Bicalutamide and Eligard

[Domas]

PSA went up to 0.87. Doctor recommend Eligard (Lupron) with bicalutimide and dutasteride. No choice. I went thru thus on Jan 10, 2024. Hospital said I have to run thru Eligard for 24 months on a quarterly basis. Every 3 month. Doctor Said Eligard works only for 2 years, and I have to find another drug thereafter. He believes Bucalutamide is still working. I asked what so I do next? He was silent. I am thinking to increase the amount of exercise. What do you think? Can I live 15 years from today? I am 63 years old. Gleason 9. Look at my profile. I have relied on bicalutamide for 40 months already. Doctor still thinks it is still working. He said somebody it works for 12 years. Is that true? What options do I have?

[GP24]

I think starting Eligard at a PSA value of 0.87 is too early, you could wait until it reaches e.g. 4.0 ng/ml. You could also get intermittent ADT with Eligard and continue with Bicalutamide.

Because you had surgery and salvage radiation, I would expect Eligard to work longer than two years. I know a patient who gets ADT for 12 years now.

[Domas in reply to GP24]

Can I have just 1 Eligard shot in a year (as opposed to 4 times a year)? Doctor originally said I need 1 shot a year, and then he or his team changed his mind to 4 shot a year, without explanation..... I am so confused. 1 shot is $4850, and I have found it is not covered by my insurance.

[GP24 in reply to Domas]

Usually a doctor uses three months shots, there is no one year shot available. There is a six months shot which may be cheaper than two three months shots. Your insurance should cover Eligard. eligard.com/getting-started/

[Gl448 in reply to Domas]

From the manufacturers website: ELIGARD® comes in 1-, 3-, 4-, and 6-month doses allowing for as few as 2 injections per year

From the manufacturers website: Lupron Depot is given every 1, 3, 4, or 6 month(s).

So, no, you can’t have one shot per year. Both forms are just administered in a larger amount to reduce frequency.

My original MO gave me a 6 month dosage, but City of Hope goes for 3 months.

You might ask your doctor about using an oral ADT drug, but the new one is probably not covered by your insurance either.

Firmagon is an option that looks to be cheaper than Eligard, but it’s only available monthly. I saw a quote of about $524 per dose

[Derf4223]

I second the idea of increasing exercise. A lot. Resistance and cardio/aerobics. Minimum of 150 minutes/week but the more the better. A trainer is recommended but IMO quantity of exercise is more important. I'm getting 11+ hours/week (660 minutes) sans a trainer. You can take a day or 2-3 off infrequently but under ADT we de-condition at a dismally fast rate.

Another factor to take into account now is bone density. Get a DEXA scan if you can so as to have baseline data. ADT accelerates bone loss, a lot.

Exercising makes treatments (RT and ADT) go a lot better. Fun fact question: what kills most men with APC? Ans: cardiovascular events (CVE's for short.) Cheers and welcome to the rest of your life. Make the most of it.

[Tall_Allen]

Bicalutamide and dutasteride are drops in the bucket if you are taking Eligard. Based on your rapid doubling time, you may be better off following the EMBARK protocol. They found that in men like you, treatment with enzalutamide+Eligard could provide longer remissions:

prostatecancer.news/2023/05...

[Domas in reply to Tall_Allen]

It appears that Doctor believes that Bicalutamide is still working, and consider changing from bicalutamide to XTANDI, only after bicalutamide is no more effective. He seems to desire to use bicalutamide until its efficacy is finished completely. And then change to Xtandi...... The impression I got from him is the main drug is bicalutamide and not Eligard. Eligard simply assists Bicalutamide, by decreasing the amount of testosterone. I am not sure if my impression was correct, though.

[Tall_Allen in reply to Domas]

If that is what he believes, it is wrong. Bicalutamide is a very weak antiandrogen. In fact, androgen receptors adapt to feed on it. And it may create cross-resistance with Xtandi. Xtandi suppresses the cancer much more strongly.

[Justfor_ in reply to Domas]

The second generation anti-androgens are still under patent protection and cost >100x (yes, over one hundred times more) than the poor man's Bicalutamide. Follow the money and things will become self-explanatory.

[Hidden]

I have been receiving 6 month Eligard shots for 9 continuous years. My highly respected MO seems to think that Eligard is still working in some capacity.

[j-o-h-n]

I had been taking quarterly shots of Lupron and daily Casodex from 2011 until 2023. I still take Lupron but the Casodex has been replaced by Nubeqa in April 2023. This doesn't mean that my regime is right for you (but you asked).

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 01/17/2024 8:32 PM EST