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Degerelix and Casodex

wardyboy
Posts: 13
Joined: Sep 2010

Is anyone taking both of these together.My oncologist at Sloan wants to put me on Casodex along with my Degerelix.I am responding well to my injections.My PSA went from 8.6 before injections to.77 then to.44 this month. Im 48 have metastatic (lymph,bladder,rectum wall,L4 spine involvment)prostate cancer that is primarily presenting in my pelvic area.My gleason score is 10.I am getting conflicting reports from my urologist who thinks that we should hold off on the Casodex until we need it since my injections are working well so far.My testoterone levels are now around 10 which I think is pretty low.

wardyboy
Posts: 13
Joined: Sep 2010

Well no responses,tells me that maybe i am the only one taking both of these concurrently.No major side effects with the recent addition of casodex,just the normal hormone problems tiredness,mood swings etc.

lewvino's picture
lewvino
Posts: 1007
Joined: May 2009

check out healing well prostate cancer forum also. They have a huge volume of members and you might get some info there.

Good luck,
Larry

tarhoosier
Posts: 193
Joined: Aug 2006

With the presentation you provide then who does your doctor believe "needs" it. What the hell is he waiting for? With those diagnosis figures you need it. I am on Zoladex and bicalutimide (generic Casodex. Do not pay for the brand) and glad of it. Avodart also as DHT requires.

mrspjd
Posts: 694
Joined: Apr 2010

THoosier,
Are you indicating you're on ADT3--Zoladex, generic Casodex AND Avodart? Or did I misinterpret your info? While I understand DHT and T (Testosterone), not sure I understand your statement: "Avodart also as DHT requires." Perhaps you can explain: Are you advocating for Avodart use only intermittantly when DHT numbers indicate benefit, instead of continued, consistant Avodart use? Why/Why not? Thanks.

tarhoosier
Posts: 193
Joined: Aug 2006

I take Avodart also, (ADT3) as DHT requires; that is, as long as my testing shows DHT =/> 5. Once below 5 I suspend Avodart.

mrspjd
Posts: 694
Joined: Apr 2010

We find the info you shared on Avodart (in conjunction with ADT3) interesting. PJD is also on ADT3 with Avodart. Is there anything you can direct us to that we can read to learn more about suspending Avodart when DHT is =/>5. Thanks again.

tarhoosier
Posts: 193
Joined: Aug 2006

Reference Range for DHT=40-575. Thus if DHT is tested on ADT and stabilizes below 5, you may be assured that it is well suppressed. This information is from my oncologist, as well.
Avodart is prohibited in international Olympic competitions and other venues, as in normal men when DHT is suppressed, it increases the testosterone figures. T is metabolized to DHT, so if this metabolism is interrupted then T remains at a higher level than normally so.
This is just more information about T metabolism, as I think no one here is worried about failing an international athletic competition drug test.

VascodaGama's picture
VascodaGama
Posts: 1740
Joined: Nov 2010

ADT3 stands for Androgen Deprivation Therapy Triple blockade. That is a cocktail of drugs working at the same time, with the aims of reducing testosterone in the body to the lowest level possible, below castration. Testosterone is the “food” of cancer cells.

The cocktail is composed of a LHRH agonist + Anti-androgen + 5-α reductase Inhibitor.
The LHRH works at the pituitary gland to stop it from sending signals to the testes to make testosterone. The anti-androgen has a structure similar to testosterone and it works by attaching itself to the receptors of prostate cancer cells, preventing the attachment of testosterone. The 5α reductase is an enzyme that transforms the normal testosterone into a more powerful (5x) type called Dihydrotestosterone (DHT). The Inhibitor drug works at the adrenal glands, testes and at the prostate to inhibitor such production.

Because each drug has different functions they can be used separately in HT protocols as single blockade, double or triple. This also means that the side effects will be higher on a triple blockade.

A good example of a 5-alfa reductase inhibitor is Finasteride that has shown other good qualities as that of reducing bleeding of prostatic origin, which led to the hypothesis that by cutting micro vascular activity prostate cancer cells will dye. It is used also as a sole drug for maintenance on Intermittent ADT.
Hope these helps any guy out there considering hormone therapy.
VGama

jogger
Posts: 47
Joined: Nov 2009

Hi, VGama,

Excellent information. Regarding castration, are you saying testosterone will still be produced in spite of it?

BTW I had my 12th shot of Firmagon recently. I've always reacted with some shivering, but this time I had to put up with an episode of intense, violent trembling from head to toe for about 2 hours. When it was over, for the next 24 hours every muscle in my body ached.

Gianni

VascodaGama's picture
VascodaGama
Posts: 1740
Joined: Nov 2010

Hi jogger,

About 95% of the testosterone in our body is produced from cholesterol at the testes. However, small amounts (5%) are made in the outer layer of the adrenal glands. Castrate level is reached when the tes-tosterone production at the testes is stopped (<50ng/ml), by means of surgery or chemical castration. This low level is almost enough to starve the cancer cells inducing a kill from hunger.

Production at the adrenal glands could be stopped by surgery (removing) of the glands, but we need them for other body functions. LHRH agonists aim at stopping production (95%) at testes. The other 5% will be circulating freely in our body being used in other functions too.

To avoid feeding PC cells with this low level of testosterone, anti-androgens drugs are used for attaching itself to the receptors (mouth) of prostate cancer cells (few number still keep the mouth open). However the “bandit” cancer adapts in feeding in very low levels of testosterone, or even adapts in feeding on the anti-androgens itself, and never dies. These are called Refractory Prostate Cancer Cells and such event signals the end of hormonal blockade

Hope this clears your question.
VGama.

plusonehm
Posts: 2
Joined: Mar 2013

Had a similar reaction this week with Degerelix.  Not sure if it was the shot or more like flu.  Lasted about 24 horus, with two hours of shaking.

jogger
Posts: 47
Joined: Nov 2009

Sorry, but I hit the post comment button twice.

plusonehm
Posts: 2
Joined: Mar 2013

My new doctor said to take just the Degerelix.  They basically do the same thing, no reason to duplicate

KHA
Posts: 1
Joined: Apr 2013

I was diagonisted with metastatic PC Oct 2011 with a gleason 8 and 9.9 PSA. The cancer had spread to my pelvic and aeorta lymp nodes. Surgery and radation was not an option for me (advised by multiple urologists, oncologists, radiologists) and they agreed that the best treatment for me was Lupron AND Casodex. I've been on it continousely since Oct 2011. My PSA contiunes to decline, currently .12 and my scans are showing regression of the large lymps nodes in both the aeorta and pelvic lymph nodes. I'm not sure if Degerelix is any better than Lupron, it seems to be more of an insureance issue. 

Best of luck to you and stay strong.

VascodaGama's picture
VascodaGama
Posts: 1740
Joined: Nov 2010

KHA

You are absolutely right. Firmagon is newer than Lupron and more expensive but they aim equally.

Firmagon (degarelix) is an antagonist; Lupron (leuprolide) is an agonist. Both drugs do the same job which is to stop the pituitary from sending signals (orders) to the testes to produce testosterone. The outcome will be castration. Firmagon "gets to the point" faster (about 8 days ahead in a life time).

Casodex is an antiandrogen. The role of antiandrogens is to stop cells from intaking androgens (PCa survives on it and dies of hunger). Casodex do that by mimicking the structure of real androgens so that it floods cells receptors, avoiding the intake of the real thing.
Taking booth drugs (agonists plus antiandrogens) is like striking a double punch to the cancer. Two blockades. In some guys double leads to better outcomes than single.

A patient may take only one of the drugs (single blockade) or take both (double blockade) at the same time or add the other when it gets difficult to control cancer progress with only one. The purpose is to stop the feeding of androgens.

All the hormonal drugs or the effect of hypogonadism lead to a series of side effects and symptoms which in some become nasty while in others are mild.

Unfortunately the cancer will start producing its own androgens to survive (Darwin’s principle of survival) and at such point we become refractory to the hormonal treatment. Such event can occur many years after starting HT (many cases of ten years), but even with refractory the fight continues for many more years with secondary drugs.

Best wishes for continuing success.

 VGama Wink

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