Avodart question

Unfortunately there is no generic for Avodart so you're stuck with your insurance company's price.

Are there studies that show the effectiveness of Avodart after failed prostatectomy? Are there many doctors besides Dr. Myers that recommend its use? When I asked the doctor, he said it artificially lowers the PSA but does nothing to improve the cancer situation. I realize there are differences of opinion to this but is there a way to look at analytically?

Are you taking it for urinary issues or some other reason? After your successful salvage radiation, I can't see any PC-related reason that has any evidence to it. Finasteride (generic) is cheaper. If you have urinary issues, there are other drugs that may work better.

BB,

I'm on the same program using Avodart in the off season. I'm not messing with the plan either....at this time.

Jerry

Below is a summary of a video Dr. Myers did on DHT, Avodart, and Prostate Cancer.

This is long but worth the read, in my opinion. I haven't yet found the original video.

Dihydrotestosterone (DHT), Avodart, and Prostate Cancer

Avodart is a synthetic 4-azasteroid compound that is a selective inhibitor of both the type 1 and type 2 isoforms of steroid 5 alpha-reductase, an intracellular enzyme that converts testosterone to DHT. DHT is ten times stronger than testosterone.
The goal of Avodart is to lessen the conversion of testosterone to DHT. It doesn’t do anything else. That’s all it does. The test for DHT is available. So why don’t doctors and men have it included when the PSA, testosterone, and other blood work is done? Avodart works about 90 to 95% of the time. Proscar only works about 70% due to the fact that it blocks only Type 1 of isoforms of steroid 5 alpha-reductase.
It is uncommon for prostate centers not to include the DHT test when testing testosterone levels. However, many Urologists and other clinicians do not include the test which is a real mistake.
Lupron and related drugs lower testosterone but can often have no impact whatsoever on DHT. The machinery for the conversion can accommodate lower testosterone and still find enough testosterone to scavenge to maintain normal DHT range of 30 – 60. Some men have DHT 200 or higher. Prostate cancer knows about the absence or presence of hormonal therapy because the androgen receptor binds to DHT and that complex migrates to the nucleus of the prostate cancer cell and binds to the DNA and turns on the genes involved in the growth and spread of cancer. IT IS DHT NOT TESTOSTERONE THAT DOES THE JOB. So, in the cancer cell, no matter what is going on outside in the bloodstream it’s the DHT that governs whether the cancer grows or not grows.
Clinicians are not focused on DHT but rather testosterone so they typically don’t test DHT levels and just administer Lupron or a related drug to reduce testosterone. If Avodart doesn’t lower DHT it is because Avodart can be destroyed by a pathway called CYP3A4. People may have high or low levels of this enzyme. So, if one Avodart a day doesn’t do the job, one option is to take the Avodart with grapefruit juice to prevent liver destruction. However, you should not use grapefruit juice if on a statin.
The ability to convert testosterone to DHT varies genetically enormously. Some people hardly do it at all and others overdo it. Again, the normal range for DHT is 30 – 60. The goal is <5. You really need to pay attention to the detail as in the case of DHT. The other implication of Avodart is its half life. If you want to quickly reduce DHT dramatically, you can take 3 pills the first day and you’ll be therapeutic in 2 – 3 days. Otherwise, it can take a month or more taking 1 pill a day to reach the therapeutic level. Once the level of DHT is <5, then you taper the Avodart down to maintain the <5 level. For the average patient, it is 2 to 3 pills a week and in some, 1 pill a week to maintain proper suppression.
Avodart can cause breast enlargement because testosterone goes up even 25% or more which in turn is converted to estrogen. This can be controlled by giving Cabergoline, Femara, or Rimidex.

Robert

Time101 has referred to the video I recall. Since he says he has not found it as of his writing I will just say that I remember the video and that after low DHT has been achieved that Myers has approved his patients moving to one Avodart every few days or even once a week to maintain the DHT level. This would lower your costs significantly. If you are a Myers patient and this is an issue then I think he would agree to such a move especially since he is likely seeing frequent lab reports for you and any change will be detected promptly

I'm on Myers Avodart plan too. My total T was 532, DHT 29 in the pre-test. A month later T was 670, DHT 3. Myers wants it below 5. The next month, T was 400, DHT <1 (and PSA dropping). Last month T was 530, DHT 2. Myers said T can actually go up when on Avodart, but DHT goes down.

I think they are strongly linked. DHT is a product of T metabolism. There are other androgens responsible for DHT, but T is the main one. So when there are castrate levels of T, the only sources of DHT are those minor androgenic steroids. Blocking the enzyme, 5-α-reductase, that metabolizes T (and other androgens) into DHT, with finasteride or dutasteride, results in an accumulation of T.

This use is off-label. The only FDA-approved use is for treatment of BPH. They have refused to approve its use in the prevention of PC because of concerns (unfounded, in my opinion) that it raises the risk of high grade disease. They have not approved it for use in high grade PC. Sometimes insurance companies give oncologists leeway in treatments of incurable cancers. For men with intact prostates, the doctor can note that it's enlarged and get coverage for his Rx.

- Allen

JNF

Isn't DHT is a by product of Testosterone?

The amount of dihydrotestosterone present in the body from day to day depends on the amount of testosterone present. When levels of testosterone increase, more of it is converted to dihydrotestosterone and so levels of dihydrotestosterone therefore also increase as a result.

I don't understand how they are separate, I think I read that their are men who can produce DHT with low levels of T.

I have not discussed this extensively with our oncologist yet, it was briefly mentioned during our visit for one the HT shots.

BB

Great seeing your news. So happy that things are going so well for you.

Cajun Jeff

BB no advice on the avodart. Just wanted to say nice to see an update from you.
All the best, and here's to pulling zeros!