Bicalutamide (Casodex) then Eligard - Question

[Mike58]

OK, Another quick question. I've been on Bical for 11 days and in 3 days I get my first 1 month injection of Eligard. I have had almost zero side effects with Bical, maybe a little extra fatigue but hardly noticeable. Does this mean that perhaps I will tolerate Eligard better than what some people experience or am I about to experience a whole new ball game?

[Justfor_]

Not related matters. Firstly, Bicalutamide takes almost 2 months to achieve serum saturation. Your 11 days is almost nothing. Secondly, apart from gynaecomastia it usually isn't accompanied by any other side effect. Thirdly, it will boost your Testosterone as your body detects the anti-androgenic environment it creates and tries to compensate by producing more. Totally different mechanism with Eligard that brings Testosterone to castrate levels. For example, the extra Testosterone consumed by the brain cells improve their functioning, while chemical castration inflicts the exact opposite dubbed as "brain fog"..

[Mike58 in reply to Justfor_]

Please see my reply below

[Tinkudi in reply to Justfor_]

I thought bicalutamide is supposed to reduce your testosterone and is hence given prior to ADT which may cause an initial flare. Where have you read that bicalutamide increases it

[Justfor_ in reply to Tinkudi]

No need of reading anything, although there are loads of reading material on the subject if you Google it. I have about 20 quarterly Testosterone bloodwork readings of mine, half of them before starting taking Bicalutamide 2.5+ years ago, that show an increase of T ranging from +50% to +250% dosage related. Bicalutamide is NOT ADT. It is ARSI (Androgen Receptor Signal Inhibitor) also called ARPI where Signal is replaced by Path, and most commonly dubbed as Anti-Androgen.

[Mike58 in reply to Justfor_]

Hi Justfor, I've now been on Eligard for 4 months and for the past 9 weeks have been traveling Japan, Europe, cruising the Med and currently in Israel ready to return home to Adelaide Australia. Have averaged walking 5kms per day (3 miles) and apart from the hot flushes which are manageable, I have faired very well. I must admit I was doubtful of even doing this holiday but I am so glad I did it because the alternative would have been sitting home not doing a lot. So my pre-worries and concerns about the effects of Eligard were unwarranted, however I am acutely aware that some PCa guys have a horrible time on it. Now to look forward to RT and Brachytherapy on my return. Hope you are going well.

[Mike58 in reply to Mike58]

I’m no medical genius by any means but my limited knowledge is that Bical prepares the body for unwanted Testosterone flair that will happen with the standard ADT drugs such as Eligard. So it is important to be on them for at least 2 weeks prior to starting ADT injections. I’m sure others will give a more comprehensive answer.

[Tinkudi in reply to Justfor_]

Thanks. Why do doctors prescribe it then before starting agonist ADT treatments ?

[Justfor_ in reply to Tinkudi]

It functions as a blocking mechanism between the Testosterone supply and the consumers, i.e. the cancerous cells. It doesn't limit the T supply, instead, it doesn't allow the consumers to go and get it. Picture it like the safe vault of a bank. Money is stocked therein, but unauthorized personnel are not allowed to step in and get any. During the initial phase of ADT there is what in medicine is called "flare", where during a brief period T goes high before stabilizing to some castrate level. It is a natural phenomenon that takes place whenever there is an abrupt change to some value. In communications it is called "ringing", in electronics "overshoot", in power engineering "transient response", etc, etc, etc. ARSIs are given to hold back T "looters" during this "turmoil" period.

[Tinkudi in reply to Justfor_]

thanks for the detailed explanation though it’s too complex for me 😀

[treedown]

My opinion is you just have to wait and see. Some of us have extreme side effects and some of us have little from Eligard. So there's lots of room in the middle of that bell curve. There's no way for us to know how your going to respond to ADT. The physical effects to your body will be loss of body hair. Reduction in the size of your junk. Loss of muscle mass unless you work very hard to keep it. A jelly roll around the midsection, again unless you work hard to avoid it. These things are due to loss of testosterone. The brain fog, hot flashes, mood swings, lack of, or loss of libido, we all have in varying degrees. You will have to experience it to see how your body behaves. Good luck. Hopefully you feel very comfortable with the side effects and you respond very well to the treatment.

[PELHA in reply to treedown]

Hubs always had a flat stomach. Was kind of shocking how fast the jelly roll appeared after that first shot of Lupron. He does weights regularly, (needs more cardio), but that mid-section is a tough one to combat!

[treedown in reply to PELHA]

I lost a bunnch of weight when diagnosed and that belly fat hangs n tight. I need more weights. I hope to start in March. Cardio is my main thing and has been for awhile so I get lots, especially in the warmer months.

[Mike58 in reply to treedown]

Please see my reply below

[quietcorner]

Hi, Mike58. My hubby didn't take Casodex, but went straight to Lupron, then Orgovyx, and finally Eligard. Lupron made him a bit tired and a little forgetful, same with Orgovyx. Eligard was fast and furious, with all sorts of s/e, it was rough. We've since learned that a 1 month shot seemed to create fewer s/e than a 3 month shot. Here's the he kicker: hubby lost 15 pounds while on ADT with no working out, so not everyone gains weight.

[Mike58 in reply to quietcorner]

Please see my reply below

[RCR38]

Hello Mike- I think Eligard side effects may be related to how high your testosterone levels are when they bring them down. I was on El and Lupron for three years, and the only side effects I experienced were some fatigue, and hot flashes. I have recently gone back on after a 2 year holiday, and once again very minimal side effects. Stay positive, and don't let the unknown get the best of you.

[Grandpa4 in reply to RCR38]

I had a testosterone level of 850 at the start and other than losing all interest in sex I had minimal side effects. I did exercise (cycling and pickelball) more than most and lifted weights. I think those are the important variables.

[Mike58 in reply to RCR38]

Please see my reply below

[Horse12888]

The only thing I would add here is to be prepared for depression. It's not a guaranteed SE, but it's not uncommon.

I eventually got on an antidepressant that addressed the problem very nicely.

If you're going this route, get a DNA test to determine which drug will be most effective for you.

FWIW, I agree with the others re: not worrying about the future. Some guys have SEs that are very mild.

[gsun in reply to Horse12888]

I agree with Horse12888

[j-o-h-n]

As the Queen said about drinking a glass of wine.........."taste my dear, taste".......

Good Luck, Good Health and Good Humor.

j-o-h-n

[Purple-Bike]

With strict weight training I maintained my strength on ADT. And it may be the same with brain fog and tiredness. It was terrible at first , but I forced myself to go on working all day long,, standing up at my desk. After two weeks it cleared rapidly and I was back to my previous energy level and mental clarity.

[Mike58]

Thank you everyone who replied to my query. The responses although varying greatly are indeed a big help. I know that up until this time I have been a little paranoid about ADT and I guess that is normal, but I also know how important it is to make it a part of the treatment plan to ensure the best outcomes.

From my understanding, it appears as though a few men suffer quite badly with SE's and a few hardly have any SE's and in between are the majority of us folk. Here's hoping I'm one that can tollerate these changes in life caused by these drugs.

Thanks again everyone and all the very best to you all.

[Professorgary in reply to Mike58]

Many of the side effects are things like increased lipids, glucose, bp and liver enzymes. I take 2800 mg curcumin daily. I suggest you research curcumin for the listed side effects as well as curcumin to fight Pca. God Bless.

[YYJguy]

I flatly refused A.D.T. and have been on 150mg Casodex Bicalutimide 20 months. Minor gynecomastia and lots of fatigue.All numbers looking great.

For the record stage 4 PC T2b & mets to pelvic lymph prostate and pelvic regions radiated two separate times. Once SBRT to prostate, then EBRT to pelvic.

[Justfor_ in reply to YYJguy]

Have you ever considered adapting your dosage to your minimum effective one? I take in a month what you take in a day!

[Mike58 in reply to Justfor_]

I'm a little lost - I take a 50mg Casodex tab per day - how is it that you are only taking 1 tab per month? Or have I misunderstood? or do you mean that you are taking more in one day than i am in a month and if so how can that be?

[Justfor_ in reply to Mike58]

My current dosage is half a tablet every 5 days, making it up to 3x50mg tablets per month, which is the daily dose prescribed for monotherapy. I am documenting my course, month-by-month 2+ years now, in a thread entitled: "An engineer's Bicalutamide maneuvers".

[YYJguy in reply to Justfor_]

How do you dose that out may I ask? Timing wise.

[Mike58 in reply to YYJguy]

I take 1 x 50mg Casodex tablet per day. - What do you take?

[YYJguy in reply to Mike58]

Currently 3 x 50mg daily

[Justfor_ in reply to YYJguy]

Pls check my reply to Mike58.

[Mike58 in reply to YYJguy]

So are you suggesting that 3 x 50mg Casdex tabs daily would be doing the same job as 1 monthly injection of Eligard?

[YYJguy in reply to Mike58]

I think it is worth an ask or opinion. The Bical monotherapy is not part of the standard of care but they allow it in some cases. PS. Theres no money to be made on it by comparison to standard leuprolide etc.

healthunlocked.com/advanced...

[Justfor_ in reply to YYJguy]

Correct. 30 generic tablets here cost, at the pharmacy, 24 Euros and the original Casodex, 20 Euros more.

[RCR38]

My Dr. has added Adderall to my treatment, and that has done an amazing job combating fatigue, reducing depression if I had any, and keeping me focused on a task or project. I now have a routine I follow with the adderall that has been quite effective.