My PSA =15 naïve ADT. Had RP, and RT. 5 lymph node locations 3 in pelvic 1 in chest 1 in clavicle.
Ive read the trial results but they don’t include ADT+darolutamide with docetaxel.
Im 64 and healthy with no symptoms.
I was thinking in lieu of chemo, I could include a 5aReductase inhibitor RAD-140
I also asked for low dose estrogen 0.1mg patch after 30 days on lupron to reduce the hot flashes, bone, and muscle health.
He doesn’t recommend 5aReductase, or E2 patch. I didn’t ask why yet over portal because I don’t want to …..hmmm irritate him. Im thinking of doing these on my own but i am still deep diving the mechanism of actions.
So should I also include chemo?
I’ll post questions on the SARM RAD-140 and low dose E2 in …week or two after I finish up my research on them.
John
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KocoPr
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One of the things to think about before doing a taxane is the side effects. I briefly mentioned docetaxel to my MO. She dismissed it out of hand because of the sides. But she did say that maybe someday down the road it might be something I have to do.
Rad-140 is a SARM and is great stuff. The dose should be 1-5 mg/day. It lowers HDL but Cardarine increases HDL. I'm trying both to check if Card can balance out Rad. I'm also taking some Ostarine. This little experiment will also be another data point for interactions with ADT. I've tested each one out using huge doses for weeks and I didn't see any increase in my T or PSA.
I have two other experiments planned. One is rapid cycling of T/ADT. I think I can do that with an oral preparation of T. Another is using bicalutamide and injecting NPP. I've read that NPP acts on muscle protein synthesis as well as ARs, and if that is true, then I might get some muscle hypertrophy without stimulating the ARs.
5ARIs (dutasteride and/or finasteride) look good on paper and there are some RCTs that show benefits. And some that don't. Plausible and some evidence so I go with them during ADT.
Darolutamide is awesome and blocks an AR variety that the other lutamides don't. I'm saving that card to play if all else fails.
Do you think i would have a hard time getting darolutamide? I am putting a lot of faith in that drug. The others I don’t need as much as the darolutamide and lupron
It is only FDA-indicated for men who are castration-resistant and non-metastatic. I've seen patients get it when the MO writes the patient up as a seizure risk. I think you would have an easier time getting Zytiga, Xtandi or Erleada.
Im not avoiding ADT anymore, I asked for it to start right away. But i had been avoiding it to try other snake oils and also tried to get on two trials, so that all delayed me.Time to get busy living.
There is a reason Lupron has been used for 40 yrs . It can work like the other adt drugs can ? Smart thinking Koco! Men have a fear of adt . It has kicked my ass for over seven years now . But from the sad shape that I started out in , im just lucky as hell to have no signs of pc .. for me I feared an advanced pc eating me up ,more than losing my macho self . Se la ve . I chopped the nuts in 2017 , dropped the lupron . Still on Tak -700 a defunct adt test drug halting my adrenal production of t thus far . Knarley side effects with no t . I’m still kicking . You will do what is best for you . 😎👍
When someone pretends to be an expert on a subject that they obviously do not know anything about, take it with a big grain of salt.
Rad-140 is a selective androgen receptor modulator. There are a number of clinical trials for various SARMs. Some of the SARMs were developed specifically to counter cancer sarcopenia. However, for those who are not concerned with muscle, bone health, and virility, SARMs will add nothing to your life and might as well be called snake oil.
Please notice that I do not cherry-pick studies. I post positive, neutral, and negative studies. My only agenda is to live a life of quality and hopefully one with a little quantity. I do not understand why some of the members here only post studies that confirm their biases. That is both ignorant and annoying, forcing us to second guess everything they post and conduct more research to either confirm or repudiate their personal opinions.
SARMs:
1. (SHBG reduction): Fat loss and muscle gain: A Selective Androgen Receptor Modulator for Symptom Management in Prostate Cancer - Study Results - ClinicalTrials.gov
12. Study to Evaluate the Safety and Efficacy of 13 Weeks of the Selective Androgen Receptor Modulator (SARM) GSK2881078 in Chronic Obstructive Pulmonary Disease (COPD) Study Results ClinicalTrials.gov
2. Dutasteride treatment over 2 years delays prostate-specific antigen progression in patients with biochemical failure after radical therapy for prostate cancer: results from the randomised, placebo-controlled Avodart After Radical Therapy for Prostate Cancer Study (ARTS) - PubMed
5. Assessment Of Dutasteride (AVODART) In Extending the Time to Progression of Low-Risk, Localized Prostate Cancer In Men - Study Results - ClinicalTrials.gov
6. Early dutasteride monotherapy in men with detectable serum prostate-specific antigen levels following radical prostatectomy: A prospective trial - PMC
10. “REDUCE” - A Clinical Research Study To Reduce The Incidence Of Prostate Cancer In Men Who Are At Increased Risk - Study Results - ClinicalTrials.gov
12. Possible PSA masking: Association of Treatment With 5α-Reductase Inhibitors with Time to Diagnosis and Mortality in Prostate Cancer | Oncology | JAMA Internal Medicine | JAMA Network
13. Study was underpowered but has a neutral conclusion: Effect of dutasteride in men receiving intermittent androgen ablation therapy: The AVIAS trial - PMC
14. A metanalysis that had neutral conclusions: Prostate cancer specific mortality after 5α-reductase inhibitors medication in benign prostatic hyperplasia patients: systematic review and meta-analysis - PubMed
RSH1 is great with providing the research, isn’t he? 👍5ARIs such as dutasteride make good sense when on an alternative ADT such as bicalutamide, because T levels are not suppressed and can be converted to DHT.
But when on the typical ADT such as Lupron (LHRHa/a-) then testosterone is extremely low (castrate) and I do not believe there is any benefit in adding dutasteride.
Taxane chemotherapy indeed sucks, but not intolerably so for most. And it is over in just a few months. So if it is under consideration for providing benefit, then consider it is probably more tolerable when we are younger.
Just some thoughts. Best of luck and wise choices. Paul
Thanks Paul. I research the heck out of things. My life and the life of others are on the line.
Dutasteride is probably not going to do a lot if you are on ADT. ~10% of T is converted to DHT. DHT is ~5x as androgenic as T. So if T is only 10 ng/ml and if the numbers stay the same (free T doesn't seem to stay at the typical ratios when you drop way down in total T - I don't know about T->DHT), then you'd get roughly 5 ng/ml equivalent androgenic action added on. Without the conversion T goes up 10% so call it 4 ng/ml. ~15 compared to ~11. I don't know what happens during CRPC or say halfway mutations or ... whatever.
You could get a more accurate guess if you are on ADT. You get "baseline" tT, DHT, fT, and bT measurements. Then go on dutasteride and a while later retake the measurements. Probably want to do a few measurements for the baseline and a few for the post 5ARI point. Then go off, stay off for 6 months or so to let duta clear, repeat the measurements. Seems like a lot of effort and time but if you have to do ADT anyway, maybe it's something to try. Maybe try with finasteride first. Duta blocks > 90% of the conversion and fina blocks ~75%. But fina would clear in a week or so. Easier to check.
I guess you could measure PSA while you're at it and see. But I think it would change as ARs mutate or upregulate. So, you're measuring a moving target. I might go through this exercise at some point. Right now my PSA drops to undetectable levels on ADT so I can't test out finasteride yet.
Sorry for the ramblings.
Good point about the taxane. That was one of the things that swayed me to do RP early on (younger = easier to recover).
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Should I do more? 
The Use of Low Dose Estradiol to Ameliorate the Effects of ADT on Bone Mass Density
Lupron+docetaxel+Abiraterone 
Lupron vacation. Include casodex?
Should I fight for Darolutamide ?
