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Avodart instead of SRT

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Posted 4/25/2014 12:56 PM (GMT -5)
Does anybody have the latest findings on the use of Avodart to lower post RP PSA numbers? It sure seems worth a try if it's safe to do so.
Posted 4/25/2014 1:54 PM (GMT -5)
If surgery is successful there is no need to add Avodart/Proscar.   If the prostate is gone and there is no cancer,  there is no need to lower DHT.    If however, your risk was such that the surgeon might not have removed all the cancer, then Avodart/Proscar could be part of Hormone Therapy based treatment that specifically reduces the DHT, but not the gonadal produced testosterone.   Some doctors will use Avodart/Proscar before surgery or radiation to shrink an enlarged prostate, but that doesn't appear to have been done in your case.

It looks like your PSA is undetectable post surgery, but rising based on your signaturee.   Generally the threshold after surgery is .20 PSA.   If your rise stops at or below that number generally you wouldn't need more treatment.    If it rises above that level, your doctors would determine the next courses of treatment wich could be salvage radiation and/or Hormone Therapy, which could include Avodart/Proscar.    As to introducing Avodart/Proscar at this point, I wouldn't think there would be harm as it usually has mild side effects.   It is just a matter of whether you would need it.   I have been on Avodart in the form of Jalyn for 3&1/2 years as part of my hormone therapy.   My Eligard/Lupron stopped this year, but I will remain on Jalyn indefinately as a maintenance treatment due to my high risk situation.  

Here is hoping you are cured.

Posted 4/25/2014 2:21 PM (GMT -5)
That's a wealth of information. Thanks for your insight.

With the consistent rise in PSA, SRT appears to be in my future. However, I want to avoid this (like everybody else) and thought a drug like Avodart (with limited side effects) may be worth trying to keep my PSA below .1-.2. My next appointment with the Uro is 5/27/14, I'm sure my PSA has risen above .05 (based on history) and will discuss the Avodart option with the good doctor.

I suppose it boils down to risk vs. reward. So long as Avodart doesn't mask an advancing PCa what do I have to lose? I think it's worth a try if the doc agrees.
Posted 4/25/2014 2:57 PM (GMT -5)
Viper,

Check out my PSA history using the link in my signature below.

I had my RALP surgery almost 3 years ago (June 2011). The only time my PSA was truly undetectable was 6 weeks after surgery. I've had ultra-sensitive PSA tests every three months since that time and have been experiencing a slow rise in my PSA. In January of this year, it had risen to just shy of .08.

When I talked with my Uro in January, I had suggested to him that taking Avodart might buy me some time until I had to board the SRT train. He didn't think it would have any affect on my PSA but he felt there would be no harm in trying.

I just had my latest PSA test about two weeks ago and imagine my surprise (more like shock, actually) to see my PSA had dropped to .024. That's a drop of almost 70% in only three months!

What I don't know is how to attribute that drop. Did it occur as a result of some benign PSA tissue that has shrunk? Did it occur because of PCA cell apoptosis? Is my true PSA being masked due to Avodart? Some say yes, some say no because I have no prostate. These will be questions I ask my own Uro when I see him next week.

In any case, it appears SRT has been put off, at least for a little while longer.
Posted 4/25/2014 4:46 PM (GMT -5)
I have not had Avdart yet but suspect it will be the first thing I try when the Lupron eventually fails.

Dr Charles Myers was big on Avodart a while back and as far as I recall his opinion has not changed

www.prostateforum.com/back-issues.aspx?id=3012

then page down to

ssue Number 3 – Reader Questions
In this issue of Prostate Forum Dr. Snuffy Myers answers reader questions about: interaction between CYP3A4, the statins and pomegranate and grapefruit juices; surgery for low risk Gleason 6 prostate cancers; Proscar and Avodart for preventing disease progression; beta carotene and prostate cancer; insulin resistance and bicalamutide and finasteride; broccoli and the GS-T-M one gene; circulating tumor cell assay and prostate cancer; using ACTOS (Pioglitazone) in prostate cancer patients who are diabetic; using coconut oil to stop prostate cancer progression; creatinine levels and prostate cancer risk; taking testosterone injections at the end of a cycle of intermittent hormonal therapy; how often to measure PSA following treatment; and Chia seeds and prostate cancer.

You can also do forum searches on this site for Avodart.

LupronJim
Posted 4/25/2014 7:06 PM (GMT -5)
Looks like Avodart might be an acceptable alternative (if not temporary delay) to SRT.

HD Rider, I had to chuckle a little about your PSA graph, reminded me of the stock market. My graph would be very similar with a steady climb. I would be doing the dance of joy if my PSA dropped like yours did on Avodart.

LupronJim, I have been on a very strict diet of broccoli, cauliflower, low diary, no red meat, pomegranate juice, green tea, Vitamin D3 (5,000 units), ground flax seed, Crestor; pretty much every anti cancer compound I could find. I also lost 20 lbs. in the last six months. Thus far my PSA has not lowered due to diet, however I have another test coming up in a few weeks. Dr. Myers seems to be quite the authority on PCa, I have seen his name mentioned on other forums. I wonder if a telephone consultation with Dr. Myers would be of benefit? My insurance would probably cover most of the cost.

I really hate the idea of SRT and don't want some of the potential complications our good friend Purgatory has experienced.
Posted 4/25/2014 7:41 PM (GMT -5)
I had a phone consult with Dr. Myers (encouraged by my uro as they have collaborated with other patients) and he confirmed my initial treatment plans as sound. He is very big on diet, exercise, spirit and stress management.....all makes sense to me. I have said I would go to either Myers or Sartor at Tulane if I get in trouble. I would suggest a consult with Myers, just understand he is hard to get to see. Consider also other oncologists like Sartor, Scholz, Lam and others of that caliber.

As to the use of Avodart, my uro was a lead investigator on the three main trials for Avodart related to PCa.....Reduce, Redeem and Combine. The first two were using Avodart to prevent and/or mitigate PCa and the last was for Jalyn, which combines Avodart and Flomax and showed the combination is synergistic. He also wrote the paper several years ago that confirmed that the Prostascint scans weren't reliable. He is a great believer in using Avodart and will keep me on it just as Myers uses it as maintenance with high risk situations.

John's experience is notable. Whether Avodart would be enough to ward off SRT, who knows. It certainly wouldn't hurt. At the least it could buy time before other treatments are necessary. I have no adverse side effects from Jalyn in more than three and a half years..
Posted 4/25/2014 8:50 PM (GMT -5)
That really does relieve some of my anxiety. Knowing that something else may work. I'm very disciplined with the diet thing and exercise like crazy. The thoughts of SRT has me so depressed but now there is another tool in the box that offers some hope. If my Uro will not write me a prescription for Avodart I'll find another one that will. It is probably worth a try. Almost anything is better than SRT as this point.
Posted 4/26/2014 12:33 AM (GMT -5)
One thing to consider with Avodart is you might want to reset your threshold for SRT down from .2 to something lower just to protect yourself in case the avodart doesn't work. For example you might set a reading of .1 as the threshold for further action, or you might say three consecutive increases above whatever nadir you achieve on the avodart. Consult with your urologist on this one. Just in case you have a cancer that keeps growing but is simply producing less PSA due to the avodart, you don't want to be blind-sided.
Posted 4/26/2014 11:03 AM (GMT -5)
Another reason to reset that threashold is that some claim Avodart artificially reports PSA and you need to double the Avodart score.

Myers disputes that since the variation on Avodart is so wide and 50% is just an average or a median, I can't recall.

Here's an old thread from 2011 that partially addresses the toipic, sure there are others

www.healingwell.com/community/default.aspx?f=35&m=2213777

Our mutual friend Jack (JNF) posted on both threads: "Additionally, some of the best oncologists, like Snuffy Meyers, keep men on Avodart/Procsar for long term maintenance after other ADT drugs have been stopped. The reduction of the DHT is important." per last post by JNF

LupronJim
Posted 4/26/2014 11:42 AM (GMT -5)
I am totally onboard with talking to your doctor about Avodart to see if you can delay, or possibly avoid, that SRT. I am a little uncomfortable with the word "instead" in your title. It is probably my GS9 prejudices showing but I think that when you get to the point where salvage radiation is appropriate then you have reached the point where salvage radiation is appropriate and farting around with Avodart at that point seems insufficient. But if you can find a way never to get there, that's OK.

For higher Gleason scores Avodart can delay recurrence but doesn't seem to prevent it. For your Gleason 6 cancer it might just delay it forever. Worth a shot.
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