Casodex before Lupron--for how long?

I will start HT in March. Hussein and Lam both say do Casodex for just a few days before adding the Lupron. My urologist is rather insistent that at least 2 weeks of Casodex should procede the Lupron. So that's what I'll be doing. It is not a big deal to Lam or Hussein.

My question is for those who have done this. How long were you on Casodex before you started Lupron (I always thought it should be 1-2 weeks from my reading).

Incidentally, we will be doing ADT2 so I will be on both.

Mel

I started my Casodex five days before my first Lupron shot. But then my oncologist is Dr Lam and as you said, he thinks it only needs to be a be a couple of days before the Lupron. FYI, Dr Lam also added Zytiga to my Casodex/Lupron combo.

I was told not to do it, since I had no evident mets that would flare.

Had no evident issues.

I was told to take mine one month before my Lupron shot to ease my body into the lack of T level from the Lupron. The reason I know that was because the Pharmacist had misread the prescription and I was on my second month of Casodex before my OCO noticed the error and told me to stop taking it and why.

Thanks for the info. As seems to be the case with our disease, no definitive answer!

Jitters - Lupron can cause a major flare up (ie: increase) in testosterone initially. That can lead to an exacerbation of the PC and if one has mets that can be very bad news. Taking Casodex first seems to prevent such a flare.

Mel

Hello Mel,
All medications when ingested breakdown (metabolize) into an active ingredient (or more) which have a period of existence in the body and theterm half-life is a measure of the amount of time required for the amountof medication available to be reduced by a factor of 2. The medication's steady-state is reached when the amount of metabolite(s) eliminated is equal to the amount of metabolite(s) formed in a 24 hour period.The "normal" dose of Casodex is 50 mg per day and the active metabolite takes 31 hours to peak(as per manufacturer).

The active metabolite formed is about 50% of the original dose. Thus, we have 25 mg of bioavailable material formed. The half-life of Casodex is 6 days and it will take 37+ days (six half-lives plus 31 hours) to eliminate this first dose. Now, if 25 mg of metabolite is formed every day by ingesting a 50 mg dose, when the 37+ days come around you reach the steady-state and at that point there is an equilibrium with a range differential of 25 mg between the high point and the low point in a 24-hr period (227 mg to 202 mg).

I would have to assume that this dose is considered therapeutic by the manufacturer (capable of preferentially blocking both T and DHT at the androgen receptor), but I don't know that this is true. If this is the case, 50 mg of Casodex ingested for 7 days only peaks at 122 mg (range 122 to 97 mg) and therefore not sufficient to block a testosterone flare caused by the LHRH. The mathematical answer to your question is 37 days before starting Lupron. It is rare the clinician that follows this timing with Casodex. On the other hand, Eulexin(another antiandrogen called Flutamide) with a much shorter half-life (8 hours) has to be taken for two days to achieve a steady-state before Lupron.

Patients with no evidence of metastatic disease are at lower risk of tumor flareup when not following this puristic 37+ days procedure.
Wish you the very best outcome.

RalphV

Ten days before my first Lupron shot.

My doc at UCSF had me do 10 days before the shot