HealingWell
Search Close Search
☰

Is there is a casodex and lupron protocol?

Support Forums
>
Prostate Cancer
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 11/4/2011 3:12 AM (GMT 0)

Hi all!

Unfortunately a newbie here. Husband (56 y.o) was diagnosed in Sept, had the DaVinci laparoscopic surgery end of Sept. After consultations, he has decided to go on casodex and lupron. Is there a standard protocol of which med is given first or taken together? I have been trying to figure it out prior to him seeing his urologist again.

On a different note, thank you so much for your wealth of information. I've learned more from all of you than the MDs.

Marcy (wife)

PSA: 5.4 (pre-op)

Gleason: 4 + 3 = 7

Path: 2 positive lymph nodes and tumor focally at margins

Stage: T3aN1M0

PSA 4 weeks after surgery: 0.10

Posted 11/4/2011 3:50 AM (GMT 0)
Your husband seems like a possible candidate for adjunct radiation treatment..Is that part of the plan? Many times, radiation is combined with hormone treatment. Four weeks is a little early to get a true post-surgery PSA reading but 0.1 is a good start..

Many doctors start HT patients off on casodex to suppress the testosterone bounce that can occur after getting a Lupron shot..Once the Lupron lowers the "T" to castrate level, the casodex is discontinued. There is no "standard protocol" with this..Some doctors feel the "T" bounce is way overblown and don't bother with the casodex.."Lupron" comes in several different flavors, made by different drug companies..Eligard is one...

While urologists don't mind taking the money gleaned from administering these drugs, many people in the community feel this job is better left to a medical oncologist who treats a lot of prostate patients and whose training allows much better control of the process and possible suppression of the side-effects that can accompany hormone treatment. You will discover a fair amount of competition between Urologists, Surgeons, Radiation Oncologists and Medical Oncologists for the dollars that are on the table here...This competition is not always friendly..
Posted 11/4/2011 10:59 AM (GMT 0)
Yes, RT will be started some time in January. That's about 4 months post-op. He'll have it for 5/week for 8 weeks.

We're in a HMO, so the urologists are the ones that administer and monitor HT. We have gone outside our plan (private pay) to get Oncologists and Radiation Oncologists' opinions.

Thank you for your response.
Posted 11/4/2011 11:16 AM (GMT 0)
Doxa

Sorry to hear about your husband, also I've very glad you found us. There are a lot of folks here with a tremendous amount of information to share. I found, as did many others, being part of our family here to be extremely helpful in dealing with this PCa.


My medical team at the VA was adamant on starting with the Casodex and being on the Casodex for two full weeks before getting the Lupron.

Just about 1 month after the Lupron shot, the medical team took me off the Casodex. Reasoning for that was to hold the Casodex for if it is needed later when the Lupron becomes (or may become) ineffective.

Other doctors will keep on both - there are valid arguements for each protocol.

I do know of at least one other who started the Lupron without the Casodex and experienced painful flares.

Bud
Posted 11/4/2011 1:26 PM (GMT 0)
Doxa

I saw my oncologist yesterday and he mapped out my HT in extruciating detail. So much so that I think I have already forgotten most of it!!

But for me here it is

We start with Casodex for 28 days (it apparently suppresses a natural Testastorone "spike" cause by the inital injection of Lupron- as your body tries to defend against the Testasterone depletion). After 28 days, its three monthly injections of Lupron (one a month). This Casodex/Lupron combination eliminates about 90% of the bodies testastorone. After the seventh month, I stop and see what happens to PSA as the testastorne level slowly increases onver the next 9-12 months. If it stays level, I"m good for now. If it increases then I do a second of HT.

After that, once PSA rasies again, its  completer ADT, removing the last 10% of tesrtastoren 9I forget the name of the drugs, One starts with a "Z" and the second with a "C" .

After that, there are other non HT things to consider, like Chemo, provenge, ect. To Early to get into that too deeply.

HT side effects apparently suck, but I'll save that for another day or for those who have experieced it already

Posted 11/4/2011 1:54 PM (GMT 0)
I suggest you also ask your doctor about reducing the DHT form of testosterone.   It is far more powerful in feeding the cancer and can be controlled by using Avodart or Proscar.   Proscar is generic and less expensive, but Avodart is more effective.   Normally during the radiation, Flomax is prescribed to offset any urinary complications.

The new drug Jalyn combines Avodart and Flomax.   I have been on it for one year now.   It both reduces T levels to near zero (I am at <3) to help kill the cancer and promotes the urinary health.   The best PCa oncologists (like Dr Snuffy Meyers) are using Avodart as a routine part of the hormone based therapy to remove all the testosterone possible from the cancer.

Posted 11/4/2011 2:10 PM (GMT 0)
JNF, just to clarify, one needs to take Avodart with Casodex and Lupron or in place of one of these meds?

Thanks all for your helpful info and your support. God knows we'll be needing it!!
Posted 11/4/2011 3:41 PM (GMT 0)
Doxa,
The goal of hormone therapy is to get testosorone below 20 and psa to .05. You doctors needs to monitor both of these markers at least monthly to see if the HT is achieving the goal. Cardiac markers also need to be monitored as well as bone density. Most experienced oncologists believe that a combination of Casodex, Lupron and proscar or Adovart, commonly called the ADT3 protocol, works the best to accomplish this goal.
You can consult with a specialist oncologist and have the treatments and monitoring done by your HMO doctor. I would be concerned to have a doctor that is not experienced in monitoring HT treat without the supervision of a specialist oncologist. On this board I have seen too many patients just get a shot of Lupron and not be seen aganin until the next shot is due. This is not the way to do hormone treatment.
JohnT
Posted 11/4/2011 3:53 PM (GMT 0)
Doxa,

The Avodart (5-alpha reductase inhibitor) is in addition as it works on the DHT (dihydrotestosterone) made from the adrenal glands. The other drugs like Lupron and casodex affect the production of the testosterone made by the testicles. The combination of the three drug approach is called ADT-3 (androgen deprivation therapy-3).

It is common to first use Casodex to stop the Testosterone flare of Lupron and other LHRH drugs and add the Avodart to provide the double blockade (T and DHT) to get the lowest possible T levels. Generally the T level must go below 20 and stay there to be considered effective. Lupron alone will reduce the T levels but generally not as low as the combination of Lupron and Avodart.
✚ New Topic ✚ Reply