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Posted 8/28/2019 3:32 PM (GMT 0)
Hey, I go for SRT imaging tomorrow and a 1-month Lupron shot to get things started. I am not sure about Casodex. Should I ask about that? Do I need it? What does it do? How about the Lupron shot itself? Anything to worry about? I will be 7 months of HT total. Thanks. J

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Age at Dx: 54 (DOB: 01/28/62)

08/31/15: PSA 2.5;
01/01/16: Urinary Frequency;
02/05/16: DRE Pos Nodule;
02/22/16: Biopsy;
02/26/16: Dx: 7-12 positive; (5) 3+3=6; (1) 3+4=7; (1) 4+3=7; T2B;
03/11/16: Bone Scan Neg;
03/23/16: CT Scan Neg;
03/31/16: Surgery Consult UPENN;
04/08/16: RT Consult/2nd Op Fox Chase CC upgrade to 4+4;
04/14/16: 3TMRI "organ confined", EPE-, SV-, LN-;
06/01/16: DaVinci @ UPENN (Dr. D. Lee);
06/08/16: Catheter Out;
06/08/16: Post-Op Path: EPE+;Marg +;SV-;LN-;G7(4+3) (G4 80% - G3 20%);tumor vol 25%;T3a;
07/01/16: Start 5mg Daily Cialis, 20mg once a week on Friday's;
07/06/16: Decipher: 0.56 (Average Risk);5 Year Metastasis 7.6%;10 Year PCa Specific Mortality 6.9%;
08/01/16: Penile rehab started (Pump);
01/30/17: Decipher GRID PORTOS: Avg ADT Response (21%);Avg Docetaxel Sensitivity (56%);
Lower RT Response (45%);Avg Dasatinib sensitivity (38%);High Genomic Gleason Grade (81%);
High Metastasis Risk (70%);High Tumor Cell Proliferation (82%);Avg AR Activity (56%)];
09/26/18: 99% continence (some stress every now and then); ED no issue (5 mg Cialis/Day);

Post-op uPSA History:

08/31/16: uPSA <.006; (3 months);
12/01/16: uPSA <.014; (6 months);
03/01/17: uPSA <.006; (9 months);
06/01/17: uPSA <.006; (12 months);
09/01/17: uPSA <.006; (15 months);
12/01/17: uPSA .007; (18 months);
03/01/18: uPSA .010; (21 months);
06/22/18: uPSA .015; (25 months);
09/21/18: uPSA .018; (28 months);
12/21/18: uPSA .035; (31 months);
03/22/19: uPSA .044; (34 months);
06/21/19: uPSA .055; (37 months);
07/22/19: uPSA .061; (38 months);
08/22/19: uPSA .073; (39 months);
Posted 8/28/2019 4:32 PM (GMT 0)
Jay, Lupron tends to cause a flare up in Testosterone initially, before driving T down to castrate levels. Casodex is often given to prevent that flare up. Worth asking about I guess, I’m not that knowledgeable about when it’s used, I’m sure others will chime in soon
Posted 8/28/2019 5:08 PM (GMT 0)
Casodex usually started 2 to 4 weeks before first Lupron shot, to ease transition. It's very mild compared to Lupron. I was on both for the full 7 months. Never had hot flashes, although my T went to 3. It's back in the 300's now.
Posted 8/28/2019 5:14 PM (GMT 0)
The casodex serves the purpose Pratoman mentioned..HT is usually used for at least a year when it's augmenting RT..Lupron is chemical castration. You will suffer the side-effects associated with that procedure...They are well publicized here and elsewhere..
Posted 9/3/2019 11:40 AM (GMT 0)
I got my first one month Lupron shot last Thursday (5 days ago). Did not get Casodex, even though I asked about it. I was told it was not needed. Anyway, from what I understand, Casodex helps with T flare. So, what is T flare and what should I expect because of it? Also, when will I start feeling the Lupron effects? RT begins in about 3 weeks.
Posted 9/3/2019 12:25 PM (GMT 0)
Jay, T flare is a sudden, but temporary spike in Testoteronw at the outset if HT.
From my experience , side effects started at about 6 weeks after start of HT. But I started on Firmagon which gets T down much faster, I didn’t switch to Lupron until the 3rd month.

Also, I just responded to your email.
Posted 9/3/2019 12:44 PM (GMT 0)
I recently started ADT and have been on both Casodex (daily pill) and Lupron. My RO indicated it was standard of care for him in my situation but I have seen varying use cases. My research left me with the feeling that it may be of some benefit and will not affect side effects too much so I was fine with keeping it as part of the artillery. The Lupron injection is nothing to worry about. In my case was given in rear hip and I did not feel anything. Wishing you all the best for your upcoming treatment!! I am now starting week 3 if SRT.
Posted 9/3/2019 1:43 PM (GMT 0)
I've gone off and then back on Lupron twice, both times my Onco started me with Casodex but concurrently, not before hand.
Posted 9/3/2019 5:02 PM (GMT 0)
I started with Casodex before Lupron, but I've seen lots of guys here that didn't have it first. I also wonder if it might be less important for SRT when there's likely just a very small amount of PCa hanging around, but I don't really know the answer to that.
Posted 9/3/2019 5:54 PM (GMT 0)
Whether it is always worth bothering with an anti-androgen (such as Casodex) before starting HT with GnRH agonists is the subject of some debate. There is fairly strong agreement that it makes sense for men with established metastases (especially bony mets) since the T spike can exacerbate their symptoms. But for men without established mets it has been mostly impossible to show that suppressing a brief T flare makes any difference. Some oncologists don't bother with Casodex for non-metastatic patients, most do prescribe it just to be on the safe side.
Posted 9/3/2019 6:01 PM (GMT 0)
PeterDisAbelard, OK, now I get it! Thanks for the extended explanation. My uPSA is only around .07, so no visible mets or any symptoms of them. Start SRT on Sept 25. J
Posted 9/3/2019 11:54 PM (GMT 0)
Peter's post makes total sense to me.
As an aside, it's important that the Lupron shot be administered properly. The 'shot' has to be prepared in a certain way.
I got mine in my thigh by an experienced RN and felt it for a few hours, but I have read about others having stronger short-term side effects. The second shot was in the other thigh, and so on.
Note that almost all men have long-term effects due to the lowering of the testosterone. In that context, ask for a T assay after a while to ascertain that the hormone therapy is effective.
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