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After failed rrp and rt, my doctor has put me on 150mg casodex daily with the view to go intermittent when psa becomes undetectable.
As this is my only treatment I'm puzzled as casodex always seems to be used with other ht drugs.
Has anybody got experience of long term use of casodex, is it unusual to use only casodex at this stage.
Jim,
It is unusual to go with straight Casodex at this stage. The standard protocol would be first 50mg Casodex and then one week later start Zoladex or another LHRH. The Casodex is only taken for the first month. In this protocol the Casodex is being taken to block the effect of the hormone surge that you get in the first few weeks of taking the LHRH drug.
That doesn't mean that that taking the 150 mg Casodex is wrong. It may even be better than the standard protocol. Certainly you will suffer less from side effects. You should ask your oncologist what different protocols he might use at this stage of treatment and why he choose this one for you. Look up pubmed.gov to find summaries of almost every research study on Casodex (bicalutamide) as a treatment for prostate cancer if you want to know even more about it than your oncologist.
Historically it is not all that unusual to consider mono therapies on PCa with bicalutimides, flutamides, nilutimide. Basically a family of anti-androgen drugs, perhaps because of your stats your doc believes high dose (150 mg) casodex is a good way to go, and it can be very effective (for some duration, same goes for Lupron and other wonders used). Dr. Labrie from Canada and a USA patient named Loyld Ney (founder of www.paactusa.org PCa advocacy group-also newsletters even on line-free), went looking for PCa drug treatments decades ago and found that Dr. Labrie had very decent results in bicalutimide and so they helped get it introduced into the USA for useage. Back then Dr. Strum was a protege of Dr. Labrie and an advisor to Paactusa.org group and he also helped in this, historical stuff (-:
The ongoing leader of PAACT, Rick Profit (related to Mr. Ney), said to me the other day that he knows of a man on flutamide useage, that is into year 20 now (talk about a unique response?). Rick also stated that casodex seems to fail perhaps sooner than Nilandron or Eulexin and such other types(I don't know on that)...he has seen plenty as leader of this group. I would say this is not typical response on anti-androgen drugs, 20 yrs.
Sometimes a patient failed on casodex can find instant response in Nilandron or Eulexin, which is interesting. The new Phase III drug MDV-3100 aka 'super casodex' is going to be really interesting, because it binds to the AR receptor unlike anything invented thus far. I say it will see approval and new results, we shall see later.
A new book out by DR. Mark Moyad (researcher type), mentions these drugs and many others, including the newest clinical trial drugs and even diet/alternative styles and how to conquer side effects in his book:
Beyond Hormone Therapy (you can get this from www.paactusa.org for the same price as it is at amazon.com $15.00 the proceeds used for patient advocacy).
In his book it also explains AAWD, anti-andrgoen withdrawal and how that may work on a patient. Especially for a patient using 150 mg of casodex and similar choices, you have a risk of effecting the AR (androgen receptor) more significantly or harder/faster concept, coupled with patients AR receptors can vary, (this AR expression can be tested for in specialized pathology, via stainings). Those with a higher expression level on the AR receptor, do not respond to drug therapies as well(to bad no doc mention why you should do this little testing!!!). As crazy as PCa is, at some point the anti-androgen drugs can feed PCa, as a source and psa could rise and disease level increase (with or without a psa rise, is even possible). Even stranger, your own AR receptor can adapt to feed itself (unguarded) via your bodies own chemistry system. Thus, you need a new pathway (different type of drug) to effect the PCa cells, there are mentioned in literature 4 main pathways types to effect PCa cells, this is why angio-genesis is found also effective.
Other factors, perhaps your doc is also instituing this therapy for his patient to get perhaps less overall side effects, perhaps bone density is less effected and memory loss less effected. No doubt the docs wallet is effected, he makes no money on pills, makes plenty of money on Lupron and LHRH (in house injections...actually those profits border obscene).
In Dr. Strums book a study done by Wheeler, et al (let me qualify this), on patients whom were hormone drug naivee or non-hrpca patients. It was found that these two different approaches to drug therapies compared about equally in effectiveness:
Lupron+casodex (more expensive route, more side effects too)
vs.
Casodex+proscar (no profits for the doc, less side effects too)
The grouped patients data, was almost identical in outcomes or results on psa and control of the PCa. How interesting???? But, everyone needs Lupron? (LOL)
Now I did qualify it...those that are Hrpca (even slightly if known would be a different comparison), it would not necessarily be held as equal choices, but then too Lupron fails in Hrpca scenarios also as does any other therapy as cells morph or mutate within the PCa processes. Thus find other methods to effect PCa cells, via the known pathways.
So, the shorter verbage on all that is: question everything in your own PCa scenario and the shotgun approach of Lupron for everybody is more wonderful for the docs, that it is for the patients. Anyway it is yours to consider, whom, what or what not you wish to use in your PCa fight. We can see the results in other patients and it all varies, just like the disease is very much full of variations. I kind of like a doc whom is more concerned about the patients side effects or choices, than padding his wallet as a primary goal. Note Zoladex is usually cheaper, but not as profittable for the docs...thus not used as much????? (worth contemplating)
