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Decision Dilemma

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Prostate Cancer
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Posted 9/16/2022 9:23 AM (GMT 0)
OK, Cliff Notes Version:
dx in 2009. Failed surgery/SRT. Have done GREAT using Casodex 2 weeks then Lupron + Casodex (50 mg/day), usually 9-12 months. Numerous HT vacations. 3 times scans found a very few ext. lymph node hot spots. Each time did a 3-month Lupron shot + Casodex + SBRT one month after starting Lupron. OK, fast forward to now. PSA rising. Did Pylarify-PSMA scan today. My dilemma:


1) Suppose I get similar scan findings. I keep reading that other drugs work better (Xtandi/Zytiga/other ones I can't remember, possibly along with Lupron?). Nevertheless, do I stick with JUST what's worked (Lupron/Casodex)? That's what I'm leaning towards with the other drugs ready if I don't get the usual response.


2) Suppose scan findings show more widespread spots, rendering SBRT moot. Same question: what to do.
3) Due to a spinal injury, I am not in the best of health (but not terrible either). Do I add chemo? If so, in both cases above, or just #2.
I will be discussing all this with Dr. Lam next month but I'd like to garner your opinions.


Mel
Posted 9/16/2022 1:22 PM (GMT 0)
Mel, I am lying here head down because of eye surgery. Can’t sleep like this, but can read my iPad. I know nothing about advanced and long term PC, but it seems that you have lasted a long time and had success with the treatment the doctor has chosen. Why change unless you believe the change in treatment will last longer. Of course if something new is found, I would hope that your doctor is ready to start whatever it takes to work on what is found. I know the other veterans here will give you better direction from their own experiences. I am here to support you in any decision you make. Also, I have nothing better to do lying face down at 4am in the morning. LOL. Stay positive and my hope is you keep on keeping on.
Jack
Posted 9/16/2022 3:34 PM (GMT 0)
Jack:

I thought you don't take anything lying down.
I will certainly chat with my doctor (Lam) before making any decisions.

Hope the eye surgery went well?

I had a stroke in my right eye. Had to have injections every month (didn't help and hated it)

Mel
Posted 9/16/2022 4:02 PM (GMT 0)
Jack - hope your surgery went well. FWIW both my wife and my mom had the bubble in the eye surgery and everything turned out okay. Mel - I feel for you. I had to take my mom for her periodic eye injections after a broken blood vessel. Also I recently reconnected with an old friend who was my best man at our wedding forty years ago. He too gets eye injections for a condition apparently brought about by his diabetes.

My take on your medication regimen is, if it works, don't fix it. Good luck!
Posted 9/16/2022 6:22 PM (GMT 0)
Mel,
Adding one of the 2nd gen anti-androgens to the Lupron might give better protection. Xtandi, Erleada, or Nubeqa are "lutamide" choices to replace Casodex (bicalutamide). My understanding is that the three drugs I mentioned bind to the Androgen receptor about 8X more tightly than does Casodex. Zytiga could also be a good choice.
Posted 9/16/2022 6:32 PM (GMT 0)
I would vote for "If it ain't broke, don't fix it". That is, unless the doc has very good reason to think you definitely would do even better on one of the other drugs. If you're tolerating the present treatment well, that sounds good to me.
Posted 9/16/2022 6:40 PM (GMT 0)
Mattam/Clock:

That's what I'm debating!

Mel
Posted 9/16/2022 7:04 PM (GMT 0)
Mel, as you know i am not well versed in the advanced "stuff". But my gut agrees with the others, go with whats been working. Save the newer stuff for later.

Just as important, want to send my good wishes to you. I hate to read from anyone that PSA is rising, and decisions need to be made. Hearing it from you is a bit of a punch in the gut, you've been such a help to me over the years. You'll be in my thoughts, i know you'll make a good decision, one that will get you many more years of HT vacations.
Posted 9/17/2022 1:56 AM (GMT 0)
Mel,
Considering that Casodex and the three other "lutamides" I mentioned are chemically related, and because they all function by blocking T from from the Androgen receptor, I personally would be most interested in the drugs that most effectively block the receptor. Xtandi has an 8X stronger affinity for the Androgen receptor compared to Casodex. That's very significant.

You said that you have done very well with Lupron/Casodex. It stands to reason that you would also do well, probably better, with one of the second gen anti-androgens. They are the current SOC when used in combination with the Lupron-type drugs or Regulolix. A couple of things to consider are the costs and possible increased side-effects from the 2nd gen drugs.

As far as the chemo goes, based on discussions with my own MO, I don't think your doctor would prescribe it at this time.

I'm sure Lam will steer you where you need to be. 🙂 Good luck!
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