Bicalutamide & Dutasteride for keeping localized PCa stable during AS

[Maximode]

Has anyone used Bicalutamide & Dutasteride for keeping localized PCa stable during AS?

[Tall_Allen]

That defeats the purpose of AS. Try exercise instead:

prostatecancer.news/2022/06...

[Maximode]

Trying not to split this into to two post, let me clarify the question: If anyone has experience on Bicualutmide & Dutasteride, rather they are on or off AS, for localized PCa? In this post, I'm not really looking for recommendations or opinions if one should, just if anyone has experience with it, thank you!

[Justfor_ in reply to Maximode]

I have experience at a later stage (post RALP and BCR) if interested.

[Maximode]

I'll use this post to chronicle my journey into this. At the moment I am 17 days in with a drop in PSA from 10.8 to 4.7. Even though this is not AS, I have diminished faith in the healthcare system to work with people that want to keep PCa stable and just find a balance in living with it vs "curing" it.

So here's my approach (my profile has the previous 2yrs of history):

I started with a PSA test and Bicalutamide (Bic) and Dutasteride (Dut) on 10/28/2024.

10/28/2024: PSA 10.8

10/28/2024: Start Bic 100mg Dut .5mg

11/08/2024: PSA 6.4

11/08/2024: Increase to Bic 150mg Dut .5mg

11/14/2024: PSA 4.7

I will retest PSA in 30 days and stay at dosage Bic 150mg Dut .5mg

Bic/Dut sourced outside of GP SOC.

MRI scheduled for Jan 2025 to track progress then infused biopsy.

I plan to take a similar approach to finding the right dosage of Bic once/if things stabilize.

Thank you   Justfor_ for the priceless information on your journey, it was the genesis of this.

[Maximode]

History of PSA test

PSA Chart

[Justfor_ in reply to Maximode]

Thank you for your kind words. In the attached table I have entered your PSA time series (up to the point when you started taking Avodart and Bicalutamide) to get a grasp of your doubling time. The results of this number crunching make me confident that your case is anything but "aggressive" i.e.:

PSADT of almost 3 years overall and if we ignore the first 6 entries and start from Feb 15 2023 (min of 5.7) PSADT shrinks to 26 months, a more representative picture as you state "Major lifestyle change" from Oct 2022 onwards. Another thing to be noted here are the regression coefficients of the linear and log curve-fittings, the linear being a bit closer to 1.0 than the log, but for all practical purposes both being the same. In "aggressive" cases the linear model eats the dust of the log one.

Based on the above observations, I think that you can get some idle PCa progression time out of the combo Bicalutamide plus Avodart. I only find your intended Bicalutamide dosage (100-150 mg/day) hugely exaggerated. Decide on some target PSA value and just take as much as needed. More isn't better. Finally, don't delay doing something against gynaecomastia that will eventually set in if you do nothing. Good luck and keep us posted.

Maximode 2024

[Maximode in reply to Justfor_]

Wow, very generous of you for this. I'll continue to refine my approach and research a reasonable path forward with a much lower dosage. And I understand I am only buying a little time before the inevitable "curative" treatment. Based on the research that is out there, it looks like it is only effective at reducing PSA by 50% - when not doing other things to kill the cancer.

My basic view on this particular doublet in my situation is:

- A treatment option for delaying disease progression

- Part of a multimodal approach rather than a curative treatment

- A bridge to or supplement for more definitive therapies

It's just better than sitting and waiting on AS for things to get worse, I wish I had this option two years ago, or even better when my GP said there is nothing to worry about when he said my PSA was at 4.5. I didn't know that was a thing way back in 2020, smh at how smart we think we are as we get older.

[Justfor_ in reply to Maximode]

The 50% is for Avodart alone, but it takes months to get there due to the long half life of it. Your PSA has declined from 10.8 to 4.7 within just few weeks and this must be attributed mainly to Bicalutamide. So, you will see further decline with time. IMO the danger is that you may be carried away for lower and even lower and by doing this your cancer cells will be forced to evolve to something else (more durable). Off the top of my head I would feel comfortable with a PSA between 1 and 2, translating to 2 to 4 without the Avodart halving. Don't they say: Abuse it and loose it.

[Maximode in reply to Justfor_]

My thoughts were going there as well, where is a nice balance to slow down to, so that it stays hooked and doesn't switch/evolve (to your point above and your long running post). Honestly, if I can get to slow down to 1-2 PSA and stay there using interval dosing, and continue to monitor it through PSA test and MRI, I would consider that a win (die with it than of it). I'll slow down the ride and back off the dosing and report back over the next weeks, thank you very much!

[mchale in reply to Justfor_]

my 2 cents about Avodart, its used for BPH and off-label for hair-loss which I've used for 20 years....I was told to double your PSA number for a true reading. So I was .70 for years then 1.2 for the next 12 years then boom 2.0-2.5 two years ago which started my journey...my real PSA was 4.2-5..... Using Avodart to bring down your PSA number in half buys you nothing unless you have an enlarged prostate. To complicate things Bicalutamide has already halfed your PSA, waiting a few months for Avodart to kick in doesn't do anything but mask your PCa.....does lowering your DHT and increasing your T levels slow prostate PCa......

[Justfor_ in reply to mchale]

I care less about the absolute value of my PSA as long as it is in the low measurable range and have it stabilised. My latest PSA was 0.008. Double it you like to 0.016. Does it make any difference for you? Not for me surely

[mchale in reply to Justfor_]

I think you really missed the point of what I was trying to say....Good Luck wish you the best

[mchale in reply to Justfor_]

Exactly my point well stated......

[fast_eddie]

Are you sure about that dutasteride dosage? My bottle says 0.5 mg, not 0.05. I was put on dutasteride when my PSA hit 3.2 8 years post HIFU full ablation. My last PSA reading, while on dutasteride, was 1.3. I recently talked to my new urologist (previous one left the practice to move out of state) and asked him if I really needed to take it. It does diminish libido and may have other undesirable effects. He is OK with me moderating my use of it or coming off of it altogether. My PSA will continue to be monitored.

[Maximode in reply to fast_eddie]

Good catch on the Dutasteride, I corrected it to .5mg. I imagine I’ll have some kind of SOC treatment in the future (“tumor kill phase”).

[janebob99]

When my PSA reached 10, I started taking Dutasteride monotherapy. After 5 months, my PSA dropped to 2.6 on Dutasteride alone. I definitely believe it buys you time, with minimal side effects.

[mchale in reply to janebob99]

IMHO and in all due respect Dutastaride doesn't buy you time, its just masks your PCa, your real number is higher double or maybe more....actually if you believe DHT not T fuels PCa then it might buy you time...the jury is out on that.....Avodart lowers DHT dramatically and increases your T levels!

[janebob99 in reply to mchale]

In my humble opinion (remember, I'm not a physician), Dutasteride has been reported in placebo-controlled trials to actually shrink PCa tumors by more an average of 30% over 6 months, compared to an average increase in tumor size of 17% in the placebo group (as measured by MRI Scans). That is much more than a "masking" effect...it's a real, physical effect on tumor size. Dutasteride also shrinks prostate volume by 50%, which accounts for at the average 50% drop in real PSA.

There is no "masking" effect. That is an unproven, unsupported, and out-of-date belief.

It is well accepted that DHT is 10 times more potent than T.

I've read at least one paper that says Dutasteride buys you more time because it significantly shrinks tumor size. That is makes sense.

Yes, there is a slight (10-15%) rise in T levels, because there is less enzymatic conversion of T to DHT when taking Dutasteride. But, the big effect is a 90-95% drop in DHT levels, which has a huge impact on PCa growth rates.

Multiple, large controlled trials have shown that Dutasteride cuts the rate of PCa by at least 30% on average (range = 20 - 50 % decrease).

If you send me your email address to [e-mail], I will send you links to 20+ scientific studies that support what I've read.

I'd be more than happy to review any scientific studies that disagree with what I've said.

[mchale in reply to janebob99]

Bob,

I've been on Avodart since it's release date November 2001 for hairloss but the blackbox warning always concerned me...... "may increase the risk of developing high grade prostate cancer".....that always sacred me so I started getting tested for PSA for almost 25 years now. I was afraid maybe this caused my PCa when I was diagnosed this year.

fda.gov/drugs/drug-safety-a...

I just saw recently in a Dr Scholtz video that the reason that black warning was originally posted was they were finding more aggressive disease in men on Avodart. The simple reason was that Avodart shrank the prostate so during random biopsies more disease was caught with sampling because of smaller prostates, not that it caused aggressive disease.

Yes I agree and I'm well aware with everything you just posted, DHT is the evil twin of T much more potent and implicated in prostate cancer along the rise in estrogen.

My T levels are very high for a man in his 60's between 750-800 which I attribute to Dutasteride, I use an aromatase inhibitor to keep my estrogen levels low.

Sadly I still developed PCa, you would think I would have avoided this curse.

I should be a poster boy for Dutasteride to prevent PCa, been on it for 24 years

Starting SBRT Monday on the Electra Linac at MSK.

I'll email you!

Best,

john

[janebob99 in reply to mchale]

Yes, the black box warning (which doesn't exist in the UK or Europe) has been throughly debunked in subsequent studies and papers. (I can send you many papers about that). So, Dr. Sholtz is correct.

Dutasteride raises T only 10-15%, compared to no Dutasteride.

I'm curious why you want your estrogen levels low? The PATCH phase-III study demonstrated that men can replace Lupron ADT with Estradiol ADT, and get the same PSA control due to low levels of T (i.e., chemical castration).

What is your PSA history?

Bob in New Mexico

[Justfor_ in reply to janebob99]

I am the exception to your 10-15% statement.

Before starting Avodart my T was 866 (N=3, σ=60) and afterwards 1169 (N=12, σ=134) that boils down to a rise of 35%.

[janebob99 in reply to Justfor_]

The bottom line is what your PSA is doing...

Have you had your DHT measured?

[Justfor_ in reply to janebob99]

We have been through that before. No need to reiterate. Just posted so that you don't take everything you read on papers as curved into stone.

[mchale in reply to janebob99]

My PSA has been steady for the first 20 years, .70 for 5-7 years, then 1.2 steady 15 until it jumped to 2.0 in 2021 when it all started to go south....MRI showed PIRADS 1,

PSA stayed stedy from 2.17-2.6 the last three years then jumped to 3.2 last November, but I had a UTI, urologist ordered up another MRI, PIRADS 4, biopsy found two cores 3=4, 4+3, PSA 2.17 6 weeks after biopsy, now it jumped to 3.4 last month. All those numbers need to be doubled as you know due to Avodart.

My MSK pathology downgraded 4+3 to 3+4 and the other core is also 3+4, 20% and 35% GG4. I also have 3 cores 3+3 Gleason 6