2nd month PSA reduced to 0.13 due to continuous BICA LUTAMIDE.

[Domas]

My 2nd month PSA decreased to 0.13 yesterday. My story is below.

Gleason 9. 2017 surgery. 14 months after the surgery, i had 20 sessions of radiation.

I am under ADT. I do dutasteride everyday and bicalutamide everyday. However, I skip bica for every 2 weeks after I had it for 2 weeks. This iintermitent Bica treatment started 2 months ago (April 2022). PSA went down to 0.13 on June 1, 2022. It was 0.22 on May 1 and 0.88 on April 1, 2022. However, in Jan 2022, PSA was 0.05 when I had BICA for 30 days without skip. Doctor suggested me to stop BICA then. Psa rose to 0.5 in Feb. and 0.88 in Mar. And then, Doctor suggested to take 2 weeks Bica and no Bica for 2 weeks. Doctor was afraid of using BICA, because Testosterone level will rise. The current T is 790. He said T is acceptable "at this time", but...... I think T used to be around 400-450 before I start BICA. It went up 1400 in Jan, when I took BICA for straight 30 days. Then Doctor asked me to stop BICA.

[Justfor_]

Instead of intermittent Bicalutamide I elected an adjustable low dose. Killing the same number of cancerous cells as those dividing, hence, stabilizing PSA to a low level, makes more sense to me compared to on-off switching. You are probably already aware of how I am doing, if not have a look here:

healthunlocked.com/prostate...

[GP24]

Yes, the testosterone level will double with Bicalutamide. I am not aware that this can cause problems.

[Magnus1964]

I do not like intermittent ADT treatment. You are only giving the cancer a chance to find a work around. You respond well to bicalutimide, stay with it, no breaks.

[LearnAll]

Domas, Why your doctor wants Bica off and on ? Is it to prevent Bica from being ineffective due to continuous use ?

[Domas in reply to LearnAll]

No. He said 50mg daily is too strong. He said that there may be situations where my dose could be increased later years. Eventually to injections. He said. He said but not right now. He said one of his clients stay with BICA for over 20 years. Not necessarily connected with Gleason Score. It could go 10-30 years. He said Gleason does not dictate the length.

[MateoBeach in reply to Domas]

50 mg per day is not too much. Some have used 150 per day but that seems unnecessary. 50 mg works and no toxicity. I am not liking your doctors approach. Perhaps get second MO opinion?

[Domas]

50mg

[Justfor_]

Not daily, but weekly 50mg.

I.e. just ONE 50mg pill split into two, I take the first half on Mondays, the other on Fridays. Remaining days of the week nothing. It is 1/7 of the usually prescribed dose.

[dhccpa in reply to Justfor_]

How'd you get Doc to go along?

[Justfor_ in reply to dhccpa]

Didn't ask for any approval. My life, my decision.

[dhccpa in reply to Justfor_]

Yes, I understand that. But how did you get bicalutamide prescribed without requiring a hormonal injection? Different doctor?

[Justfor_ in reply to dhccpa]

In my neck of the woods a GP can prescribe Bicalutamide and it is covered by the public healthcare system 100%.

I have the same GP since my early 30s, so he doesn't play the paternalistic card on me. He has been prescribing my statins since the 80s and Avodart since my RP. A very nice gentleman altogether.

[dhccpa in reply to Justfor_]

Ok thanks

[maley2711]

I see that you have received conflicting advice, and different opinions on intermittent treatment> Tall_Allen has not responded with actual clinical trial references, so perhaps you should undertake an effort to find some actual data re results with different approaches. And ask your Doc what studies support his advice. Deciding based on anecdotal "evidence" is perhaps not the best way to arrive at a decision.

[Dynamo]

Some years ago my first & most brilliant Onco put me on high dose 150 mg Bicalutamide monotherapy as she noted they had good success with it in Germany.. It kept my PSA down to 1 or below for almost 7 years before it started to rise.. She was gone from my area by than and I found out she moved to Nashville & got a job as a cancer researcher at Vanderbilt U. I sure miss her & the only side affect I had was I developed man boobs but they weren't a problem for me.. (just no public swimming) Good Luck..

[dhccpa]

What country are you in?

[Seasid]

Do you have a MO?

[SteveTheJ]

FWIW, with Lupron and Erleada my testosterone has stayed less than 20 for the past two years. No intermittent anything.

[Domas]

New York, USA

[Domas]

Wat do you mean by MO?

[MateoBeach in reply to Domas]

Medical oncologist = MO

[Domas]

I asked my doctor if he can give me Lupron. He said "no". He said that Lupron has some side effects. He want me to manage all of this without Lupron this time. He hopes that my T not over 800....., which I think may not be easy with Bica.

[Justfor_]

Monthly PSA tests. Before reaching current 0.05 (steady for 4 months now) I went as low as 0.04 with a higher dose. But, I am not after low numbers. IMO they are only offering bragging rights. My target was 0.05-0.06 from the start, for the reasons I PM you, so I reduced the dose to the current level. And mind you I use alternatively 2 different labs.

[Justfor_ in reply to Justfor_]

All (and more) I wrote about before can been seen in the following graph.

Time series of Bicalutamide dose control to achieve target PSA (0.05)

[Domas in reply to Justfor_]

Thanks. I am reading the graph now. Did you talk to your doctor? If so, what did he say. I fully understand the necessity to maintain Bica in a certain level.

[Justfor_ in reply to Domas]

My doctor is reminiscing his fresh years in a teaching hospital where his professor had him collecting patient's data for trials, thing that makes him happy when I talk numbers. Further to this, he doesn't express his own views which come down to: "Follow the instructions within the medicine box". From my part, I do not need any confirmation. Medicine is still in the middle ages regarding individualizing treatments (automation in engineering parlance). Summer coming, I have a test for you and other SoC devotees:

You wanted to buy a new air-conditioning machine. Which one of the following four units would you go with:

a) One with only manual on-off control. No thermostat. Plug it in and it brings the temperature down to freezing. To avoid getting a thermal sock when returning home it must be switched off beforehand.

b) One with a fixed temperature thermostat. To change the room temperature you would need to call a technician who will adjust it with a screwdriver.

c) One with a smart thermostat that you can adjust from your office via the Internet and returning home you will find it at the temperature you like.

d) A DC inverter unit that doesn't only do the tricks of c) but constantly matches consumed power to the cooling load, thus, increasing efficiency and bringing down your electricity consumption bill.

SoC is unit a). We can do better than this!

[RonnyBaby]

I have been on 150 mg daily of Bicalutamide as a monotherapy - approaching 1 1/2 years and counting. It is an acceptable monotherapy for some - it is based on a few circumstances - but has been used extensively in Europe for many years. It is NOT the SOC in the Americas.

I have been undetectable (<0.03) for nearly 1 year and all signs point to being on this treatment for as long as I continue to see results. My medical team believe this will work for a long(er) period of time - as opposed to the stronger form(s) of ADT that drove me crazy and ruined my life at the time.

My Dx at the time (6+ years ago) was worse than yours.

You might have to FIGHT hard for a 'chance' or maybe switch oncologists to see IF you would have success ...

[MateoBeach]

I have a different viewpoint on this Domas.Many here have used bicalutamide with dutasteride continuously as an alternate form of ADT with considerable success. It can work for years, sometimes many years. For myself I was on this continuously for nearly 5 years before PSA began to rise and I had to stop it. At some point bicalutamide can begin to stimulate the androgen receptors rather than blocking them so PSA starts to slowly rise. Then when you stop the bicalutamide, the PSA goes back down again. But you cannot continue it after that. Must change.

The high testosterone while on this does not appear to cause problems. Quite high testosterone levels actually help suppress PC growth rather than stimulating it. This is well supported and is actually the basis of BAT therapies. And the presence of normal to high testosterone levels supports physiologic well being even though the androgen receptors are blocked.

So I would suggest you just stay on it for as long as possible! The stopping and starting seem unnecessary. Just micro manipulation which might make it work less well and also “hide” the small PSA rise that may eventually signal it is time to stop and change to something else.

Best of luck with it. Paul

[GreenStreet]

Interesting I am UK based and my Onco has me on 150 mg daily for 6 months which is SOC for bicalutamide use in U.K. I would be interested in taking less if it could prolong the effectiveness without a work around is there any data on this? I have slightly sore boobs Lol. I have been prescribed 20mg Tamoxifen on a once weekly basis but can go up to 2 a week. Next PSA test next week last one was 0.02 after 3 months and CyberKnife to Lymph nodes. Not that great because still there though down from 0.2.

[Justfor_ in reply to GreenStreet]

Have you checked my Bicalutamide Maneuvers thread?

[GreenStreet in reply to Justfor_]

I did but will re look carefully. I think that was what got me thinking about it. Thanks