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Casodex monotherapy?

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Posted 8/30/2013 3:56 PM (GMT 0)
I am considering going on a 4-6 month course of HT while I further contemplate my treatment options and perhaps change insurance in January to enable me to be treated at UCLA. My wife is concerned that, because I have GL3+4 in all cores of my left side with a possible ECE, that the cancer may spread further while I wait.
I have read studies where 15% of men never recover the ability to produce testosterone after even a short course of LHRH (Lupron) and that the general SEs are more severe. Casodex, although only 70% as effective as Lupron, has only 30% of the SEs and recovery is faster. It should at least arrest the spread while I wait, shouldn't it?

Has anyone ever done Casodex as a monotherapy? Of course, the main SE with this route is the breast enlargement. Would I need to take Femera as well to prevent it? Any thoughts on the matter would be greatly appreciated.
Posted 8/30/2013 4:28 PM (GMT 0)
I did Casodex as a mono therapy before BT/IMRT. My RO wanted to use Lupron for 3 months, but my oncologist said that Casodex would work just as well and convinced my RO.
My psa went from 40 to .02 in three months of Casodex, so it worked very well. I did take Femera to avoid breast enlargement, because I had had some tender breasts and lumps while taking Finisteride I knew I would be prone to enlargement. Side effects were tolerable, hot flashes about once or twice a day for 5 to 10 min. Loss of libido, but still had the ability to get an erection. All side effects went away in 2 months after stopping it.

The main reason I took it was to shrink the prostate prior to BT. It went from 60cc to 32cc. It also helps the radiation become more effective, and by shrinking the prostate the same overall dose is delivered to a much smaller area creating more killing power. I believe it also helps in the event you have micromets, as the HT can kill them before they have a chance to set up.
In your case Casodex makes sense if you are going to wait a few months before treatment as it should stop any growth dead in its tracks and prepare the prostate DNA for radiation. With high risk cases I'm of the belief that cancer hates change and the more change you can throw at it at once the less it can handle. Changing diet, adding supplements, taking HT as well as throwing two different types of radiation isotopes at it, is an overwhelming amount of change that the cancer DNA cannot process and adapt to.
Posted 8/30/2013 4:59 PM (GMT 0)
John T,

What dose were you taking?
Posted 8/30/2013 10:22 PM (GMT 0)
50 mg daily
Posted 8/30/2013 10:54 PM (GMT 0)
Bicalutimade can be a mono-therapy and can have short term control of PSA and can actually shrink tumor size. But the key term above is short term.

There are actually new trials being designed to see if enzalutimide (Xtandi) or orteronel (TAK700) against bicalutamide to see if they are better might be better in that front as both appear to have more effective disease control as an AR drug. The goal is to see if either will work better and for longer periods which is suspected. They do have different mechanisms that bicalutamide.

From what I understand is that monotherapy through bicalutamide is not as effective as an LHRH agonist and therefore less prescribed. But usually because these drugs work well in combination they are commonly prescribed that way.


Good luck with what ever you do!

Tony
Posted 8/31/2013 12:38 PM (GMT 0)
Yes mono therapy can be done with this and similar drugs, friend of mine has gone off and on this for over 3 years now and still has good psa's, even with higher risk scenario PCa. Breast enlargement is possible but not a guaranteed event with this, you can take another drug or get breast radiation to assist this to not happen, not a guarantee either of course with PCa not a lot of guarantees anyway. I had breast radiation little later on with electron rays, it was an easy gig and seemed to work.

Google Dr. Labrie and you can read his info on mono therapy of which he is the master of that modality. You could even add proscar or Avodart to this mix and likely get a super low psa soon, it is also not without some controversies. But the side effects are not to bad either. There actually are more choices than most people are never told or aware of, but then again there is money to be made in this mix too. The latest concept is $100,000 a year for some drug modalities, who wants to cure that system?

I am a professional patient (lol) yeah having seen and done plenty of drug options over 11+ years. Got a Phd. in it now: Piled High on Drugs= Phd.     Graduated with dishonor too, fought some choices, fired a few docs and proved my uro-doc was wrong on Lupron for life.  Didn't know I was in this reality Twilight Zone episode until year 3 on this.

Post Edited (zufus) : 8/31/2013 6:46:43 AM (GMT-6)

Posted 8/31/2013 4:06 PM (GMT 0)
jackansan,

I have a good friend on iADT who achieved undetectable PSA on Casodex + Avodart. He hates the psychological effects of Lupron. He had breast radiation to prevent gynecomastia. Tamoxifen is also given for that.

In one study, they looked at one group of men who had bicalutamide monotherapy and another group who had LnRH-agonist monotherapy prior to radiation. Although the bicalutamide group's PSA didn't get as low as the LnRH-agonist's group, their freedom from biochemical failure was equivalent after 4 years median follow-up.
Neoadjuvant hormone therapy for radical prostate radiotherapy: bicalutamide monotherapy vs. luteinizing hormone-releasing hormone agonist monotherapy

The length of time a man is on ADT is a big factor in determining how long it will take testosterone to recover afterwards. Because you only intend to be on it a few months prior to treatment, your recovery ought to be rapid. In the following study, 93% of men on ADT for 9 months recovered their baseline T within a year:
Kinetics of testosterone recovery in clinically localized prostate cancer patients treated with radical prostatectomy and subsequent short-term adjuvant androgen deprivation therapy.

I guess you can always try the Casodex first and see how low that gets your PSA.
Posted 8/31/2013 4:28 PM (GMT 0)
good stuff Tall- you should start a PCa website I think you are qualified, always like your info lines....
Posted 7/17/2017 11:56 PM (GMT 0)
Taking Casodex as primary therapy alone. Told to take for 2 years- then consider holiday and then switching to Lupron at that time. Told 8-10 year survival, though most literature suggests a lot shorter..

---------------------------------
65 years old- Gleason 8 (3+5), T-3a, Davinici prostatectomy 1/15, biochemical recurrence, 72 Gy radiotherapy 1/16, biochemical recurrence, Casodex started 3/17- PSA 3 at dx- 0.51 before Casodex, 0.04 3 month point.
Posted 1/16/2018 2:19 AM (GMT 0)
I have been on IADT with 50 mg casodex (bicalutamide) for three years. It has controlled PSA within a range (11 to 50), SE is gynecomastia even though I had breast irradiation. No concern about regaining T levels because casodex blocks the androgen receptor, so T level actually rises (doubles) during treatment. No hot flashes, fatigue, or castration resistance (yet). Scans stable. Have avoided all LHRH agonists and antagonists so far.

DX age 52 09/08. PSA 136, RRP pT3bNOMX, IMRT, BLPLND GS 8 (4 + 4)
Posted 1/16/2018 4:52 AM (GMT 0)
Tamoxifen 20 mg daily may reverse the gynecomastia if it hasn't gone too far - it works MUCH better than chest X-rays.
Posted 1/16/2018 5:31 PM (GMT 0)
Richard,

I would be interested in seeing a summary of your treatment history if you are willing to post it in your signature.
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