50 MG Casodex pills 9 days ago. Two months ago, my PSA was 4.68. Although I have since that time had a CT scan, a prostate biopsy and a PET scan, I have not had another PSA level taken. So, yesterday, out of curiosity, I went to a Quest Diagnostics lab in our local Walmart and paid to have a PSA test done. The results arrived this morning and showed 3.08.

Here is my question. I am wondering if this is statistically significant or meaningful in a good news type of way, such as to suggest that the ADT therapy is already working. If not, that's OK. I prefer to live in the real world. But, if it is good news, I would gladly accept that also :).

Perhaps, down the road, I will establish a communication pathway with my doctors to ask questions, but I have not yet found that pathway with my current doctors. Consequently, I am very grateful for this forum.

Thank you for your opinions on this. They are appreciated.

[LearnAll]

Do not underestimate power of Casodex...It has potential to take your PSA below 1.0 or even lower.

[Magnus1964]

This is a good start. With the addition of eligard you should get great results.

[dac500]

Comparing PSAs from different labs may not give the correct picture. I always go to the same lab for my PSAs.

[Skipper238 in reply to dac500]

Thank you. Yes. Good point.

[Justfor_]

I got almost 50% reduction on PSA after 10 days on Bicalutamide 50mg (Casodex) i.e. from 0.17 to 0.09. But don't get alarmed because there are significant fine prints. Firstly, I don't have a prostate and almost the totality of my PSA comes from cancerous cells. I understand that you have your prostate intact and not sure whether benign PSA is affected by Bicalutamide. Secondly, your base line value is a bit old and there is a possibility of some rise until the day you started getting Casodex. For example, if half of your total PSA comes from benign cells not affected by the drug, you have got the same percentage of decline of your cancerous component just like me.

[Skipper238]

Good point. The old PSA number could be a lower baseline or comparison, so my new number of approx. 3 might compare more favorably. I'm going with that! 😀

[Justfor_ in reply to Skipper238]

Don't overlook the possibility of the PSA coming from benign cells responding to the drug differently.

[Skipper238 in reply to Justfor_]

I’ll have to research what that means. Thx.

[Justfor_ in reply to Skipper238]

Start from the fact that cancerous cells need more blood compared to their benign neighbours. Since the drug circulates with blood their exposure to it is hastened time-quantity wise.

[Tall_Allen]

Casodex is a mild anti-androgen. Eligard actually increases testosterone at first, before it shuts it off completely. So, they give it before Eligard to prevent the temporary excess testosterone from activating your cancer.

[Skipper238]

Thank you.

[tango65]

If you have Medicare you could discuss about doing a Pylarify PET/CT and confirm if those lymph nodes are PC. If they are and you have only 3 mets, you could discuss about radiation treatment of the prostate.

[Skipper238 in reply to tango65]

Thank you.

[Hidden]

Old school which has worked great for me states stick with Bicalutamide 50mg & Eligard until you have three consecutive PSA rises upon such time eliminate Bicalutamide & consider chemo or Zytiga. I'm a proponent of using chemo early in treatment, waiting may very well eliminate the opportunity.

[Hidden]

I'm curious as to why you can't communicate with your doctors. How in the world do you ever know what to do or what a test means?

[Skipper238 in reply to Hidden]

Hello TreeDLeader, You make a very good point. I have an issue right now, with my doctors not being responsive enough. I plan to address this, probably by switching doctors, but it is an issue for now. I'll give one example.

My Oncologist recommended a 3-month dosage shot of Eligard. The Urologist was supposed to take care of getting it scheduled, but his nurse dropped the ball with the scheduling. I called the Urologist's office after 3 days had passed with no confirmation of scheduling and asked them to please schedule. They did, but they scheduled a 6-month dosage and not a 3-month dosage. After thinking about it for a day, I sent an email to the Urologist and asked if I could get the 1-month dosage Eligard shot first and then follow that with the 6-month shot, JUST IN CASE I had an adverse reaction. Six days went by without a response. I received assurance from Tall_Allen on this site, HU, which was enough for me to relax into getting the 6-month shot. In fact, I just got the shot this morning and all has been good so far. I'm confident that everything will be fine, but this is an illustration of my not having an open line of communication with one of my doctors.

I will get it fixed, or at least I'll do my best to get it fixed! Thx.

[dadzone43]

Yes it is meaningful--at least to you. As others have pointed out, variability among labs can be great. Feel good about it.

[j-o-h-n]

Hello again Skipper, Full speed ahead..... don't like your doc? push him/her off the dock. You appear to be a "take no enemies type of guy" so I would like to advise you "to take no enemies". Yes, try to use the same lab for your tests, you don't want to skew the results...or you will eventually get screwed. Stay with us and don't abandon ship...

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 12/10/2021 6:51 PM EST

[Skipper238]

Thanks, John.