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Casodex to prevent flare -- how soon

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Posted 11/21/2014 1:27 AM (GMT 0)
I am going to restart HT soon. I remember getting vague information on how soon to start Casodex to prevent a flare. I will be doing Casodex plus Lupron. Last time, I started Casodex 2 weeks before. I am thinking if maybe 10 days this time

Mel
Posted 11/21/2014 2:14 AM (GMT 0)
Hey Mel, this site says 5-7days before Lupron click here, but I have also heard 7-10days before. This flare appears to be of most concern when there is bone mets, but I don't know why anyone would not want to prevent such flare, if they can.
Posted 11/21/2014 2:27 PM (GMT 0)
According to my uro, once you have been on a course of HT, many docs do not use the Casodex to prevent a flare unless there are known bone mets in the spinal area that could cause a compression. This is in line with what Don is saying.

Generally the Casodex is used before the first hit of Lupron. If you haven't fully recovered your T levels a flare is probably not an issue with intermittent HT.
Posted 11/21/2014 4:34 PM (GMT 0)
Ditto, JNF reply. I only took casodex on the initial round. I just stopped taking it on the third round as my PSA is rising and the doctor thought we might get a bump by stopping since I have been on it for a year.

Don
Posted 11/21/2014 5:33 PM (GMT 0)
Guys, maybe I wasn't clear.

When I first started HT, I did Casodex for 2 weeks and then added Lupron. So, I was on Lupron and Casodex for 1 year (three 4-month shots and Casodex every day). My PSA went to undetectable so we dropped everything (well, I did add avodart).
I was on an HT vacation that looks like it is about to end after only 9 months.

So, assuming my PSA goes up next week, I will then be starting a NEW ROUND of HT. My T score was at 10 at the height of my HT, but it has been shooting upwards along with my PSA.
My PSA went from undetectable and it is now, after a few increases, at 2.90. Assuming another doubling next week, it will be time for sure to get back on the hard stuff (Lupron and Casodex)

Meanwhile, my T has gone from the aforementioned 10 to over 300 now. So, the good news is that my PC seems to still be very hormone sensitive.

Let me repeat my question. In this setting, it would seem that I should again start Casodex early. I am thinking 10 days or so. Any thoughts?

Mel

Post Edited (compiler) : 11/21/2014 10:55:57 AM (GMT-7)

Posted 11/21/2014 5:50 PM (GMT 0)
What does your doctor say?
Posted 11/21/2014 5:59 PM (GMT 0)
Surprisingly, neither Dr. Lam or Dr. Hussain pushed for an early Casodex round before Lupron. They both said 1-3 days. But, Dr. Lam was not adamently against it. I guess he thought if it made me feel better, then he will humor me and that's fine.

In short, no strong opinion.

Maybe it's because no bone mets are showing up.

So, it's up to me again and I might as well do the same regimen that worked last time

Mel
Posted 11/21/2014 9:40 PM (GMT 0)
My dad has a similar pattern to you, Compiler. He did Casodex+Trelstar for 1 one year (took the Casodex for a week before the Trelstar). He went on HT vacation for two years, but now his PSA is rapidly increasing, with pelvic lymph node involvement. So, we're back on HT. His urologist said to take Casodex for 7-10 days before his Trelstar/Lupron shot this coming Monday. We've also added Avodart for a triple blockade.

The uro's thinking was there is no need to allow a flare, even if no bone mets. Assuming the cancer is hormone sensitive, it is best to hit it as quickly as possible. So, take the Casodex for a few days before the Lupron.

Arthur
Posted 11/21/2014 11:28 PM (GMT 0)
Dr Lam was a bit maddeningly vague for me about when to start Casodex. He told me "a few days" before starting Lupron. When I asked him what was the definition of a few days he told me it meant "a few days." In my case, I think that ended up being 4-5 days. He did insist, however, that I start it first.

Sorry your HT vacation is coming to and end.
Posted 11/22/2014 12:03 AM (GMT 0)
I was fortunate that even though my uro did not put me onto Casodex first, I had no flare or if there was a flare my PSA decreased from its max of 3.68 to 0.90 on 4-26-13 a month after I started Lupron on 3-28-13.

In retrospect another indication that my bony mets diagnosis by our small town imaging firm was in error, but I did not know that at the time.

Both my second opinion urologist and my medical oncologist at Shands said they would have preferred I had been given Casodex two weeks in advance.

Since I had no flare, my MO was happy to keep the Gleason 9 PCa guessing and not knowing Casodex was yet another tool at our disposal the cancer did not have a chance to develop a work around for.

Sounds like can't hurt, might help, so Mel, why not do the Casodex first, whether that be 4 days, 7 days, 10 days or 14 days, every litter bit helps.

Try not to tear up too much when I see you on New Years eve in Marina del Rey, CA, and no we can't go shoe shopping as I have a plane to San Jose to catch that afternoon.

LupronJim
Posted 6/15/2019 2:47 PM (GMT 0)
I have been on Casodex for 4months after a failed surgery to revoke a prostate cancer tumor on the outside of my Sigmond colon. Was very sick after operation and PSA continued to rise so Dr put my on casodex only to control PSA went from 11.5 to 5.2 in 3 months, now it flared up to 19.2.
Has anyone heard of this happening I have an appointment tomorrow with my oncologist I guess he will start Lupron.
Posted 6/15/2019 6:54 PM (GMT 0)
Here is an interesting article from NCBI https://www.ncbi.nlm.nih.gov/pmc/articles/pmc1476081/. It discusses the flare associated with is luteinizing hormone-releasing hormone (LHRH)-agonist therapy. It further discusses the serious side affects associated with flare inlcuding an increase in bone pain, uremia, etc. So it seems that beginning a course of casodex prior to restarting Lupron is a good idea and should be started between 1 to three weeks. So your idea of 10 days before seems to coincide what medical experts recommend.
Posted 6/15/2019 8:58 PM (GMT 0)
I started on Casodex 3 weeks befor my one and only 6 month Lupron shot. Stayed on Casodex the entire time. No flairs, no hot flashes, no weight gain, none of the other commonly mentioned side effects.

For what it's worth. Good luck!
Posted 6/16/2019 4:32 PM (GMT 0)
Mel,

Doctors Lam and Hussain's indifference to when you start the Casodex is easier to understand if you bear in mind how the drug works. It doesn't lower your testosterone, it just blocks the effects. As long as the drug is established in your bloodstream before any T flare starts you should be fine. On the other hand, if you want to end your vacation with a few weeks of Casodex mono-therapy before you start the Lupron again, that's probably OK, too.
Posted 6/17/2019 1:24 AM (GMT 0)
The doctors' indifference may also be that maybe it mostly doesn't matter if one takes Casodex to prevent flare. I once read a study that found that if a guy has testosterone level of 150 or higher that Lupron does not cause an increase in PSA and therefore presumably doesn't promote tumor proliferation. Sorry, but I can't remember where I read it and I haven't seen any others to support or refute that finding. Personally, since Lupron does take several weeks to start working, once I've decided to start treatment again I'd rather just get on with it and start with Casodex. Plus, since it is known that Lupron does cause an increase in T I'd rather be safe and add Casodex straight away. As I understand it, Casodex has a long half life of about a week so theoretically one would want to start several weeks before the Lupron. But both times I've started Lupron I began Casodex the same day I got the Lupron injection because that's just how it worked out. But maybe it doesn't matter.
Posted 6/17/2019 2:54 AM (GMT 0)
When I restarted lupron, i started casodex a week earlier but stayed on it for a total of thirty days. Then just lupron
Posted 6/17/2019 12:13 PM (GMT 0)
Argent,

I've seen those studies, too -- the ones where they. question whether Lupron flare is even a thing. It does seem that actual scientific evidence for T flare is rather thin on the ground. There is a general perception that the anecdotal evidence is more compelling than the actual studies suggest but everyone is so worried about flare (and casodex is such a relatively-benign drug) that there aren't many doctors willing to test the theory on their own patients.

Here's a link to a recent survey of the literature on flare. Risk of Testosterone Flare in the Era of the Saturation Model: One More Historical Myth. It's fairly new so it's probably not the one you saw. Maybe it was this one from four years ago: Risk of disease flare with LHRH agonist therapy in men with prostate cancer: myth or fact?
Posted 6/20/2019 3:46 PM (GMT 0)
Met with Oncologist on Monday tumor size on outside of sigmoid colon increased from 3cc to 4cc in 8 weeks. Told me to finish the last 5 pills of Casodex and gave me a 3 month Lupron shot. I need To go back in 7 weeks to see if it is working to lower my PSA he told me on average works from 2 to 5 years. Has anyone heard of Nano Knife where they go in with needles to kill cancer cells?
Posted 6/20/2019 4:48 PM (GMT 0)
Jerry,
When you say “Oncologist” I wonder if you’re referring to a Medical Oncologist with lots of PCa experience? If so, did he/she discuss adding Zytiga or Xtandi to the Lupron very soon? If not, I would encourage that discussion because the addition of either of those drugs early gives a significant advantage over Lupron alone.
Posted 6/20/2019 7:09 PM (GMT 0)
Thank you for the information I will definitly talk to my oncologist regarding adding it to my Lupron. He deals mostly with Prostate cancer.
Posted 7/5/2019 8:29 PM (GMT 0)
Well been onLupron for 3 weeks so far hot flashes a few times a day. I continued the bleeding when I urinate my urologist decided to do a urine culture came back I has a UTI went on Cipo for a week bleeding stopped but today their was a small clot of red blood. Not sure if it is still the infection or just the radiation cystic. If it keep up I will call the doctor next week. Go for my first PSA a week from tomorrow since being on the Lupron he said he did not want to add anything else to the Lupron at this time.
Posted 7/5/2019 11:56 PM (GMT 0)
Jerry,
I'm still not clear who is directing your ADT. You mentioned you have an oncologist but in your most recent post you only mention your Urologist. In any case, if I understand correctly, you're having a recurrence since having surgery and RT a number of years ago. The standard of care now has moved to adding Zytiga or Xtandi to the Lupron. Of course I'm no doctor and maybe yours has good reason for not doing so. The Lupron will likely do a good job of bringing your PSA down.

Good luck with your upcoming PSA test!
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