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Does it make sense to stay on Casodex during Lupron vacation?

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Posted 2/21/2017 2:27 AM (GMT 0)
Hi

Husband just saw Onc today (vs Urologist) for first time since last March. The Onc ok'd Lupron/ADT vacation considering husband has been on ADT for approximately 18 months. He said let's clear the drugs and see if there's been a cure or if the cancer reemerges. He also said if PSA hits .5 or above he needs husband to come back.

I asked him if we could/should stay on Casodex during the time off Lupron so that if testosterone decides to creep up at least the Casodex would block the effects. He said "no, stop Casodex now. Casodex doesn't matter" But I really still don't understand the reasoning!

Can someone please explain?
Posted 2/21/2017 2:55 AM (GMT 0)
If it stabilizes around 0.5, that would actually be a decent out come from his treatments. Long term control from radiotherapy hanging around 0.5 is pretty good.

It will go up some as his testosterone recovers. You'll want to check testosterone and PSA both, to monitor the rise of both of them.

The PSA pattern in this situation is rather unclear. Good to chat with the oncologist if you see 0.5, but don't push the panic button yet. Actual recurrence has been accepted around a rise of 2 points above the lowest value seen, including on hormone therapy.

I'm in that spot right now. In March, I get my next PSA, and it will be quite indicative of where I am. If it's still about 0.5, then cool, we do nothing and check again in 3 more months. If it's .85, 1.0 up in that range, then we get more concerned and maybe even consider follow up options at that point. It's unclear, but if my G9 is that active, I'm more interested in doing something than not.
Posted 2/21/2017 4:49 AM (GMT 0)
No, it makes no sense to stay on Casodex. That would defeat the purpose of coming off ADT, which is to see if the radiation cured him. This is not a "vacation" - it is the potential completion of his therapy.

If your husband is not convinced that 18 months of adjuvant ADT is enough, he should stay on Lupron. But there is some data that 18 months is as good as 3 years, so this is probably enough.

If it did not cure his PC, it will only be a vacation before he has to go back on it.
Posted 2/21/2017 9:47 PM (GMT 0)
Moreover, wouldn't it be nice to keep Casodex 'in reserve' for any future developments?
Posted 2/21/2017 10:38 PM (GMT 0)
Great points by all.

Sr Sailor -- Have you been off Lupron since 12/14? If so has your doc mentioned at what point they would consider putting you back on?
Posted 2/21/2017 11:41 PM (GMT 0)

peanut307 said...
Great points by all.

Sr Sailor -- Have you been off Lupron since 12/14? If so has your doc mentioned at what point they would consider putting you back on?

Yes, the last shot was in Dec 2014. Of course it took several months for the Lupron to wash out of my system and for the testosterone to 'recover'.
The Radiation Oncologist who treated me told me that nadir+2 would be the signal for action. At that point he would transfer my care to a Medical Oncologist.
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