a recent post prompted me to write this question.
i was diagnosed Gleason 8-9 in Fall 2018, with 3-10 possible bone Mets. i started bicalutamide, then three weeks later started Lupron. Continued bicalutamide for three more weeks before dropping it. Almost four years later, still on Lupron only (except for starting Xgeva in Jan 2020).
My PSA is 0.66 now. The low was 0.5, and most readings (six (weeks and quarterly) have been 0.6 the last 18 months. My MO has been reluctant to add more treatment because of my four year stability.
I wondered what the pros and cons are of adding back bicalutamide at this point. Would it give additional protection in an inexpensive form?
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dhccpa
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Bicalutamide is more toxic to the liver than Enzalutamide.
Bicalutamide is very weak and don't last long. Ones it will lose its effectiveness it will start fueling your cancer and then you should stop it.
Allen Edel said that bicalutamide is like a drop in the ocean when you compar it with Enzalutamide.
My biggest problem with bicalutamide is that I am afraid that by using it I will weaken the future deployment of Enzalutamide (that Enzalutamide will fail quicker.)
I am not sure in this, but because of higher liver toxicity and short effectiveness plus the need to be always be alert in stoping it (will start fueling the cancer) I will ruther not use it.
I know someone who said that he was on Degarelix plus bicalutamide for eight years.
I also know someone from this site who was 6 years on Degarelix alone. His PSA actually dropped from 1.9 to 1.1.
Professor Richard Epstein said that some people live long on ADT alone.
Honestly, why would you introduce something what has little benefits but could fuel the fire?
You can always add Zytiga, Enzalutamide or something similar ones ADT alone is not effective.
I believe our liver health is very important!
I read a taiwanese study where one Asian man received 21 cycles of Docetaxel (the cycles were 4 weeks long and the dose was 70 mg/m2) and he dyed from liver failure not from the prostate cancer.
Therefore I strongly believe that I shouldn't use bicalutamide.
If you want to use bicalutamide, 50mg is enough per day.
Thanks. My liver readings are all excellent, as is my whole metabolic panel. But I welcome all input. And yes, I do look for cheap and effective, if it fits in.
I believe you can get generic Abiraterone relatively cheap in your country. Maybe that would be an option for you? But again, lot of people said that they had to stop Abi after 6 years as they developed problems with the liver. Therefore again liver toxicity.
My MO calls Apalutamide (Erleada), Bicalutamide 2.0 & has me & 20 other patients on it, due to less side effects. I have extensive mets., but am castrate sensitive. On Lupron & Xgeva, also. PSA went from 7.3 to 0.2 in 3 months. Will have PSA tested in 2 wks.
No I did not. I first had my T-11 Lamina Cyberknifed & it was the only lesion that showed up on the Axumin scan, with a PSA of 0.4. I had been off Lupron for 1.5 years with PSA's of <0.1. My T went up from the 240's to 330 & that may have caused the surge of mets. to 7.3 with lesions on T-4 & T-8 & small lesions all over my skeleton, too numerous to count.
The one on the T-4 was trying to get into the spinal column & my RO wanted to Cyberknife it. But my MO immediately put me on Lupron, Apalutamide & a month later, Xgeva & the T-4 lesion immediately began to shrink, so they held off on the Cyberknife. A month later my PSA dropped to 0.7, then a month later to 0.3 & another month 0.2. T only dropped to 39. Hopefully it will drop more. Will get another PSA in 2 weeks.
It adds very little, and may incur cross-resistance with more effective meds later. There's no reason to add anything until your PSA or imaging demonstrates that the cancer is growing. Usually wait for PSA=2 or PSADT<9 months
My father's case is same like yours (Gleason score, bone mets, starting meds). After he was on Lupron and Bicalutamide for a year, the oncologist that he came for 2nd opinion said that he would rather have Lupron alone because Bicalutamide won't help much. He then switched my dad to Xtandi, half dose and it's working well so far. With Xtandi, your psa probably will get lower than 0.6 (my dad's is undetectable). I don't know if that does any help for the big picture. Just want to share our story.
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