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!

[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.