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Looking for expertise in Casodex (bicalutamide) monotherapy

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Posted 9/1/2016 10:15 PM (GMT 0)
Hi all,

I am very interested in educating myself in Casodex monotherapy. Do any of you know of particular physicians in the U.S. or elsewhere that are known as experts in this approach?

I would also be interested in any studies that discuss this as well. Here is one I found that intrigued me: https://www.hindawi.com/journals/criu/2015/928787/[url]

It seems to be a very popular treatment in Europe but not in the U.S.

Thank you!
Posted 9/1/2016 11:44 PM (GMT 0)
How about posting your signature so we know where you stand? What is your cancer diagnosis and what treatment have you had so far?
Posted 9/2/2016 8:41 AM (GMT 0)
This is for my husband who will be finishing his first round of Lupron in about 6 months. We are researching ways to potentially keep things in check post Lupron.
Posted 9/3/2016 4:11 AM (GMT 0)
I just started monotherapy here in Japan in March of this year. Dr. Charles "Snuffy" Meyers mentioned using monotherapy with Casodex on an elderly patient who he thought would not tolerate the side effects Lupron. Usually, he prefers to prescribe a two-punch approach, Lupron + Casodex, as just one example. Other than this, in my own research I have not come across many references to monotherapy, also called "step therapy".

My doctor explained to me that monotherapy starts with a drug like Casodex and once the Casodex fails, the treatment is "stepped up" with a stronger drug like Lupron. Your husband is already taking Lupron, and for him, monotherapy with Casodex seems to be a step backward.

By all means, consult with your doctor about the feasibility of starting monotherapy at this point in your husband's treatment.
----------------------------------------------------------------------
No symptoms prior to dx.
2013/08 Routine blood test revealed high PSA of 12.7. DRE negative.
2013/11 Transurethral bx revealed cancer in 7 of 21 cores. Staged T2c (DRE negative), Gleason 7.
2013/12 2nd opinion upgraded one core Gleason 7 to Gleason 8. Surgery scheduled same day.
2014/02 Robotic RP, Tokyo Medical University Hospital. Catheter removed 8 days later.
2014/03 Post-op path report confirmed Gleason 8 and revealed up to 7 tumors ranging Gleason 6, 7, 8. Seminal vesicles and both pelvic lymph nodes removed and dissected, both vesicles and nodes were negative for any sign of cancer. One margin suspect (pathologist could not decide if it was positive, so it was judged “to close to call.”). Right nerve bundle was taken, left nerve bundle spared. Final staging T2cM0N0. Good recovery from stress-urinary incontinence after 6 weeks, pad free after two months post surgery. ED remains a problem.
2014/08 Hospitalized again to repair large hernia at ventral incision above the navel.
2014/09 PSA levels (tested every 60 days since surgery) 0.1, 0.1, 0.1, 0.2, 0.3.
2014/09 Started SRT (EBRT), 30 sessions (6 weeks), 2 gy per session. After third week of SRT, PSA dropped from 0.3 to 0.2. PSA reading after SRT on 27 Oct: 0.2
2016/08 PSA continued a slow but steady rise over 18 mo. from 0.2 to 2.0. Finally, started HT monotherapy with Casodex in Mar. 2016. PSA dropped from 2.0 to 0.3, to 0.1, and finally to <0.1
Very pleased with the reaction to Casodex, but how long will it last?

Post Edited (Yank31) : 9/6/2016 4:52:58 AM (GMT-6)

Posted 9/3/2016 5:42 AM (GMT 0)
Hi Peanut,
Your MO started casodex prior to IT, and I haven't seen that before. The early chemo was probably a good idea. I am curious as to why your DH is going off lupron since it appears to be effective. My DH did quite well on survival for a long period, so perhaps that would be a good next option if the psa creeps upward. Best wishes in finding the best tx.
Beth
Posted 9/3/2016 8:07 AM (GMT 0)

peanut307 said...
This is for my husband who will be finishing his first round of Lupron in about 6 months. We are researching ways to potentially keep things in check post Lupron.

I don't understand. The website you referenced doesn't seem to have anything to do with your husband's situation. It's about a man who had a recurrence after a prostatectomy and was treated with an intermittent antiandrogen, having refused salvage radiation. In contrast, your husband had potentially curative radiation+ docetaxel+ Lupron as a first-line therapy and has not had a recurrence. He has only had 6 months of Lupron so far. I assume he will have at least a year more of Lupron, and when that is done, you will be able to see if he has been cured.

Why are you asking about Casodex if he has been cured? What am I missing?
Posted 9/5/2016 6:55 AM (GMT 0)
Hi Peanut307,

I have been on Casodex mono therapy for the last two years. In 2014, when my PSA started to rise, my MO started with 150mg daily Casodex and PSA dropped from 0.8 to 0.02 in a month. Then my MO decreased the dosage to 50 mg/day. Due to breast swelling and tenderness I started Tamoxifen in May 2015 (20 mg daily in the first month, then 10 mg). After starting Tamoxifen, my testosterone decreased continuously, from 566 to 125 in 6 months. We don't know if this testosterone decrease is related with Tamoxifen usage or not. My MO wanted to see how PSA and testosterone will react with no medication, so I stopped taking Casodex and Tamoxifen for about 4 months. Testosterone level recovered but PSA started to rise as expected. So we started Casodex again, with a new dosage, one 50 mg tab per week. It was not enough, so Casodex dosage was increased to two 50 mg tabs a week. Because of the breast swelling and tenderness, I started Tamoxifen 10 mg as well. So we'll see if testosterone will start to decrease again or not and wher PSA will stabilise. Anyway, my PSA is at 0.25 and testosterone over 500 after 9 months of intermittent Casodex mono therapy. I added up all the Casodex tablets that I've taken during this 9 month period and it's only 24 tablets (50mg tabs). So it seems for me, there is good response to Casodex therapy. And the only side effect is breast tenderness and swelling and it can be fixed with a daily 10 mg Tamoxifen tablet.
Posted 9/5/2016 7:00 AM (GMT 0)
Please see the attached graph showing blood test results in 2016

/www.keepandshare.com/doc20/11160/blood-test-results-august-2016-pdf-94k?da=y
Posted 9/5/2016 7:03 AM (GMT 0)
Hi Yank31,

Are you taking 50 mg Casodex daily?
Posted 9/5/2016 9:43 AM (GMT 0)
Traveller58

Yes, I am taking 80 mg of Casodex daily.

I have been on monotherapy with Casodex since late March 2016.

Since then, my PSA went down rapidly from 2.0 to <0.1. I cannot be more precise because the hospital does not use the double-digit assay test.

I have experienced some breast tenderness and swelling (not much that anyone would notice!).

No hot flashes, luckily. Some fatigue, but bearable. I try to exercise daily and watch my diet.

Hang tough, there, Traveller
Posted 9/5/2016 9:17 PM (GMT 0)
Sorry I've confused everyone with this line of inquiry. But what I'm doing is looking down the road at possible treatments. My husband has been on Lupron for almost a year now and will be for at least 6 months longer. He wants off of the Lupron eventually. What I am saying is that there will come a point when he is done. And it is possible that his PSA could eventually start to rise again. So why not, as Traveller58 has done, try treating with Casodex.

Tall Allen . . . you ask why I'm asking about Casodex if my husband has been cured?? If you've looked at my husband's stats, you will have to admit that the odds of him being "cured" are very low. We know that it is extremely likely he will have a reoccurence at some point. I'm just trying to educate myself of the options that will give him the best results and the best quality of life if and when this happens.
Posted 9/6/2016 2:38 AM (GMT 0)
peanut-
If he didn't think this would cure him (and I agree the odds are against it) he wouldn't have undertaken these therapies. I think you have to live with that hope for now. It doesn't help you in any way to imagine dire scenarios that are completely irrelevant to his current situation. It is a source of anxiety to do that. Much better to regard him as cancer-free at the end of his curative therapy, until proven otherwise. After 18 months of Lupron and SRT, it may be a while before you will be able to know if it worked. If it turns out later that it didn't work, you will deal with it then based on whatever knowledge is available at that future date, and may not be available now. The options can change rapidly. It helps him not one iota to go through this in your head now. I think you have much to lose from your anxious deliberations and absolutely nothing to gain. Anything that keeps you from fully appreciating the present moment is a distraction from authentic living.

- Allen
Posted 9/6/2016 8:36 AM (GMT 0)
I agree with what TA said but I understand you peanut, because I'm like you too. I also want to get educated and prepared when there is no time pressure so that if and when it happens I'll not panic. But I learned that it doesn't work like that.
When I had PSA recurrence back in 2014, I had a Ga68 PSMA PET/CT and the report showed a 1.1 cm lesion at the prostate bed. It was a shock as I had IMRT to the prostate bed after surgery, and I was not prepared for this! MY RO, Dr Zelefsky at the MSKCC was not convinced with this finding and asked me to do a biopsy. The biopsy was done at the Heidelberg University and it was negative. I met with MO's and RO'S (I guess the number was 10 doctors or more) in Istanbul, Heidelberg and NY.
So my point is you may never get prepared against how the disease will progress. It's ok if you educate yourself but this should not keep both of you away from enjoying life.
Casodex mono therapy is working for me, at least for now. I think you can not find an expert in this approach as it is not the standard of care in high risk advanced pc cases. I believe the doctor should be very experienced in managing this disease and should feel confident to try different approaches.
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