Dumb Question on Casodex

[dac500]

Four weeks of Casodex 50 mg alone reduced my PSA from 1.10 to 0.42. Casodex stops testosterone from all sources from binding to cancer cells. While Lupron decreases testosterone produced by the testicles. Why shouldn't Casodex be better than Lupron?

[GP24]

If you would live in Sweden, you could have 150 mg Casodex instead of Lupron. But in the US the guidelines do not recommend this therapy.

[Magnus1964]

Interesting question. I think Lupron alone would be and is a good treatment. If and when Lupron fails, then move on to casodex.

Each approaches the testosterone problem differently. Neither, eliminates all testosterone. The pituitary also produces a little testosterone.

[MateoBeach]

Casodex, bicalutamide, is an option to Lupron that can effectively control PC progression for some. It did for me for nearly 5 years before it failed and started feeding rather than blocking the PC. Then it must be stopped. I felt much better on bicalutamide 50 mg than on Lupron and similar, because there is still testosterone in the body. Since testosterone levels can be higher on this, it is wise to add dutasteride 1.0 mg daily to it to block DHT conversion. It is not known for sure that bicalutamide/dutasteride is as good as Lupron ADT in the long run, so some risk possibly there.

[noahware]

Casodex stops testosterone from binding to the AR of cancer cells for an uncertain length of time... and then it doesn't! Not only can it cease to be an AR antagonist, it can transform into an AR agonist and begin to promote cancer progression rather than hinder it.

Some men can get many years of success from Casodex. I only got six months or so (doing 150 mg daily).

Follow-up question: while some say that men should never use Casodex again after it fails, is there anything known to re-sensitize a man's PC to it so he can return to it and get more mileage out of a drug that is extremely cheap and low in side effects?

[dac500 in reply to noahware]

For some Lupron doesn't work for long. For me it has worked well for nearly four years.

[noahware in reply to dac500]

Four years is great. Yes, lupron can stop working, and men become castrate resistant... but at least it doesn't turn into a "Benedict Arnold" and take side with the enemy like Casodex does! So I think the only caution with Casodex is to keep up with a monthly PSA, to make sure that isn't happening and then stop immediately if it does.

[Tall_Allen]

Casodex is a weak antiandrogen and results in incomplete blockage of the Androgen Receptor. What's worse, the androgen receptor eventually adapts to feed on Casodex. Lupron is much more powerful. Since you are metastatic and recurrent, you may be able to knock it back more completely with a more powerful second-line hormonal agent (like abiraterone or enzalutamide) in addition to Lupron. Maybe that will give you a longer vacation.

[john4803]

My MO says, Apalutamide (Erleada) is Casodex 2.0 and I have been on it, plus, Lupron, & Xgeva for 3 months. My PSA has dropped from 7.3 to 0.2.