Casodex 150 mg for how long

[Odon]

Hi everybody,

I am after RRp in 2014, SBRT in 2017, now on Casodex 150 mg

I had Casodex for 1 year and I reached nadir 0.02. My MO put me on vacation, but after 6 months PSA went up to 0.79

I started again Casodex 150 mg. Now after 1 year My PSA in stabile 0.04.

My MO wants to put me on vacation again.

I have supportable SE. I would prefer to continue.

What are your suggestions?

For how long time can I continue the Casodex monotherapy?

I am afraid of the vacation because last time PSA increased very fast.

Any halp is welcome, thanks.

[Magnus1964]

Get a new doctor. All those drug "vacations" do is give the cancer a chance to find a work around to the drug and spread. Get back on casodex fast. If you PSA still continues to rise, switch to Zytiga and stay on it.

Magnus

[Tall_Allen]

You can continue with intermittent Casodex until PSA increases while you are taking it.

[Odon in reply to Tall_Allen]

Thanks T_A. Next month I will meet my MO. Should I ask for more alternatives ? Like adding pelvic RT for my suspicious 2 lymph nodes? Or surgery?

[Tall_Allen in reply to Odon]

I thought you already got SBRT to your lymph nodes?

[Odon in reply to Tall_Allen]

Yes, it was in 2017, but last year's PSMA PET CT after the ADT vacation showed 2 possible active lymph nodes.

[Tall_Allen in reply to Odon]

Should never hit LNs separately. If there's even one, assume that all pelvic LNs have cancer in them.

[Odon in reply to Tall_Allen]

Thank you.

[Odon in reply to Odon]

Is it possible to get pelvic radiation after SBRT in 2017?

[Odon in reply to Tall_Allen]

Is it possible to get pelvic radiation after SBRT in 2017?

[Tall_Allen in reply to Odon]

They have to look at the total radiation dose to the previously treated lymph nodes. They may be able to leave them out, but it is difficult because that area moves so much. If you have access to an MRI-guided linac (Viewray MRIdian or Elekta Unity) it may be more possible.

[Odon in reply to Tall_Allen]

This was my treatment with SBRT in 2017.

DT=42G/7 Fr (EQ D2 =75,6 GY ) alfa/beta=3

[Tall_Allen in reply to Odon]

Dose to organs at risk depends on the dose-volume histogram.

[GP24]

An alternative is to reduce Casodex to 50 mg per day instead of a vacation. This dose works well too.

[Justfor_]

Adjust the dose such as to stabilize your PSA. You may want to take a look at my Bicalutamide maneuvers thread where I document my doings.

[Dynamo]

I am sort of in the same situation as you.. I had an RP way back in 1995 & was good for around 8 or 9 years. Than had radiation to my Pelvic bed.. Only good for about 3 years.. Than got an Oncologist who put me on Casodex 150.. Got 6 1/2 years of low PSA's out of that.. Yeah..!! No vacations from it.. Only SE I got was man boobs but they don't bother me at all.. So now I'm on Prednisone & Zytiga and coming up on 2 years of that with low PSA.. Hoping that works forever.. I'm 79 now.. Got to get a bit more life yet... Hang in there..

[GreenStreet]

Plenty of good advice. I would spin it out on Casodex as long as possible as TA suggested particularly as you can tolerate the SEs and if you can get an Onco to vary the dosage that sounds good provided you have relatively frequent PSA checks

[winkoliu]

The comments offered by GP24 is workable for me, do this you will be happy.