Bicalutamide

Welcome to HealingWell. Sorry you to have to be here, but I think you'll find the sense of community to be very valuable.

Bicalutamide is a common drug used in hormone therapy...I'm taking it now myself (brand name Casodex). The 3-month shot is probably Lupron, which is also something I am receiving. These drugs aren't hormones, but rather will suppress your husband's ability to produce hormones, namely testosterone. Prostate cancer cells need testosterone to grow, so cutting off the "T" is an effective way of dealing with the cancer cells.

It sounds to me like you didn't get much information from your doctor on how hormone therapy works. It also gives significant side effects, such as hot flashes, loss of libido and more. Most people find these side effects manageable, but they are significant and you should be prepared for them.

I'm sure others that are much smarter than I will weigh in on this, but any additional info you can provide on your husband's biopsy results and subsequent doctor visits would be helpful.

I wish you both luck and try to learn as much here as you can.

Michael

David:

I sent you an email

Mel

It sounds like what they plan to do for your husband is external beam radiation therapy with neoadjuvant androgen deprivation therapy (ADT). Since you asked about bicalutamide I can explain a bit about the ADT part.

Bicalutamide works by preventing the cancer cells in your husband's body from responding to testosterone. I blocks the receptor sites so the testosterone molecule can't attach. This will usually keep the cancer from growing for a while and will often make it shrink. That is the pill he is taking now.

The shot he will be given every three months starting soon will make his testes stop producing testosterone. The shots work well but but they work in a roundabout way. They actually act to increase the production of testosterone at first until the body finally says "the heck with this" and gives up producing it at all. During the first couple of weeks the testosterone goes up -- this is called testosterone "flare" and in some cases it can cause problems with the cancer which is why they start the bicalutamide first. That way the excess testosterone will be blocked from acting on the cancer cells.

The doctors will usually have the man continue taking the bicalutamide (or similar T blocking drugs) while the shots are suppressing T production. This is called ADT2 because there are two drugs in the "blockade".

Since you mentioned that he will be getting the shots for a year that means his doctors probably hope to kill enough of his cancer with the radiation so it won't come back (soon, anyway) and he won't need to stay on the ADT for a long time. Being on ADT at the time of radiation treatments and for some time after has been shown to make the radiation work better. Doctors don't like to use the word "cure" (since they never know the cancer won't come back) but they will talk about a "durable remission" which means the same thing most of the time. It sounds like that is what they are hoping for with your husband.

The side effects of the ADT will be hot flashes (likely), weight gain (likely), loss of interest in sex (very likely), erectile dysfunction (very likely), mental vagueness (common), depression (common), crankiness (almost certain), loss of muscle (very likely), loss of bone density (very likely), cardiovascular problems (not uncommon). I mention all these because there are ways to deal with most of them. Exercise helps with a lot of them and his doctors can help with most of the others.

Hi Glenn...I'm doing pretty well, finished up my IMRT so I just need to hang tough until HT ends in November. The gambapentin has helped a lot with the hot flashes...I still get them but not as often or as intense.

Hope your T continues to go up and your PSA continues to stay down!

Michael