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Posted 12/2/2017 11:32 PM (GMT 0)
After 13 months of Lupron 22.5 and Casodex 50m,my MO took me off Casodex. I have been off Casodex and remain on Lupron for about 5 weeks now. The fog has lifted, I have less fatigue and don't have as harsh of a reaction drinking alcohol. My hot flashes are tempered and joint pain is not as bad. I still don't have any libido but at least I feel better. For me the combo of Lupron and Casodex was toxic but successful. We'll see what happens next visit but so far...so good. Anyone else have this experience?
Posted Yesterday 12:18 AM (GMT 0)
Interesting. Why did your doc remove casodex? I’m on my second tour of ADT3 which was Lupron , casodex and avodart but Lupron was just switched to trelstar. I don’t understand why you would drop the triple blockade.
Bob
Posted Yesterday 12:48 AM (GMT 0)
Bob,

I have had difficulty with side effects. My oncologist suggested taking a break from Casodex and see what happens. If my PSA stays at zero...we will eliminate. If it rises we will reengage. I'm 62. I hope for a better quality of life. Sometimes I think the meds create half of the problems.

Be well,

Mike
Posted Yesterday 2:11 AM (GMT 0)
I haven't seen any evidence that double or triple blockade is any better than a single agent. As long as your PSA stays down, why incur the extra toxicity?
Posted Yesterday 12:38 PM (GMT 0)
Before jumping off what turned out to be a cliff into Zytiga, we tried adding Casodex to my Lupron. The reaction was several months of significant PSA increases. Too much to be a simple rebound. So we dropped that, and went to Zytiga. To go into all the SEs and issues would be just dragging up some miserable days.

TA - My uro is also of the opinion that more meds than needed to do the job are accompanied by excessive side effects and potentially reduced usefulness of the additional drugs later down the pipe.
Posted Yesterday 6:07 PM (GMT 0)
TA

So you think I’d be ok dropping casodex and avodart and just using Trelstar? Given how well I’m doing neither my RO nor Urologist think I should rock the boat. You think they’re being too conservative? To be honest, I don’t know what side effects if any are attributable to each of these blockade meds. My only SEs this time around have been brain fog, weight gain and gynomastia. Can you refer me to data re: the efficacy or lack thereof for these drugs as tools for androgen deprivation?
Bob
Posted Yesterday 6:30 PM (GMT 0)
Bob,

You have to ask your doctor that question. My medical oncologist did not hesitate to remove Casodex. She is well regarded (former University of Michigan), now Northwestern Lurie Cancer Center in Chicago. She has done a lot of research and work with higher risk PC patients.Dr. Maha Hussain. Plenty of reading available.
Posted Yesterday 7:40 PM (GMT 0)
Bob-

There have been a lot of studies trying to determine whether adding an anti-androgen to a GnRH agonist conferred any benefit. A large meta-analysis showed that the increased benefit was only 2-3%, but due to the uncertainty in the meta-analysis, it may be as low as 0% or as high as 5%. Many doctors don't think the added side effects are worth it for so small a potential benefit.

www.thelancet.com/journals/lancet/article/PIIS0140-6736(00)02163-2/fulltext

There was a small randomized clinical trial about whether dutasteride was beneficial along with ADT (Bicalutamide+GnRH agonist). It wasn't. In fact, the men using it progressed faster, although the difference was not statistically significant.They achieved the same PSA nadir with it and without it:

/www.ncbi.nlm.nih.gov/pmc/articles/PMC4250242/

Certainly, if monotherapy failed to get your PSA low enough, that would be a good clue to explore other options.

Gynecomastia can be prevented with tamoxifen.
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