Possibly going back on ADT

Hi Mom,

It is most unfortunate to read that the bandit didn't keep dormancy. I do not recall your husband's story (age, extent of disease and treatments) but you need to choose wisely what to do next. Casodex is an antiandrogen that does not interfere with the production of testosterone but acts in avoiding the absorption of the stuff by the cancer. It works well for a period (long in some guys but short in others) at the cell's androgen receptors (their ugly mouth). The drug's biostructure mimics the testosterone enticing the bandit to try to absorb it but the stuff gets stacked prohibiting absorption of the real androgen.
The baddy with Casodex is that leads to refractory once the bandit manages to unclog the obstruction and starts feeding on the casodex itself. This happens with all types of antiandrogens (Zytiga too). One needs to be vigilant and stop taking it as soon as the PSA starts increasing continuously (three considerable increases from a nadir).

Firmagon may be a substitute to Lupron. It is an antagonist working similarly at the pituitary to stop production of testosterone but it is friendlier as it doesn't cause havoc to the extent of that caused by agonists (Lupron, etc), therefore with lesser side effects. It is more expensive than Lupron but cheaper than Zytiga. The pitfall of Firmagon is that it is taken on monthly basis.

In any case, the increase from undetectable (???) to 0.3 ng/ml can be considered low in a patient where Lupron had worked so well. I believe on intermittent approaches in hormonal treatments and you could explore possibilities in advancing with intermittent protocols in ADT. You should consult a medical oncologist specialist in PCa. You can also inquire on the continuing symptoms he is experiencing. Some doctors recommend estrogen patches to elliviate persistent hypogonadal symptoms. Estrogens are known to substitute lacking testosterone in the functioning of organs that depend on testosterone for its proper work.

Best wishes and luck in his continuing journey.

VGama

Another feature of Firmagon is that with Lupron they usually add Casodex at the beginning to avoid the "flare" that comes when you start the Lupron class of drugs. Firmagon does not have this issue, as a matter of fact my doctor uses Firmagon alone for the first moth before switching to Lupron or staying on Firmagon as I did.

George

There is a T99 technitisium bone scan and an F18 pet bone scan which is better for dectection.

There are various types of pet scans. There is an axium that is coverage by medicare, and is Okay.. There are also investigation pet scan which are better,and provide better dectection. Here in CA there is G68 PSMA that has just been approved. ucla and ucsf are two hospitals that provide this..Up until now there has been a 2700 charge for the scan at ucla. Some of the other major institutions in the United States also have or in the  process of developing "better" pet scans. These petscans are very effective in locating spots of cancers that can be erraticated. This is state of the art.

Best

hopeful and optimistic said:

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There is a T99 technitisium bone scan and an F18 pet bone scan which is better for dectection.

There are various types of pet scans. There is an axium that is coverage by medicare, and is Okay.. There are also investigation pet scan which are better,and provide better dectection. Here in CA there is G68 PSMA that has just been approved. ucla and ucsf are two hospitals that provide this..Up until now there has been a 2700 charge for the scan at ucla. Some of the other major institutions in the United States also have or in the  process of developing "better" pet scans. These petscans are very effective in locating spots of cancers that can be erraticated. This is state of the art.

Best

I had Axumin Pet scan a week ago and when I went to Urologist yesterday the report showed that the cancer has mastasticized into two lympy nodes. 4 1/2 years ago the Dr did biopsy of prostate and found cancer Gleeson score of 8 and did 44 rad treatments and the Nadir after one year went to 0.3 then gradually up to 2.3 by March of 2021 so now I am back on Eligard and Dr wanting to do a new drug called Erleada but problem is my health insurance plan (Medicare Advantage) has denied. I cannot afford this drug as it would cost $13000 a month or about $150 K a year taking 4 tablets a day. After seeing this happen i wonder if a prostate cancer servivor has to be rich to get the right treatment if Insurance denies. ?