experience with ADT, specifically Casodex followed by Eligard shots?

[Cafu6]

Hi there,

Met with RO and have been doing a ton of reading. To be honest, it can be a bit overwhelming the options/drugs out there. The RO is recommending a 30 day treatment of Casodex hormone therapy concurrent with PET scan scheduling, followed by injections every 4 months of Eligard for 2 years or so. Radiation to follow in about 6 months (5 weeks, 25 sessions at a rate of 68 gray).

Dad is waiting on his CT (next week) and then PSMA PET scheduled immediately thereafter (apparently he is required to do a CT to get a PSMA PET in Canada). I am looking to get some input/feedback on experiences with Casodex and Eligard. This will sound silly, but also wondering if there is like an advanced prostate cancer drug “cheat sheet” to compare the different options? Does anything like that exist? I have been following PCRI YouTube channel very closely as well.

Many thanks and take care.

[Tall_Allen]

The second line hormonal drugs have never been tested in a randomized comparison.

[Cafu6 in reply to Tall_Allen]

sorry to be a pest, but can you elaborate what you mean by that? Are you referring to Eligard? I guess it’s being used in place of something like Lupron, are you saying Lupron has more studies/research associated with it?

[Tall_Allen in reply to Cafu6]

Zytiga, Xtandi, Erleada and Nubeqa are the second line hormonal drugs. The first line/basic ADT drugs (e.g., Lupron, Eligard, Zoladex, Firmagon, Orgovyx) shut down the manufacture of testosterone.

[saniku in reply to Tall_Allen]

Where does Xtandi fit i ?

[Tall_Allen in reply to saniku]

Thanks, I accidentally omitted it. Now corrected.

[VHRguy in reply to Tall_Allen]

I didn't know that, interesting. Do you mean not tested randomized against each other?

[pe43 in reply to VHRguy]

See Tall_Allen's long reply to this issue: healthunlocked.com/advanced...

[Oatmeal2]

I know everyone has different side effects from ADT. My husband is taking Firmagon injections monthly for hormone therapy and aside from some pain from the injection he has not had major side effects. If the injection is properly administered per the company guidelines, it really cuts down on any reaction from the injection.

Firmagon does not require the patient to take a drug like casodex before the initial injection because there is no testosterone flare that happens with agonist drugs like Eligard, and Firmagon works almost immediately to drop testosterone and PSA whereas eligard takes up to 28 days. With Eligard or Lupron, the patient has to take a course of casodex (aka bicalutamide) to help prevent the effects of the testosterone surge from the Eligard injection.

If you can get the Firmagon approved, it’s a better way to go (in my opinion) at least on the first injection and if you can get approved to stay with the monthly Firmagon injections, I highly recommend it. Firmagon is a little more expensive so I’m not sure if health insurance in Canada would approve it but you should inquire about it.

[Cafu6 in reply to Oatmeal2]

Thanks so much for taking the time to respond! It’s great that there are lots of options out there to support everyone, but it’s a bit overwhelming! I’ll share this info with my mom/dad and we will definitely look into Firmagon (still have to meet with MO for guidance).

[dhccpa in reply to Oatmeal2]

All that you say is true, but it's really no big deal to take a month of casodex (I took it for six weeks-three of those weeks after starting Lupron) leading into Lupron.

[Izzysdad]

What was explained to me by my RO is Eligard causes a testosterone “flair”, something you don’t want. Casodex stops the cancer from using the testosterone until Eligard kicks in and shuts the production down. The Casodex is given for 30 days. Are you saying he is getting Casodex for 30 days and then Eligard sometime later?

[Mascouche in reply to Izzysdad]

Casodex can be given for 30 days when it is used to tamper down the Testosterone flare up that takes place when you get your very first Lupron injection.

There are other scenarios when it is given longer term. My doctor tried to fight my cancer with just Casodex in the fall of 2020. The dosage started at 25mg which I tolerated well, up to 50mg where I began to lose weight, up to 100mg where I began to have issues breathing and simply had to stop taking Casodex.

[Izzysdad in reply to Mascouche]

What confused me is how the OP worded it. It sounded like he was going to get Casodex for 30 days and then, sometime in the future, start on Eligard. That doesn’t seem to be the usual way they do it. Perhaps it has something to do with the scan he is hoping for. Anyway, all good.

[tdouds]

I believe that most often in the US that Casodex (Or bicalutamide, which is the much less expensive generic) was given with the 1st line (i.e., Eligard in your case), as the body tries to overmanufacture Testosterone because the Eligard is trying to turn it off - this is known as the flash effect, and the week or two of Casodex counteracts that effect, because some folks have reported pain with out this. I was in a clinical trial where I took Casodex daily with quarterly shots of Eligard for 6.5 years, and it kept my PSA controlled for all that time…I felt fortunate to have had it.

[dhccpa in reply to tdouds]

Still on that combo? Or did it fail?

[Justfor_]

Bicalutamide can be VERY effective on its own right, my current N=1 experiment proves it. But it only costs 24 Euros per box. Second gen lutamides cost x100 that. Follow the money...

[SteveTheJ]

4 months' interval is a new one on me. My experience was casodex initially plus a 6-month Lupron injection by the urologist. Approximately one month later, MD Anderson started me on Erleada instead of casodex. Lupron every 3 months thence.

[VHRguy]

The RO's plan sounds solid. Unless there are some extenuating factors, it appears to be a good approach. Starting with bicalutamide to suppress the flare is a proven strategy. The flare effect does not recur as long as one stays on Eligard thereafter.

I was on bicalutamide and Lupron (same drug as Eligard) for 3 years as part of my primary therapy (Gleason 9, 5+4, stage 3 at dx), along with IGRT (radiation) to 79.2 Gy. The ADT suppressed my T, and PSA, the whole time I was on it. [Edit to add: I was on six month Lupron shots.]

(Monthly Firmagon seems more bother, more pain, and more cost. But that's just my opinion.)

[ChloeSS]

My dad was also treated with Casodex (30 days to prevent flare) followed by 2 years of Eligard shots (just had his last one) in addition to high dose brachytherapy and pelvic EBRT for his t3b cancer. His main side effect has been hot flashes, typically one a hour, but otherwise he has been feeling pretty good. I’m sure you’ve read, but working out and maintaining muscle mass is important as it may help lessen the side effects of the ADT.

[j-o-h-n]

to Cafu6,

I started Casodex in approximately 2008 and was on it mainly (off once in awhile) and finally stopped it in April last year( 2023) which was replaced by Nubeqa. Been on quarterly Lupron forever (and still am). I was diagnosed in 2002 at age 64 (now 87). BTW how old is your Dad? Give him my (our) regards.

p.s. Looks like Nubeqa is working better-er

Good Luck, Good Health and Good Humor.

j-o-h-n