Avodart added to my treatment regimen. I am Leary of it.

[Pianodude]

My MO prescribed bicalutamide and avodart after my 20 rounds of SBRT. My PSA went up to 21 after the SBRT. The bicalutamide I understand. I am leary of the avodart. I am concerned that it will mask PSA rise from cancer. Any thoughts on this?

[j-o-h-n]

FROM HISTORY FILE (MORE OUT THERE IN HISTORY FILE IF YOU WISH TO VIEW)

BrianF505

7 months ago

I understand! Been on Xtandi, Avodart, Finesteride since 2014. Had a really good run. But it’s failing and I’m looking to the next step. That being said, the fatigue was/is killer. Tho, I’ve just adapted and can manage myself fairly well with rest and naps.

Note: you may want to contact UserID BrianF505 for more info?

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 10/17/2023 6:49 PM DST

[Tall_Allen]

Please clarify: SBRT is 5 rounds - do you mean you had SBRT to 4 metastases?

What kind of therapy would give Casodex to a man with metastases?

[Pianodude in reply to Tall_Allen]

I looked at the records this morning. My bad... I had 20 rounds of IMRT. The recent history (which I need to update on my profile) is that I was on Orgovyx and Nubeqa. We took a break in March to allow my PSA to go up a little for a PSMA PET scan in April. The scan showed that my bone mets were not active but I had a new tumor in my prostate. That was when the MO sent me to a RO who set me up with the 20 rounds of IMRT. I had those over the summer in June - July. In August, my blood labs showed that my PSA was continuing to go up. That was when my MO started me on Bicalutamide and Avodart. My labs in the end of September showed my PSA was dropping. I forgot to mention that my Alkaline Phosphatase levels have been heading up, although still within normal range. I also have been getting more pain in my pelvis and ribs. I have a new PSMA PET scan scheduled for October 27th. Sorry for the earlier lack of detail.

[Tall_Allen in reply to Pianodude]

The standard of care for a man with just a few bone metastases is to have ADT(Lupron/Firmagon/Orgovyx)+chemo+Nubeqa. It's called "triplet therapy" - which is what you had. If there were only a few bone metastases, then debulking the prostate with IMRT may be beneficial too. So far, so good.

Then, for some inexplicable reason, you switched from Orgovyx+Nubeqa to Bicalutamide+Avodart. It's like switching from a missile to a pea-shooter. This makes no sense to me. You should have been on Orgovyx+Nubeqa permanently.

Your ALP levels are up and you are feeling pain because your medicines are substandard. In fact, it is likely that the bicalutamide is feeding the cancer.

I hope you get a second opinion from a more competent MO ASAP.

[Pianodude in reply to Tall_Allen]

Thanks TA.

[Justfor_]

Avodart can fool the uninitiated by lowering the benign PSA and thus hiding the cancerous one from the mix. This isn't the case with you. If you still have benign PSA to be lowered (very unlikely after all the treatments thus far IMO) it will clarify the true amount of cancerous PSA, not mask it.

[TeleGuy in reply to Justfor_]

The reason that I'm in this "club" is that my former urologist had me on Avodart to help "prevent" PCa but ignored my PSA rising while on it. Today the wisdom is that, in a normal untreated person, it should cut PSA in half, and if it doesn't, that suggests a biopsy, and if your PSA goes up at all while on it, you should biopsy. I realize that isn't the case here, since Pianodude has been treated, but I would be very leery of any PSA increase while on it.

[Yearofthecow]

if you start Avodart, you simply establish a new baseline. If the PSA goes up after the new baseline is established, then you need to explore why. Note Avodart take a month to a month and a half for the new baseline to be established. As a rule of thumb Avodart lowers the PSA by half if you weren’t on it.

Do you have BPH? Is that why he wants you to take Avodart?

[Pianodude in reply to Yearofthecow]

I do not have BPH. That is why I was wondering why he added that to my treatment regimen. My PSA went up after SBRT. He said he wanted to lower it again. I was concerned that it could mask any real problems.

[Yearofthecow in reply to Pianodude]

As I mentioned pianodude, you will just establish a new baseline under Avodart. That way it won’t mask anything.

What Avodart does is prevents the conversion of testosterone into dihydrotestosterone(DHT). Some researchers hypothesize that Avodart may reduce prostate cancer growth.

I hope you are sharing with your doctor your concerns.

Wishing you all the best.

[addicted2cycling in reply to Pianodude]

Yearofthecow wrote -- " if you start Avodart, you simply establish a new baseline... "

👍👍

I've been on Avodart(Dutasteride) since 2015 (GL10,) plus 1,700mg/day of Metformin and dealt with PSA from level after beginning *Avo.* Just stopped Metformin and changed to Berberine Phytosome by ENZYMEDICA. Both A1C and Cholesterol dropped to better levels.

[EdBar]

I’ve been taking Avodart, Xtandi and Lupron for nearly 10 years now after being diagnosed with Stage 4, Gleason 9 PCa. It is part of Snuffy Myers triple ADT regimen. Snuffy’s rationale for using it was that it helped prevent cancer from developing a work around for the other therapies by blocking the formation of DHT, a highly potent form of testosterone.

My current MO, Dr. Sartor has no issue with me taking it.

Ed

[MateoBeach]

Bicalutamide can be an effective alternative to standard ADT for many. Blocks the androgen receptor but does not decrease testosterone, rather increases it due to blocking of feedback inhibition (hypothalamus-pituitaty-testes axis). The high T levels convert to higher DHT levels. So Avodart (dutasteride) is a good way to block that and keep DHT levels from rising. It is a good strategy and can be effective for some time (4+ years for me) until it fails as will be evident from rising PSA levels. Avodart does not hide that rise in PSA when bicalutamide ultimately fails and strategy must be changed at that time.