My father in law was recently diagnosed with advanced pca . Psa 700 with Mets everywhere. He has been on casodex for about 2 months. He is feeling much better, with a big improvement in his back and hip pain.
He has numerous other health issues and some dementia. He is currently in a nursing home with his wife ( they are so happy to be together again after living apart for a 6 months).
He has a urologist appointment tomorrow. We are going to discuss the pros & cons of Lupron vs continuing with casodex only.
Does anyone have any experience with casodex monotherapy for such an advanced case?
He seems to be doing pretty good at the moment. I’d rather not change anything if possible... with Lupron he will experience significant side effects?

Leah, I would say that if the casodex is working (witness the pain reduction), then it becomes a QOL question. With early dementia, the chances are real that he would see a worsening because of the Lupron. We're talking about maintenance with him not cure. I hate to put it that way, but the goal now is to keep him going as long as possible without making other things worse.

In this day and age...being what it is...thank you so much for re-membering...the high truth of a man and a woman...remaining together...thru it all...cancer...smancer...their commitment...absolutely obliterates the pound of flesh in exchange for 56 grams of spirit combined...truly....in deed and truth...well done well begun...to them both

I’m sure they will be doing that tomorrow... will be interesting to see what it is.

Casodex monotherapy is not mentioned in the guidelines and therefore your Urologist will probably not agree to continue with that. However, it is only a very small difference between Lupron and Casodex 150 mg. This study
https://pubmed.ncbi.nlm.nih.gov/9643663-a-randomised-comparison-of-casodex-bicalutamide-150-mg-monotherapy-versus-castration-in-the-treatment-of-metastatic-and-locally-advanced-prostate-cancer/
concludes:
"Conclusions: 'Casodex' 150 mg is less effective than castration in patients with M1 disease. However, 'Casodex' has shown a benefit in terms of quality of life and subjective response when compared to castration and has an acceptable tolerability profile. Thus 'Casodex' 150 mg monotherapy is an option for patients with M1 prostate cancer for whom surgical or medical castration is not indicated or is not acceptable."