Hello,
Wondering if anyone has just been on bicalutamide by itself (without the hormone injections) as a form of treatment?
My father, for complicated reasons, can't have hormone injections, so his oncologist is recommending just bicalutamide for the time being, with possible radiation down the line.
Age 75, gleason score 9, cancer in prostate and a couple of pelvic lymph nodes.
Thank you
Bicalutamide works but not as well as injections. Better use Relugolix pills. They are more expensive but as effective as the injections.
Hi !
Probably he can’t have Relugolix (Orgovyx) either because it’s a ’traditional’ ADT in the form of pills and not injection. It’s an antagonist version like Firmagon.
Like TA mentioned, a 2nd gen treatment could be used instead.
Best wishes - Ulf
We do not know the reason why he cannot get lupron. This makes it difficult to recommend alternatives. I think the father will take Bicalutamide as his Doktor recommends and his son asks if he should worry about that.
Check my thread: "An engineer's Bicalutamide maneuvers". YMMV.
ChatGPT said: (check it for accuracy with your doctors)
"Yes, bicalutamide can be used as a standalone treatment for prostate cancer, though it's more common to combine it with hormone injections like GnRH agonists or antagonists (such as Degarelix or Lupron) to achieve maximal androgen blockade. Here are some key points to consider when using bicalutamide monotherapy:
1. How Bicalutamide Works:
Bicalutamide is a non-steroidal anti-androgen that blocks the androgen receptors in prostate cancer cells, preventing them from responding to androgens like testosterone.
However, it does not lower testosterone levels in the body, which differentiates it from hormone injections that suppress testosterone production.
2. Monotherapy Use:
For patients who cannot tolerate or are not eligible for hormone injections, bicalutamide alone may be a reasonable option.
In your father’s case, the oncologist may have opted for bicalutamide to reduce the risk of side effects related to testosterone suppression (e.g., cardiovascular issues or bone thinning) or due to other medical complications.
3. Efficacy:
Bicalutamide monotherapy has been shown to be somewhat less effective than full androgen deprivation therapy (ADT) in terms of disease control because testosterone levels remain unchanged. However, it still provides some level of control, especially when combined with other treatments like radiation.
For a Gleason 9 prostate cancer, which is aggressive, monitoring the effectiveness of bicalutamide will be critical. Regular PSA testing and imaging may be used to track the response to treatment.
4. Side Effects:
Common side effects of bicalutamide include breast tenderness, gynecomastia (enlargement of breast tissue), and hot flashes, but these are generally milder than the side effects from hormone injections.
If your father experiences bothersome side effects, the oncologist may adjust the dose or consider additional supportive therapies.
5. Possible Future Radiation:
Given the involvement of pelvic lymph nodes and the Gleason 9 score, radiation therapy will likely be an important part of his treatment plan down the line to provide localized control and target any remaining cancer cells.
6. Close Monitoring:
Since bicalutamide alone may not fully block the progression of an aggressive cancer, close monitoring is essential. If bicalutamide alone does not seem sufficient, the oncologist might reassess the need for additional treatments, possibly revisiting the hormone therapy option if your father's condition allows.
In summary, while bicalutamide monotherapy isn't as aggressive as full ADT, it can still offer some benefit in managing prostate cancer, particularly if other therapies aren't viable. Regular follow-ups and personalized treatment adjustments will be key to managing your father's condition effectively."
Ask for a second opinion if possible.
Maybe you should check for inherited BRCA genetic mutation in order to avoid the possible development of Brest cancer.
ChatGPT said:
"Testing for an inherited BRCA mutation can indeed be a valuable step, particularly for those on anti-androgen therapy like bicalutamide, which can increase the risk of breast-related side effects such as gynecomastia and breast cancer. The relevance of BRCA mutations extends beyond breast cancer to prostate cancer and other cancers as well.
Why Check for BRCA Mutations?
1. BRCA and Breast Cancer Risk:
BRCA1 and BRCA2 mutations are known for increasing the risk of breast cancer, not only in women but also in men, although it’s less common.
Men with a BRCA2 mutation, in particular, are at an increased risk for male breast cancer, which could be further influenced by treatments like bicalutamide.
2. BRCA and Prostate Cancer:
BRCA mutations are also associated with more aggressive forms of prostate cancer, and men with these mutations may have a higher risk of recurrence or progression.
Identifying a BRCA mutation can influence treatment decisions, as patients with BRCA mutations may benefit from targeted therapies like PARP inhibitors (e.g., olaparib).
3. Bicalutamide and Breast Cancer Risk:
Bicalutamide has been associated with an increased risk of breast cancer in men, though the absolute risk remains low. However, if your father has a BRCA mutation, his risk might be higher than average.
Genetic Testing and Decision Making:
If your father has not yet undergone genetic testing for BRCA1/BRCA2 mutations or other relevant mutations (such as ATM), this could be a crucial step. If a BRCA mutation is identified, the following may be considered:
Closer Monitoring: More frequent breast exams, mammograms, or ultrasounds may be recommended.
Preventive Strategies: In some cases, preventive measures like tamoxifen (which can reduce the risk of gynecomastia and breast cancer) or even prophylactic surgery may be discussed.
Treatment Adjustments: Knowing about a BRCA mutation might also lead to different prostate cancer treatment choices, including options like PARP inhibitors if cancer becomes resistant to other treatments.
Next Steps:
Discuss the possibility of genetic counseling and testing for BRCA mutations with his oncologist. This will help assess the overall cancer risk profile, including breast cancer, and potentially guide personalized treatment strategies.
By understanding his genetic profile, your father’s treatment can be tailored more specifically, and risks can be mitigated where possible."
They could send the biopsy samples for genetic testing.
"Yes, sending biopsy samples for genetic testing is a valuable approach for understanding the underlying genetics of your father's prostate cancer. Genetic testing on biopsy tissue can provide critical insights that help personalize his treatment and manage risks more effectively.
Benefits of Genetic Testing on Biopsy Samples:
1. Identify Inherited Mutations:
Genetic testing of the biopsy can help detect inherited (germline) mutations like BRCA1, BRCA2, and ATM. These mutations can influence not only cancer behavior but also potential treatment options.
2. Somatic Mutations:
Aside from inherited mutations, genetic testing on biopsy samples can also reveal somatic mutations (those acquired in the cancer cells themselves). Identifying somatic mutations can help guide the use of targeted therapies, like PARP inhibitors for BRCA-related cancers or immune checkpoint inhibitors for certain other mutations.
3. Treatment Tailoring:
If a BRCA mutation or other high-risk mutation is found, your father's oncologist may consider more aggressive or tailored treatments. This could include:
PARP inhibitors (like olaparib or rucaparib) if the cancer progresses.
Closer surveillance for breast cancer and other cancers associated with BRCA mutations.
Avoiding certain treatments that might increase the risk of breast cancer, or adding protective measures like tamoxifen to counteract the breast tissue effects of bicalutamide.
4. Precision Medicine:
Genetic testing helps oncologists offer precision medicine—tailoring treatments based on the genetic makeup of the tumor. This ensures that treatment is as effective as possible while minimizing unnecessary side effects.
Next Steps:
Request Genetic Testing: Speak with your father's oncologist about the possibility of sending the biopsy tissue for genetic testing. Many cancer centers routinely offer this, especially for patients with aggressive prostate cancer (like a Gleason score of 9) or those who may have inherited mutations.
Genetic Counseling: If the biopsy reveals important genetic findings, the oncologist may refer your father for genetic counseling to discuss the implications for both his treatment and the potential cancer risks for family members.
By testing the biopsy samples, you can gain a clearer picture of the cancer's genetic landscape, helping to inform better treatment decisions and anticipate potential risks like breast cancer while on bicalutamide."
ChatGPT advice.
If he can't use ADT, but he can use bicalutamide monotherapy, he can probably use a stronger anti-androgen monotherapy (enzallutamide or apalutamide).
Yes, six years ago I did bicalutamide by itself for one year following my successful third treatment, salvage ePLND. The recommended use of daily oral bicalutamide came from my 'European medical team' whereas my US team recommended Lupron and additionaly the Stampede protocol. I listened carefully to both teams and did my own independent reading. One interesting note is that bicalutamide was $1 per day, dispersed by local pharmacies and self-administered; I self-paid as that year I did not meet my insurance deductible. At that time I was an otherwise very healthy and fit 61. All the best for your dad.
There are already a number of very well informed comments on your question.
I would simply add a question and a commentary.
Q) what is his general state of health eg does he have diabetes, cardiovascular disease, obesity etc? This must be taken into account.
C) what does he want? Is it maximising quality of life over quantity? Or balance of the two or whatever. I ask this because once we hit 75 we are “in the waiting room” as it were and more intense androgen control increases other health risks which counterbalance benefits of Ca therapy. Bottom line is that there may be little benefit in terms of overall survival and he should have all the facts about side effects, not a rose tinted view from an over enthusiastic oncologist.
“evidence based” treatment should be tailored to fit the individual.
I did three wonderful years of bicalutamide mono therapy. My T rose. I felt great. Loved PSA<0.1. Now PSA has risen. Biochemical recurrence #3. Late August back on Lupron. Suspect it’s ineffective and will be going with something else after I see the doc in a few weeks. My genetic testing has been negative for accepted PCA markers. But, as a chemist, I’m not surprised my PCA origin is likely environmental. Worked with a lot of nasty stuff over the years.
Hi StaceyMac My 82 year oold husband's story involves several Lupron injections with very bad side effects Unusual lost 15 pounds in 3 months most men gain weight. He is now on Bicaluamide his PSA has dropped well below 1 his only side effect was painful breasts but that has subsided. We follow up everythree months and each month continues to be better.
Best of luck on this journey.
Hello. Dx 12/2014. T3b. Gleason 9 (4+5). Began Bicalutamide. Had radiation to pelvic area but otherwise only Bic till 9/2016 when put on 2 yr holiday. Restarted 9/2018. SABR for oligo met 3/2019, continued Bic till 8/2021. At that point PSA was rising so started Zoladex and Zytiga.
In hindsight it may have been more effective to combine it with something. But I found it easily tolerable. Took Tamoxifen for breast tenderness, main SE. Hope this info is useful. Good luck.
I've been on it (only) for three months. For me, it's a miracle drug (so far). Went from not being able to sleep to sleeping like a baby within two days. Energy returned and I began working out. It's almost like being (what I imagine) on steroids. Muscle mass buildup is akin to when I was completely healthy. (I tested at Gleason 8 with some pelvic mets 6 years ago, but never had it treated until now; why - short version - I was stupid(.
My husband was given that when his PSA started to rise. It did work for a few months but then PSA started to rise again. He is similar age and Gleason score and has bone Mets. So now on doublet therapy which has brought the PSA back down.
I used Bicalutamide as monotherapy successfully (PSA-wise and for my goals anyway) for 6 years. It kept my PSA between 0.6 and 5.0 . My Testosterone levels during that time were always between 1000 and 1200 . Side effects are enlarged breasts and were (now gone) nipple tenderness - both tolerable .
I was taking bicalutamide (casodex) daily with my Lupron (injection every 3 months) for mucho years. Doc replaced the casodex with nubeqa in April 2023. So far my Psa is dropping.....
Good Luck, Good Health and Good Humor.
j-o-h-n
I was on bicalutamide only starting in fall 2020. I didn't want Lupron injections and my doc went along with it. But it raised my liver enzymes after a few months. They continued going up even at a half dose. So I stopped and in Oct. 2021 went on Orgovyx. I'd had radiation in the interim and went a number of months with no ADT before the Orgovyx.
Hi Stacey. I was on bicalutamide for 14 months until I began feeling quite unwell from it. It doesn’t work very well by itself. I would suggest enzalutamide.
yes, 2 yrs on Bicalutimide monotherapy 150mg daily with good results. This is not in a standard of care they will recommend as this drug is off label now but numerous guys on here are doing this protocol. I rejected LUPRON as I did not want the devastating side effects.
Bicalutamide is used as monotherapy in many countries outside the USA. It works best with PCSPES for me and has so for 10 years.
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