Casodex monotherapy

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.

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

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 said:

Thanks for your interest. I

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

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