Prostate Mass

[Iber]

Hello. We received disappointing news today regarding my husbands health. He just finished his docetaxel treatment and we were pleased by the drop in his PSA from 900 to 6.2, however, he began experiencing pain while urinating and was constipated. Scans today found a large mass around the prostate and we are waiting to see the oncologist tomorrow to see if we have any options.

We are devastated by this and are looking for words of advice.

[GP24]

The hormone therapy will cause the mass to shrink and probably allow to radiate it. It is recommended to combine the triplet therapy with RT. See the PEACE-1 trial.

[GP24 in reply to GP24]

I know a patient diagnosed with Gleason 10 and large extraprostatic mass. He had trouble urinating and constipation. His doctor did not want to touch him and arranged an appointment with a specialist in several weeks. I gave him Casodex and a week later he told me I am a happy man, no more trouble urinating and constipation. I was surprised.

[Iber in reply to GP24]

Thanks for the response. My husband has taken casodex and is on a triplet therapy. This prostate mass was just diagnosed following his chemo. We are hoping he has another option.

[GP24 in reply to Iber]

I did not want to recommend Casodex instead of Nubeqa. Just illustrate how effective ADT can be in shrinking tumor mass.

[Seasid in reply to GP24]

I am curious what was the daily dose of Casodex?

[Iber in reply to Seasid]

I’m sorry we can’t remember.

[Seasid in reply to Iber]

I actually asked GP24

[GP24 in reply to Seasid]

150 mg per day. For flare protection before Lupron you would use 50 mg per day.

[Seasid in reply to GP24]

I am aware of the official dosing in Europe it is 50 mg in Japan it is 80 mg because of the difference in the metabolizing Bicalutamide between different populations. That is the approved dose with ADT.

I just wanted to know with that very successful of the dose of 150 mg per day did you use ADT in parallel on your particular situation to which you are referring above? I assume not.

[GP24 in reply to Seasid]

I take 150 mg per day and gave him some of my pills. He got no Lupron injections. Dhccpa reports the same result below.

[Seasid in reply to GP24]

I am taking 100 mg of bicalutamide per day with degarelix ADT injections at this moment.

[Seasid in reply to Seasid]

It is not an approved dose but I have the official approval from my medical oncologist.

[dhccpa in reply to GP24]

I had casodex in 2018 before changing to Lupron. Within a day of starting, my urination went from a year-long trickle to a waterfall! I always appreciate casodex for that reason. Too bad US doctors don't strategically use it more often.

[Seasid in reply to dhccpa]

What was your Bicalutamide dose?

[dhccpa in reply to Seasid]

I don't remember. I was on it six weeks. I'm sure it was an ordinary "bridge to Lupron"-sized dosage.

[Seasid in reply to dhccpa]

Most probably.

[Seasid in reply to dhccpa]

They are using it also in the USA. You should just ask.

[dhccpa in reply to Seasid]

I suspect "they" is a tiny minority of doctors, not the vast majority. Except as a transition to ADT like Lupron.

But I will ask my oncologist again. I am unaware of any downside.

[Seasid in reply to dhccpa]

I believe j-o-h-n was on bicalutamide for some time before switching to Nubeqa.

[Seasid in reply to Seasid]

And in a Jewish hospital in St. Luis someone was on bicalutamide plus ADT for some time and when stopped with Bicalutamide the cancer was down for 2 years. This could happen to only about 15 % of people on bicalutamide.

[Seasid in reply to dhccpa]

I am not suggesting that you go on bicalutamide, but some people from Canada added Bicalutamide to ADT when the PSA was 1. In 5 months on bicalutamide plus ADT the PSA dropped to 0.2 and in 14 months the PSA went black to 1 again. After that they switched to Abiraterone plus prednisolone and they are on abiraterone plus prednisolone for years with only 2 small Mets showing up.

[Seasid in reply to Seasid]

Which could be radiated with SBRT irradiation.

[Seasid in reply to Seasid]

Here is the Bio:

Bio

From Vancouver Island, British Columbia, Canada. 🇨🇦

Diagnosed July, 2018 at age 55. Stage 4 prostate cancer. Gleason 9. Mets to lymph nodes, pelvis, spine, ribs.

No family history of cancer. Cancer discovered as a result of a military medical doctor requesting a baseline PSA test. It was my first PSA test; I had passed all previous biennual DREs. The result shocked us with a PSA of 103.0.

July 2018 - started ADT (Zoladex) and six rounds of docetaxel.

Slow PSA decline to nadir 0.17 after one year.

Slow PSA increase to 1.0 during the next 18 months.

February 2021 - added bicalutamide.

PSA decline to nadir 0.10 after 4 months

Slow PSA increase to 1.0 during the next 15 months.

September 2022 (over 4 years since diagnosis) bicalutamide was stopped and abiraterone started.

Scans in April 2022 showed no visible bone mets. Testosterone level is currently <0.2 nmol/L. Bone density scan shows signs of osteopenia.

July 2023: PSA continues to slowly decline since I started abiraterone 10 months ago. Today it is 0.014. Testosterone is undetectable. No visible bone mets.

July 2024: Six years since diagnosis. PSA remains low (<0.03) but is rising slowly. CT scan may show some growth in my spine. We will repeat the scans in the fall. I am doing remarkably well and consider myself very lucky.

I haven't made many changes to my lifestyle. I have always eaten a fairly health diet with lots of vegetables and less processed food. I still enjoy red meat and dessert on occasion. Moderation is key. I have a few drinks on the weekend. I go for walks, bike, swim, garden, chop wood, go curling, etc. but I don't actively work out in a gym.

[dhccpa in reply to Seasid]

Very good. I'll ask my MO to consider it. Might be a good compromise to starting on a "heavier" drug.

[Seasid in reply to dhccpa]

That was also my idea. Start with 50 mg per day.