Inputs on side effects Casodex vs Lupron

Usually, Lupron comes first, and when that starts to fail, Casodex is added..But you could reverse that, it's called Casodex Monotherapy, and see if the casodex on its own can control your cancer..Lupron eliminates testosterone, Casodex stops it from binding to PC cells which kills or suppresses them..But it has its side-effects too..All drugs have side-effects..

Well they are entirely different and you expect different side effects and treatment results.

Lupron shuts down the production of testosterone in order to starve the cancer. When that happens you get the castrate menopause side effects of no T. Hot flashes, weight gain, low energy etc.

Casodex is a blockade. It puts a barrier between the cancer cell and T so the cancer cell doesn’t feed. Side effects are entirely different.

Have a very serious discussion with your medical oncologist and make certain you are both on the same page as to the treatment direction.

The radiation oncologist who did my SRT in 2010 put me on Casodex for 90 days during treatment. When my PSA reappeared in 2014 he said he would recommend waiting until PSA rose to a level TBD based in part on rate of increase - which was, so far, pretty standard advice. He said when it was time to start treatment he would recommend Casodex monotherapy, because in his opinion it was just as effective as Lupron until it started to fail and then we could switch to Lupron. In his view this offered added years with fewer side effects. While I wanted to avoid the expected SEs of Lupron or similar drugs, I was also skeptical because his approach is not widely used. I found this rview / review article that discussed "Controversies in Management of Biochemical Failure"

https://www.hematologyandoncology.net/archives/november-2012/current-controversies-in-the-management-of-biochemical-failure-in-prostate-cancer/

See especially the section headed "Peripheral Androgen Blockade."

In 2016 when my PSA had increased to 0.2 I transferred my care to an MO at Dana-Farber. I asked him about Casodex monotherapy and he said he could not recommend it because it wasn't shown to be as effective as Lupron, Degarelix, or the similar more widely used treatments. In early 2018 my PSA levels began accelerating rapidly and I started on intermittent ADT with an initial one year course of Degarelix (Firmagon) in May 2018. I've been on break from Degarelix since May of this year. I had virtually none of the side effects many or most patients report. I had no hot flashes and no fatigue. I know I've been luckier than most so far in that regard. FWIW, when I was on Casodex for 90 days during my SRT I was having breast tenderness by the third month, which I assume was the start of the gynecomastia that is widely associated with Casodex, and went away a moth or so after I stopped Casodex.
Jim

Jeff,

let me cite the NCCN guidelines: "Patients with an increasing PSA level and with no symptomatic or clinical evidence of cancer after definitive treatment present a therapeutic dilemma regarding the role of ADT. [......] Early ADT is acceptable, but an alternative is a close observation until progression of the cancer, at which time appropriate therapeutic options may be considered."
The European guidelines (if you would have a European prostate cancer instead of an US one ) are clear on this: "Do not routinely offer ADT to asymptomatic men with biochemical recurrence." This is based on the existing evidence showing no benefit regarding overall survival for starting with ADT early, just with the intent to bring down the PSA value in asymptomatic patients. (Except for the underpowered TOAD study).

So there is no need for ADT at all in your case, although patient and doctor anxiety usually cause an early start of ADT. Therefore you do not need to take the drug that maybe works best against the tumor, you can either take none at all or the one which may not be as effective as Lupron but will bring down the PSA value just as well - Casodex. I did six months of Casodex following salvage radiation. Significantly fewer side effects than Lupron. You can do intermittent Casodex therapy six months on, six months off as long as you like since the guidelines allow you to do no ADT at all.

Radiating my breast was insufficient to avoid gynecomastia, I took 10mg Tamoxifen. My URO called a large university clinic to make sure he could prescribe this to me. He did not have a patient before on Casodex monotherapy. But he did not object to Casodex in my case. I came along with the relevant pages of the guideline printed out.

Post Edited (George_) : 10/13/2019 12:25:46 PM (GMT-6)

mattam / george, slightly off topic but much appreciated - if I can postpone treatment I would prefer to.
It sounds like general consensus here is Casodex monotherapy has less SE than Lupron - and of course no treatment has fewest SE .

I am in no hurry to start treatment. I was entertaining a trial that used Casodex along with Metformin - I had decided against that based on my initial surgical oncologist's frowning on Casodex - but perhaps I will pursue.

I am about 30 pounds over where I would like to be - my present resolution is to lose the weight first and then go on treatment - good to hear that some can lose weight even while on Lupron.

My "team" so far has been a surgical uro oncologist, who has been treating me for the last several years (I really like him), an RO that did my SRT (who last I saw him said he was not value-added at this point and don't come back) and the new guy - a medical oncologist who offered either Casodex or Lupron (and sent me to genetic counseling - testing for various genetic markers). General consensus is to start treatment, but that is my decision .
Thanks for the advice, all.
Jeff

I was given option of Lupron also, however Med Oncologist wanted to wait till psa reached between 5.0 and 7.0. All scans showed no metastasis. When we reached the number of 7.8 we started with Firmagon ( degarelex) It is a 28 day injection into stomach and releases over the 28 day period. Within the first 2 months psa droped from 7.8 to .1 where it has been for past 5 months. treatment period is 7 months. Injection site is painful at site for 24-48 hrs but symptoms ease after that. still has same side effects as Lupron but there is no testosterone spike at first and it has less long term side effects. AS always you have to be your own advocate and be diligent on treatment and research