I’m about to start treatment with bicalutamide and lupron. Should I Stagger start?

[pj1121]

im just about to start treatment with bicalutamide and lupron. Have the bicalutamide but will be away for 10 days without access to the lupron. Should i start the bicalutamide a week before lupron? Thought I heard someone on this forum say it would better prevent flares.

[Don_1213]

I believe a normal protocol is ADT to do bicalutamide for several weeks before getting your first Lupron shot - so if I understand your question - what's happening should be fine (check with your medical oncologist - if you don't have one - you should..)

They're done serially - bicalutamide first (which lowers your PSA) then start the Lupron (which if started without the bicalutamide will cause a "flare" in PSA.)

[pj1121 in reply to Don_1213]

my mo prescribed therapy as “start on same day” then I told her my situation and asked if I should start bicalutamide first. Her response was I think that should be Ok! This did not give me confidence that she is on top of things. So!

[Stevecavill in reply to pj1121]

there’s definitely meant to be a “lead time” with the bicalutamide. So no, that MO wouldn’t fill me with confidence either!

[Jancapper in reply to pj1121]

I was told by my RO to start them on the same day, which is what I did. Additionally, I did double check. This is what I found.

Description as to when to start Bicalutamide

[Seasid]

I was put on Degarelix. It was an expensive option but I had mets in my spine and had to avoid spinal cord compression. I also had sciatica pain which gone 7 days after starting firmagon injections.

[GP24]

Start with Bicalutamide now and continue two weeks after the Lupro shot. It is better to start with Bicalutamide some time before the shot.

[Magnus1964]

I hate to go against you doctor but I would start bicalutimide, wait and see what your next PSA test shows.

I'm not big on throwing a bunch of drugs at cancer all at once.

[GP24 in reply to Magnus1964]

I agree. As PJ has affected lymph nodes only, he could control the cancer with bicalutamide only for quite some time and avoid the side effects of Lupron. However, how shall PJ decide whether to follow the advice of Magnus and GP24 or his doctor's advice?

[Tall_Allen]

Lupron actually causes testosterone levels to go sky-high briefly before it is shut off entirely. Bicalutamide prevents the excess testosterone from stimulating metastases and causing pain.

[treedown]

Between your profile and this question I am curious what your treatment plan is. I agree that bicalutamide was probably planned only to prevent pain from a flare as TA has said and may not be intended long term. If it is I would be a ljte surprised.. What has the MO said about long term treatment? Is your cancer confined to the gland. With a PSA of 300 I doubt it. Is radiation planned in a few months? How is your health in general?Bicutamide is a older drug and these days mostly used for that one purpose but others on this forum have used it successfully as a monotherapy. My MO didn't think I needed it and my pharmacy messed up when I restarted Lupron recently so it didn't show up. I started on a newer drug a few days after my shot called Xtandi and experienced no flare but the extra testosterone was noticeable on my longer bike rides at the time.

Anyway, more info in your profile will help others answer questions better.

Best of luck that your treatments, whatever they may be, are successful and that you tolerate ADT well.

[dhccpa]

I was started on bicalutimide three weeks before Lupron in 2018. I stayed on it for another three weeks after starting Lupron.

[SteveTheJ]

Nobody mentioned flares to me but the logistics were that it was faster to get the pill than the injection. I don't remember how far apart but in any case, I wouldn't worry about it. Important thing is to get started ASAP.

[hopefull99]

I starter with bicalutamide followed by Lupron in 2 weeks. Then switched to Zytiga 2 weeks later (in place if bicalutamide).

[Mgtd]

I was told to start Bicalutamide/Casodex a week prior to first Lupron shot. Worked great.

Since I was also going to have radiation they put me on Tamoxifen to prevent breast enlargement and pain. That too worked superbly.

[Mgtd in reply to Mgtd]

forgot to add that the flare is ONLY for the first LUPRON SHOT. There is no need to use it for subsequent shots. The rise is well below castration level.

[doc1947g]

*(2020/04/04). Casodex 50mgX30 day. Missed Eligard 45.0mg/24weeks

(2020/05/31)+(2020/08/24) Lupron Depot 22.5mg/12weeks X 2

VMAT-RT 3Gy X 20 fx (2020/06/08 - 2020/07/07) = 60Gy

After 3 years my PSA went from 20.3 μg/L down to 0.02 μg/L and Testosterone from 438.04ng/dL down to 60.57 ng/dL 🙈🙉🙊.

[Benkaymel]

Standard of care is to have bicalutamide for about 2 weeks then have the first lupron shot and continue bicalutamide for another couple of weeks. The bicalutamide prevents the testosterone flare you would otherwise get from the first lupron shot.

Have you had an MRI scan? More detail in your Bio would help others help you.