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I was supposed to start Zoladex injections this coming week. However I was totally unable to tolerate the course of Cyproterone Acetate and I have no wish to go onto the alternative which was offered, Bicalutamide. I have a lot of angina and I'm seeing a cardiologist shortly which will probably lead to a bi-pass op. Both of these drugs have the side effect of shortness of breath which is just not acceptable with my angina at the state it is.
I understand that these two drugs are to prevent a flare-up of testosterone which is caused when you first go onto Zoladex. Can anyone tell me if it is acceptable to go on to Zoladex without having first used these other drugs or is the testosterone flare-up to be avoided at all costs?
Thanks Ken from NZ
I have to say I have never understood the perceived importance of attempting to controlm the 'flare' that is sometimes associated with Zoladex. Because it is a 'flare' I.e. The PSA levels can sometimes rise and then fall, I don't understand whatbdamage can be done by this transient effect.
I'd be interested in any justificationsmfor the suppressionnof the 'flare' apart from " rising PSA is bad"
Terry
I saw the specialist yesterday and when I explained my situation he promptly said he would not use those drugs. Instead he started me off with an injection of Lucrin, a different drug which does the same job as Zoladex. The injection was for 1 month and he said that if I tolerated it OK he would keep me on that with 3 monthly injections.
Ken from NZ
I researched this at the beginning of my treatment.
What I found was that the drugs of this class (Zoladex, Lupron, Lucrin, et al.) initially cause the pituitary gland to over produce Lutenizing Hormone for 2-3 weeks before shutting down that hormone completely through the duration of treatment.
What this means to the testes is that they have a corresponding rise in testosterone (T) production before they quit producing it altogether. (The remaining blood level T is produced mainly by the adrenals - females have this too.)
I never really though about this in terms of PSA but of T percentage. During the initial 2-3 week period following the injection there is a giant rise in T. This "Flare" of T has supposedly been responsible for several side effects some of them life threatening. During this flare time with high T levels bone pain and spinal compression have been reported due to rapid growth of mets.
Casodex or other similiar drugs that "kill" T directly, are used in some cases to control this excessive T until that initial time period is over.
p - (Alaska, USA)
Yes, I read similar studies and pieces but it seemed to me that the 'flare' was really only a consideration where there were severe symptoms which might worsen for a short time. I seem to recall that the flare suppression did not work in all cases - is my memory right on that?
That's why I felt that for most people, asymptomatic as they are, the addition of Casodex or Avodart was just adding another drug - and of course I am drug averse in principle:-)
I just put up what I think is a good cartoon in regard to multiple medications on TROOPC
