Bicalutamide

[OFPF16]

My Dad last week was diagnosed with 3 spots of cancer on his prostate. 3+4=7, 4+4=8, and a 4+3=7 spot. The thing I don’t understand is during the visit to the Urologist to discuss his biopsy results, the urologist prescribed 50mg of Bicalutamide to begin reducing his testosterone. I believe this is premature. What does this esteemed group say? I’ve only had my prostate cancer with mets for nearly two years. I’m still learning about all of this, but should a urologist decide treatment plans without an oncologist consult? Thanks.

[Boywonder56]

It was and still is the soc...to prevent t flare when lubpron/ eligard....next phase starts ...ta wil chime in and set you strait...bw

[OFPF16 in reply to Boywonder56]

I understand that he is just beginning the process of further diagnosis. They want him to do a regular PET scan, not a PSMA.

[Seasid in reply to OFPF16]

Which is the regular pet scan?

[Gl448]

Are you sure the Urologist didn’t consult with an MO before seeing your dad?

Mine did. The MO told her to start me on Lupron, get me an MRI and PET scan before sending me to him.

Has your dad gotten any of those things scheduled or referred yet?

Casodex is normal starting point for aggressive cancers, which that 4+4=8 is.

Edit: some urologists treat prostate cancer routinely. It’s not out of their purview. There’s a couple here in LA that are well respected for that.

[OFPF16 in reply to Gl448]

His urologist did not consult with an oncologist before this treatment. I specifically asked this question and my Dad said no. If it had metastasized I believe it should be verified by a PSMA scan, then I think the SOC is Firmagone for a month then Lupron/Eligard with Zytiga and Prednisone.

[Tall_Allen]

I agree that bicalutamide is premature until he has a bone scan/CT and a PSMA PET/CT to determine whether he has any metastases and if so, where. Bicalutamide may interfere.

He does not need a medical oncologist unless he has distant metastases.

[OFPF16 in reply to Tall_Allen]

Copy that! Thanks for your input!

[vintage42]

"... should a urologist decide treatment plans without an oncologist consult?"

Many urologists are effective oncologists. Mine, for instance, at a very large practice, is part of their "advanced treatment center" for prostate cancer. I have an MO/Hemotologist for urologic cancers that I check with twice a year, and he defers to the urologist as being in charge.

[OFPF16 in reply to vintage42]

His urologist is not an oncologist.

[dhccpa]

Urologists do that regularly, rightly or wrongly.

[Bethpage]

My husband's bicalutamide was prescribed by an RO but _after_ what is now Pylarify identified BCR to the prostate bed. My husband had the F-18 DCFPyL (became Pylarify) scan in phase II trial in December of 2018. One of the conditions for participation in the F-18 DCFPyL (Pylarify) trial was that the participant could not have been on any form of ADT prior to having the scan.

[MateoBeach]

Just to clarify: He should have prompt scans including a PSMA PET scan and a full CT scan and perhaps a bone scan. If there are metastases outside of the prostate or pelvic lymph nodes, Then he will be treated "medically" such as with an ADT drug plus an ARSI.

If there is no cancer found outside of prostate and/or pelvic lymph nodes then he is a candidate to go for curative-intent treatment either surgically (prostatectomy with lymph node sampling) or with radiation. Both a VERY experienced urologic surgeon and a Radiation Oncologist (RO) should be consulted to discuss these.

How old is he and how is his overall health and functioning? What was his PSA?

[OFPF16 in reply to MateoBeach]

Thanks. It’s been a busy few weeks with all of this happening for my Dad around Thanksgiving. His recent PSMA showed no cancer outside of the prostate and he will do radiation at some point after the New Year. They are putting gold markers in his prostate as well as shooting him with Leuprolide tomorrow. No Prednisone, no Firmagone, just a 7.5mg shot of Leuprolide. There has been no RO and only a 20 minute visit with an MO at a cancer center next to, no kidding, Walmart.

[Cooolone]

You lack mentioning the entire diagnosis... What was the PSA history? What was the amount of Gleason 3 or 4 in those biopsy core samples (volume). What, if any imaging or scans were performed?

Any single test, is not a good prognosticator of what is or what may be. A proper and accurate diagnosis consists of many tests when combined can properly assess a patient...

A Urologist is a doorway physician, but once a Cancer diagnosis is present, getting to an Oncologist is Paramount to receiving proper care. Let alone you'd want to get the BEST, of course, and THAT is available at Cancer Center's rated in Excellence!!! Get to whichever one you can access, travel if you must, don't skimp! There is no comparison of Local facilities to COE's, the care provided, the ability and access to cutting edge detection, treatment and trials if necessary!

Good Luck and Best Regards

[OFPF16 in reply to Cooolone]

I completely with getting to a COE like The Mayo Clinic in Jacksonville which is 7 miles from my Dad’s house. He would rather stick with his Urologist of 25 years than go to Mayo. Apparently, his Urologist recommends a strip mall cancer center that uses VMAT and IGRT to radiate prostate cancer. My Dad’s PSA history has been in the 2.0 region. But on his latest visit in November to the Urologist the PSA was 3.5. The Dr said since he was on a drug that could mask the real PSA by 2 points, so he ordered the biopsy. The biopsy returned 3 spots of cancer. One was 4+4=8 on his upper left prostate, the mid left was 4+3=7, and lower left was 3+4=7. My Dad went to the strip mall cancer center as directed by the Urologist and they immediately wanted to schedule radiation treatment. I begged my Dad to get a PSMA scan which he did just to confirm no Mets. I’ve advised him to go to a COE but he refuses. I bought him Patrick Walsh’s book but he won’t read it. I’m out of ideas how to help except to support him in whatever treatment he chooses. Thanks for your your input!

[Cooolone in reply to OFPF16]

We do get stubborn as we age, lol. You can do only what you can do. And parents don't always listen to their children, maybe as payback for when children were younger and not listening to their parents

Male healthcare is problematic because many don't even seek treatment. So that he is at all can be a good thing. But I'll say this... It's funny to think, but if we had a leak in the roof of our house and we asked friends or neighbors of they "knew" someone, we do it because we are looking for the "Best" and not just someone out of the phone book (revealing my age). If our car breaks down, we do the same, because we want the "Best" and not someone who'll give our car the sunshine special (sitting outside collecting sunshine while we wait forever for it to be fixed).

We do these things because we are not knowledgeable or capable of fixing it ourselves, but when letting go and trusting to someone else to fix it, we want the best, we don't want problems later, and we want the fix to last!

So it's a weird thing then, that with our body and our health, we would just go with anyone... It's confounding! Befuddling! We only get ONE shot at it (fix), there are no do-overs... We can find someone to re-fix the roof should the job go bad, but with our health, we don't get a do-over! So maybe share this story with your dad, print it out and let him read it, from someone who doesn't even know him, to say to him, that if I was at the bar and buying my last drink I'd ever have, I'd buy TOP shelf, nothing but the best, because I deserved it! Same went for my body when it was time to find who my care team would be... Nothing but the BEST! Why would I treat myself any less?

Anyways, good luck and best regards!

[j-o-h-n]

FYI I was on Casodex (Bicalutamide) together with Lupron from 03/18/08 to 01/04/2023

My M.O. at MSKcc said to stop taking Casodex and start taking Nubeqa (to stay on Lupron). I just had a dramatic change in my PSA.

It went from 0.94% as of 06/20/16 to 0.80% as of 11/08/23.

That's the lowest PSA that I had in 5 years.

I neglected to say that during that time frame my PSA was at a high of 3.46% as of 01/08/18.

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 11/26/2023 5:09 PM EST

[Seasid in reply to j-o-h-n]

Did you have more side effects on bicalutamide than on Nubeqa?

[j-o-h-n in reply to Seasid]

No, just my "normal ones"....... I still have the neuropathy in my feet, fat stomach, big tits, memory loss, a dick referred to as a pee pee and a no sex drive........ Come to think of it why do I still want to be alive? Maybe it's the pizza.........

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 11/26/2023 5:20 PM EST

[Seasid in reply to j-o-h-n]

There are lots of things why we want to hang around longer. I believe that degarelix is a Fontaine of eternal youth. Girls refer to me like good looking. I just say my skin looks so youthful because of my chemotherapy and degarelix ADT.

[OFPF16 in reply to j-o-h-n]

That’s funny j-o-h-n. Made me laugh pretty good!

[Cooolone in reply to j-o-h-n]

It does become all about the "Food"...Lol

[LakeT]

My Uroligist did prescribe Bicalutamide. High Alk. Phosphatase(327) from my blood test was an early indication that there would be mets.

[OFPF16]

UPDATE on Dad: Well my Dad’s PSMA showed that he has three small spots that were contained in the prostate. His Urologist who is not an Oncologist, is placing gold markers in the prostate tomorrow prior to his 6 weeks of radiation which will occur sometime after the new year. Then tomorrow he will receive 7.5mg of Leuprolide right after the markers are set. He is apparently not doing the Firmagon first then Leuprolide. Plus, shouldn’t he also take prednisone to keep his cortisol levels up? Is this the SOC for prostate cancer that is contained in the capsule?

UPDATE on me: After nearly two years of treatment my ADT is working on 5 of my 8 original Mets. Three of the spots are still showing on the recent PSMA scan, plus one new spot on another rib. The one in my right iliac actually grew so the Mayo Clinic did some SBRT at the 2400 cGy level. That was two weeks ago and there have been no issues at all. My Endocrinologist conferred with my MO about switching to Hydrocortisone instead of Prednisone. They wanted to increase my cortisol levels. . Has anyone switched to Hydrocortisone? Is this an ok switch to make? I’ll update my profile to include this recent information.

Thanks for your inputs!