Continue Casodex or move to Lupron?

[Bruce66]

Hi guys,

All the details are in my profile but the thumbnail is -

RP 3 1/2 years ago with persistent PSA thus radiation and Lupron for a year. One year off, rising PSA at 1.6. Opted for monotherapy Casodex 50 mg. Two months later, PSA dropped to 0.5 so we stayed with it for another 6 months whereupon it eventually rose to 1.2 then 1.9. I was moving to another city and didn't have a new doctor set up yet so I upped the Casodex to 150mg. 6 weeks later PSA is 1.6 (as of last week), trending (possibly) downwards.

Bone scan a month ago, no mets and have never had any.

What do you all think about continuing Casodex and watch the numbers monthly? If it rises, back on Lupron of course. But if Casodex is keeping it at bay, much fewer side effects to deal with.

Is 1.6 a livable number, or should I go full-on Lupron and get it to 0? Not a big fan of Lupron and I know some of the guys here have gotten a good length of time on Casodex at higher doses.

What think?

[Tall_Allen]

You can stick with it until it stops working. At that point, just stopping it may lower your PSA because the androgen receptor learns how to feed on Casodex.

[Bruce66 in reply to Tall_Allen]

Thanks Allen, I was thinking the same thing. Confirmation bias is a wonderful thing lol

[EdBacon]

Casodex can feed the cancer so definitely want to get off that if PSA is rising. There's someone who just posted on Enzalutamide monotherapy. I linked some studies in my replies. Enzalutamide is like Casodex on steroids, only you don't need steroids with it. It's 5X Casodex.

Not SOC by itself, but see what your doctor says. It doesn't reduce your Testosterone.

[Bruce66 in reply to EdBacon]

Thanks for your input Ed, I agree. I didn't know Enz was 5X Casodex, that's cool to know. I did check T with PSA and it's only slightly below normal - highest it's been. I know Caso is neutralizing it and I can feel the lack of energy, but it's just nice knowing I still have some. Maybe it's good for other things.

Thanks for your thoughts.

[LearnAll]

In Europe, for decades Casodex montherapy was coommonly used. This treatment gives the best quality of life and does not weaken bones. This does not cause low testosterone so energy, muscles and bones remain OK. Enjoy it until it stops working after months or years.

[Bruce66 in reply to LearnAll]

Good to know - thanks for the info.

[MateoBeach]

No, it is time to stop it and don’t go back. Once bicalutamide switches over from blocking the ARs to stimulating them, via mutation, it will continue just feeding the growth of the PS. That is what your rising PSA on it indicates.However, you can try switching over to another anti-androgen like enzalutamide.

See responses to similar question today and links to enzalutamide mono therapy trial by EdBacon. Darolutamide May prove to be even better, both in side effects and in developing resistance to fewer mutations.

ncbi.nlm.nih.gov/pmc/articl...

[Bruce66 in reply to MateoBeach]

Thank you so much for this info. I have a phone consult with the doc next week and will discuss this with him. Appreciate your response!

[Hidden]

Bruce:I rode the Cassodex train from 0.5 to 4.2 and that took six years.

Ride the train baby!!!

Tom

[Bruce66 in reply to Hidden]

Thanks Tom - appreciate you sharing your experience. This route is my first choice, hoping to be one of the lucky ones and ride for awhile - six years would be beyond expectations but I'll take what I can get!

[TEBozo]

What about Xtandi as a monotherapy? Not suggesting just asking.