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Casodex alone as Androgen-Deprivation Therapy

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Posted 9/14/2013 3:29 PM (GMT 0)
Here I am coming up on a PSA test in a couple of weeks and once again am over-thinking what condition my condition is in. I had open RP 11 years ago and SRT 3 years ago. My results so far have been way better than I or my RO expected, for which I'm grateful. But I still keep expecting the other shoe to drop whenever PSA test time comes around.

When I plug my numbers into this nomogram, which is specific for people who've had SRT:
rcc.simpal.com/692O71

it gives me a recurrence-free probability at 6 years of 37 percent if I say yes to "Neoadjuvant Androgen-Deprivation Therapy." If I select no my percentage drops to 13 percent.

So here's my puzzlement. I see on this forum and elsewhere that many people receive Lupron or Lupron plus Casodex for neoadjuvant ADT and often for a fairly long period of time. In my case I received Casodex alone (no Lupron) for three months during my SRT. Does anyone know or have an opinion if 3 months of Casodex counts as neoadjuvant ADT?

Jim
Posted 9/14/2013 5:00 PM (GMT 0)
I would say yes it should count, can we know with certainty how much better or worse it is comparatively (I don't know, maybe at best). Dr. Labrie is the top experienced doc on casodex mono therapy, you can find his info via google or he is part of the docs at www.prostatepointers.org

Many guys have done well on casodex as mono therapy for PCa usages, friend of mine has done some intermittent use and covering 3-4 years now.

Dr. Strum mentions in his book a study by Wheeler et al did this comparison the patients outcomes were almost identical and equal. For newbies to HT therapy aka HT naivee patients they call them:
Lupron + casodex (if added casodex)
vs.
Casodex + proscar (2nd drug to block DHT converted from our T levels)

Well the second drug combo was found to be equally effective, the caveat is in HT naviee (aka newbies to HT therapies)......would likely be different in guys that are getting refractive or prior HT's used.

Bottom line in PCa is there are no guarantees in whatever you do and especially for high risk and recurrence guys.

What you might want to do is get ultra-sensitive PSA testings and see what might happen. Say you got .007 right now and within a month or two it is .02 or .1 even, then consider HT's asap or look at your options.

Hopes this helps, Dr. Labrie knew about casodex back in the 70's/80's. Helped with Dr. Strum and Lyold Ney to bring it to America.
Posted 9/14/2013 9:25 PM (GMT 0)
Jim,

I think you had less ADT than high-risk guys who have SRT because your Gleason score was relatively low and there's less convincing evidence that ADT is of benefit for Gleason 3+4, at least for initial therapy: (the nomogram you used doesn't distinguish 3+4 from 4+3)
www.ncbi.nlm.nih.gov/pubmed/22245201
www.ncbi.nlm.nih.gov/pubmed/22836052

Anti-androgens do increase the radiosensitivity of the prostate cancer. In one study, Casodex was equivalent to Lupron in lowering PSA-failure rates with 4-year follow-up:
www.ncbi.nlm.nih.gov/pubmed/22677511

What seems to be more important is getting enough radiation. 70 Gy seems to be about the right amount.

- Allen
Posted 9/14/2013 10:58 PM (GMT 0)
Thank you both for your comments. I'll do some research on Drs. Labrie and Strum. Allen - thanks for the links to papers. I just skimmed but will read carefully and file in my great big file of medical papers.

My RO told me at the time that he is is a big fan of Casodex, at least for some patients, because it's SE's tend to be less than Lupron, and at least for a time it's results can be as good. So far it looks like whatever he did has worked as well or better than what anyone else might have done. I still can't help getting hyper-vigilent as test time approaches knowing that my chance of recurrence of over 65% within 6 years and I'm now in year 3. I guess this is also just personality and ancient training - watch the doors and always have a plan b.
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