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Anybody had Bicalutamide (Casodex) Monotherapy? Why not?

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Posted 6/16/2015 11:37 AM (GMT -5)
Just wondering if anyone here has used Casodex instead of Lupron, longterm, to control rising PSA in non-metastatic setting? What would be the harm or reason not to try?

Jim and a couple others here on the forum have enjoyed a Lupron vacation but are now facing the dilemna of having to go back on the Lupron. Why not try to extend the intermittent with bicalutamide?
Compiler, Sonny3, or others, have your doctors ever suggested this?

wampuscats (with PSA rising, dang it!)

this is an older study but explains it well
jco.ascopubs.org/content/22/13/2546.full
Posted 6/16/2015 12:46 PM (GMT -5)
I guess I wouldn't consider myself on bicalutamide monotherapy but I'm taking it. I go to Myers. My psa was rising after surgery. He put me on Metformin, Crestor, Avodart (plus supplements). PSA stopped and dipped, but then started up again but much more slowly and leveling off. At my six month checkup he said mine was an indolent form and the metformin was starting to work. I asked if it wouldn't be better to do something to make it go away instead of just leveling off. So he put me on (I think 50mg) bicalutamide three times a week. PSA went from 0.18 to 0.13 to 0.124 to 0.119 over the following three months. I hoped it would drop it faster.

I read the study and I see my dose is way less than what they gave the study participants. I also have tender and growing breasts, and that isn't good. Meyers said I wouldn't have any side effects but I've been an overachiever on SE's all along, so why not this one? ;-) Maybe Avodart is the main culprit. I'm waiting for my DHT test to come back and then I'll propose adding nefazodone for depression and avodart enhancement (so I can use less $$ avodart), and tamoxifen for the breast issues. It seems a low dose tamoxifen would have been a good thing to start along with Avodart to prevent it.

One more thing, T is up from 555 to 607 to 688 to 720 since starting bicalutamide.

[edit: DHT just came back <1 so maybe I can reduce Avodart]

Post Edited (Rigby) : 6/16/2015 2:40:04 PM (GMT-6)

Posted 6/16/2015 1:20 PM (GMT -5)
Yes, my husband is on bicalutamide monotherapy, 150 mg. daily. His psa dropped from 6.18 to .7 in one month, so it certainly seems to be working. Side effects are breast enlargement, which he had when he was on Lupron, Avodart and Casodex in 2011, so he had radiation to his breasts before starting the monotherapy. Still has sore breasts from that, hoping that goes away. Would love to hear from others who are going this route. My husband has psa only recurrence after initial surgery and salvage radiation therapy--hoping to keep from going back on Lupron.
Posted 6/16/2015 5:25 PM (GMT -5)
A word of caution: According to my Oncologist, Casodex may have a detrimental effect on liver function and must be monitored closely. According to him, Casodex should only be administered for a maximum period of nine months +/-. Casodex can thereafter be stopped for a "breather" and started again observing the same protocols assuming liver function continue to test within parameters.

Something else to be worried about.

NavyPilot128
Posted 6/16/2015 5:35 PM (GMT -5)
I was on casodex only, no lupron, for three months during SRT. I am now having small rises in PSA after nearly five years of zeros. Both my uro and my RO have suggested starting with Casodex monotherapy when the time comes to begin further treatment. Though when that time will be, and if that suggestion holds depends in part on whether my future readings show a fast or slow increase. I will consult with a Medical oncologist before deciding what to do. I have one in mind who I met with at the time of my diagnosis and is now a leading light in the realm of prostate oncology. My RO is a believer in Casodex when and while possible, which he says is much more commonly used in Europe, because the side effects are milder and Lupron can be held back as the next step. I am curious to hear if the medical oncologist thinks this is a reasonable approach. Next blood test is in late July.
Posted 6/16/2015 7:04 PM (GMT -5)
Next question..do you become castrate resistant on Casodex since testosterone is NOT suppressed but on blocked from the PC cells?
There's got to be reason doctors don't prescribe it as a monotherapy. I hope it's not because it's not as profitable as Lupron. One generic pill a day, correct?

Thanks everyone for the replies. Very interesting.

Wampuscats
Posted 6/17/2015 8:28 AM (GMT -5)
In my simplistic way I think of Zytiga as super Luron and of Xtandi as super Casodex.

So Jim having been on Xtandi was in effect on Casodex plus.

Seems though since Xtandi is often used as a monotherapythat if Xtandi is overkill, Casodex monotherapy may be in order, or along with Proscar or Avodart to limit the DHT.

As usual I will defer to Tall Allen though.

No replies yet, but there is a similat thread today on Inspire.com

www.inspire.com/groups/us-too-prostate-cancer/discussion/casadex-as-single-antihormone-agent/

"My brother has selected pencil beam proton radiation therapy for his 4+3 Gleason.

Flomax is prescribed as part of the protocol in order to prevent decreased urine flow due irritation to the urethra caused by the radiation. However, due to side affects after being on about 10 days the doctor decided to try Casadex instead. Since it will help shrink the prostate and at least theoretically help with the urine flow issues associated with the radiation.

Since this isn't the normal way Casadex is used, I was wondering is anyone has had any experience with or thoughts on the idea.

Ben"

I know you do not frequent that site. So if I see any sage replies I will let you know on this thread or by email.

Post Edited (Nomar Schottzenkeister) : 6/17/2015 7:35:33 AM (GMT-6)

Posted 6/17/2015 9:09 AM (GMT -5)
Perhaps liver failure issues are what limits the prescribing of Casodex...
Posted 6/17/2015 10:52 AM (GMT -5)
about 5 years ago Andrew, going by "Drillbit" on this forum, had PC which extended into the Bladder and had to use a catheter. A few doctors told him it was the worst case they had seen and wanted to remove his bladder. Took Casodex only and within a week the catheter fell out on its own. He's only been on Casodex for those 5 years and his psa is below 1.
I took Casodex mono therapy to shrink my prostate before brachy and in three months psa went from 40 to .02 before treatment. I continued to take it for 6 months after treatment and psa 6 years later is .05. I believe there are certain cancers that respond very favorably to it.
I would imagine its long term effectiveness 10-15 years, is not great, but in the short term it is very effective with only about 20% of the side effects caused by lupron or other hormonal drugs.
I think most doctors don't use it because they are only familiar with Lupron, and in many cases to reduce the prostate size before treatment or to stop PC while awaiting treatment, Casodex is just as effective as Lupron without the major side effects.

Post Edited (John T) : 6/17/2015 9:57:12 AM (GMT-6)

Posted 6/17/2015 3:56 PM (GMT -5)
This is an encouraging story. Did your doc also put you on Tamoxifen to prevent gynecomastia? From what I've been reading this is a pretty common side effect of Casodex and Tamoxifen is a relatively safe and effective treatment (or preventative at 10mg). I'm asking this mainly because I suspect Myers might up my Casodex dose to make my psa drop faster when I see him next.
Posted 6/17/2015 4:48 PM (GMT -5)
Wamp:

Dr. Lam has me on Casodex and Lupron. He also had me on Metformin but we stopped it due to kidney issues. If that is cleared up (testing coming up Friday or Monday) I might go back and add the Metformin.

I think the idea behind both is to fight the T at both ends: producing it (Lupron) and the cells receiving it (Casodex).

Frankly, I suspect the worst SE are from the Casodex.

Mel
Posted 6/18/2015 1:47 PM (GMT -5)

compiler said...
Wamp:

Frankly, I suspect the worst SE are from the Casodex.

Mel

I agree. One month off of Casodex and all liver functions returned to normal.
Posted 6/21/2015 1:45 PM (GMT -5)
My liver functions did not suffer from Casodex, but two months into Zytiga the numbers have gone crazy, so I'll be on two-week blood work for a while, and maybe stopping Zytiga altogether. Supposedly Zytiga only has liver impact on 1% of patients, but that niche has always been mine, so nothing new.
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