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Casodex monotherapy

tonybuxton
Posts: 86
Joined: May 2012

I have been successfully treating my cancer with Casodex (bicalutemide) monotherapy 50 mg daily for four years. I'm on intermittent treatment two months on, three months off. however, I have now reached the stage where the cancer mutates  and apparently feeds off the drug. So I have stopped taking it and instead of PSA going up. It is gone right down. I gather that it will stay down for quite some time.  What I want to know is when it starts rising again. Can I resume taking Casodex  or has it become  resistant. If so, what do I do next? I cannot take drugs like Lupron because one 3 month shot nearly killed me.  I cannot take drugs like zyrtiga because there's no way I can afford them. I have no insurance or healthcare. if casodex will not work any more. Will other antiandrogen drugs work? My cancer is still in the prostate gland and has not spread.

Grinder
Posts: 440
Joined: Mar 2017

Are you located, tony? If here in the states, have you applied for Medicaid? My brother was on it for years, but that was before Obamacare... so I dont know how it is run anymore. Are you avoidung other treatments because of the high cost? Those costs can be negotiated.

I think guys need a WHOLE lot more information... like, have you discussed other treatments with your doctor? Why did you settle on ADT over such long term? ADT will only supress cell activity in the prostate, for a while. Here is a diagram of Androgen activity if it will help.... ADT supresses androgen production and or androgen reception. I dont know which Casodex does.

If you have been posting in this forum since 2012, why havent you pursued other courses of treatment? Just curious. 

Grinder
Posts: 440
Joined: Mar 2017

graph

As guys point out on this forum, ADT is not curative, and it sounds like you are playing a risky game just suppressing cell actvity. Once your cancerous cells have mutated a resistance, they will continue to divide and multiply more resistant cells.

Maybe someone with more experience with ADT can help you better than I can, but my first impression is to start investigating other forms of treatment and their accessibility. I am guessing Casodex inhibits androgen reception. That is why it the PC cells are becoming resistant. But someone else needs to address that.

VascodaGama's picture
VascodaGama
Posts: 3012
Joined: Nov 2010

Hi Tony,

I am sorry if refractory is the issue. You did well in stop taking the drug. However, the decrease of the PSA signifies that the cancer is still hormonal dependent which assures you prolonged control on the advancement of the bandit. Typically oncologists replace antiandrogens by others with different chemical compounds (eg: instead of Bicalutamide they use Cyproterone acetate or Flutamide or Nilutamide, etc), which cost approximately the same. Other tactics is to increase the dose from 50 mg to 100 or 150 mg. When these fails then patients move to other more drastic blockade approaches like castration (chemical or permanent). One drug to consider before permanent castration, which works similarly to Zytiga, is the old drug Ketoconazole also a CYP17 inhibitor but cheaper. It has been used before Zytiga become available by the several famous oncologists treating prostate cancer. The drug has more side effects than Zytiga so that it has been put on the shelves. You need to consult your oncologist to verify if it interferes with your other health issues.

We have discussed on bicalutamide refractory before. I think it better for the newbies reading your post to be informed about the phenomenon of the antiandrogen withdrawal response (AAWR) you are experiencing. This drug is made up of a similar biostructure of the real androgen, faking and trying to instigate the bandit in absorbing it. At the beginning of the treatment, the drug successfully stacks the receptors of the cancerous cells (the mouth of the bandit) so that it avoids the absorption of the real stuff. The effect can last many years but the bandit manages to mutate its ARs (androgen receptors) start feeding on the antiandrogen itself. The PSA increases and then goes down once we stop the drug. Here are reading materials on the matter;

https://pcri.org/-aawr-the-anti-androgen-withdrawal-response/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3359896/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2615041/ 

Reading material on antiandrogen's monotherapy;

https://www.europeanurology.com/article/S0302-2838(06)01006-2/pdf/antiandrogens-in-the-treatment-of-prostate-cancer

I wonder your PSA histology. Can you tell us what the last value is and how much it has decreased?

Best wishes,

VGama

tonybuxton
Posts: 86
Joined: May 2012

Hi VG. Nice to hear from you

I had been on Casodex for five weeks. When I checked my PSA it has gone down from 34 to 3.5. Just afterwards I was hospitalised with food poisoning and the doctor stopped all my medication. I was off Casodex for 10 days and rechecked my PSA. I had expected it to go up. But it had gone down to 2.5.  I presumed that the medicine had become refractory.  So I didn't take any more. My plan is now to recheck my PSA again in another two weeks. I would presume that if it still down, the medicine has become refractory, but if it goes up, it probably means that it hasn't. Because normally when I stop taking the medicine my PSA goes up quite quickly. So really I am at a bit of a loss what to do next. I guess I could try one of the medicines that you mentioned, but I think ketokonazole has an interreaction with wafarin.

Thanks very much for your help. Tony

Old Salt
Posts: 720
Joined: Aug 2014

Sorry, but I don't understand the issue. You report that Casodex dropped the PSA from 34 to 3.5. Hence, it was 'working'. Then you went off Casodex for other reasons and the PSA dropped some more. Maybe due to the lingering effect from the prior Casodex therapy. Doesn't matter, really. I don't see evidence that you have become Casodex 'resistant'.

Just to be clear, the medicine does not become refractory, the cancer does.

tonybuxton
Posts: 86
Joined: May 2012

Thanks for your interest. I start taking Casodex When my PSA goes up to about 35. I take it for about two months . the check my PSA which usually about 2.5 to 3.5. I then stop for three months. I have been doing this for a long time. Very recent MRI showed that the cancer was still in the prostrate and had not spread outside. Usually after taking the medicine for two weeks. It does go right down. But if I stop taking it, then, it will go up again quite quickly. I find that I have to take it at least two months and the longer I take it the longer it takes to go up again.

You may be right in that the casodex  was still lowering my PSA After I stopped taking it.

I realise my efforts to keep my cancer in check might be rather strange.  But I have a lab close by which checks my PSA for $20 without seeing a doctor or any extra expenses. So I can keep an eye on it

I live in Thailand and the cancer doctors which are available near where I live, don't even know what casodex is. The ones in the big Cities that do know what it is, claim it is too expensive to use here. There is no Genetic bicalutemide  available. I get it brought in from friends living abroad.   I get more good advice from this forum than I get from any doctor here.

I am 87 and since I stopped seeing doctors about five years ago. I've got better and better, all they do is prescribe me masses of medicine. 

Tony

Old Salt
Posts: 720
Joined: Aug 2014

Your treatment plan doesn't seem 'rather strange', in light of your explanation. I hope the 'on-off' strategy will keep working for you.

PS: I am surprised though that you can't get generic bicalutemide in Thailand

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