Prostate Cancer Metastatic To Lymph Node

Does anybody know if casodex and lupron, versus lupron alone is any advantage especially if lupron knocks down the PSA by itself. I realize that Casodex knocks down the small amount of testosterone that comes fron the  adrenal glands, but if the PSA comes down with lupron would it be necessary to also take the casodex? Anybody with prior experince or knowledge about this the info would be appreciated.

initially the Casodex prevents tumor flare, so it should be started a week or so before Lupron.  If you have been on the Lupron for awhile, then flare is not a concern, but the combination does appear to lessen treatment failures.  If there is disease progression then the Casodex can be stopped.

Lupron alone is often used. As said previously, the combination of Casodex can be more effective which is why it  is sometimes added after failure of  Lupron or similar drugs.

Two men I know have seen their PSA reduce to under 1 and .04. One has Eligard, and the other one Zoladex. They discontinued Casodex use after the initial few weeks.

The book by Dr Myers on the subject is very informative.

First let me say to you, I wish you all the best in the journey that lies ahead of  you. I was diagnosed approximately 15 months ago with advanced prostate cancer. My PSA went from 0.2 (approx) to 17.6 in one year. Biopsy revealed that the cancer was out side the prostate gland already, and my Gleasons was 9, my cancer at stage 4. Prior to surgery, I was put on hormone therapy, Lupron, and Casodex. I had serious side effects resulting from the Lupron. Anger, mood swings, depression, hot flashes and more. Following my radical prostatectomy, I was told the Cancer had spread to two of six lymph nodes that were taken and dissected. I was also placed back on the  hormone therapy, (Lupron and Casodex again), and the side effects returned. Following surgery my PSA was still 3.5. After a couple months it had dropped back to 0.2. The side effects became so intense, I opted to discontinue, the Lupron. My Oncologist also discontinued the Casodex at that time as well. Shortly after discontinuing the meds, my PSA rose to 3.6, four weeks later, it went to 4.8. I've since increased the Casodex to 3 per day, but have not yet returned to the Lupron depot. While on the Casodex I have not seen as much of the side effects as with the Lupron/Casodex combination. However in two more weeks I will have to have another PSA test done, at which time if the numbers have gone up again, I will have the choice to make again, as to whether or not I will return to the Lupron therapy. At this point I don't know. I think it important to know that my PSA went from 0.4 to 0.2 in one month, and then from 0.2 to 3.6 in only four weeks. In four more weeks, the numbers went from 3.6 to 4.8. So, the point being, the Lupron did work better with the Casodex than the Casodex has worked alone, although I will know in a couple weeks if the triple dose of Casodex has done the job by itself. It's also important to know that it takes time for the medicine to build up in the system; which is the reason I have still opted not to return to the Lupron yet, but I am waiting to see if the larger doses of Casodex will have the same effects on the Cancer that the Lupron and Casodex combination had. I know this does not necessarily answer your question, but the information may help you. I have also been prescribed a mood stablizer (Lexipro) in order to counter the effects of the depression. All the best.

I would like to expand on some of the information you discussed.  

First, the actions of lupron and Casodex are very different.  Lupron turns off the bodies production of testosterone from the testicles.  This is why you experienced the side effects.  Casodex is an anti-androgen, it works in the body by blocking the androgens (male hormones) so they can not bind to the cancer cells.  With Casodex alone you still produce testosterone, but the cancer can not use it, so you don't experience the same side effects.

In the Uniter States the FDA has only approved 50mg (one pill) per day which needs to be accompanied with the Lupron.  In Europe, they have approved 150 mg (three pills) has a single treatment, this is called monotherapy.   Monotherapy is not as effective as Lupron with Casodex.  However, if the side effects have been that bad, monotherapy clearly offers a good alternative. 

An additional point, anyone one monotherapy must have their liver functions monitored on a regular basis.  Liver damage is a common and significant side effect.  

If you are on a Lupron Depot, besides your PSA,  have your doctor regularly monitor your testosterone (T) level to make sure that you have been able to get it below 20 ng/dl (meaning you are chemically castrate).

I   write a blog about my advanced prostate cancer at www.advancedprostatecancer.net   Feel free to take a read.  Also sign on to the petition to make prostate cancer a national priority at: www.prostatecancerpetition.org

Joel 

I was diagnosed with prostate cancer in Sept. 2007. I had opted to use the HIFU (high intensity focused ultrasound) treatment but my prostate was too large for the treatment; being 72cc. I had to reduce it to 40cc. The urologist place me on Zoladex implant and Casodex pills (one per day). I did not experience any of the mode swing problems. The only problems I did experience were hot flashes, no erections, shrinkage of the testes, loss of some body hair and reduced muscle strength. I did not have any emotional changes. Everything was normal other than the phyical and physiological changes that I mentioned. The combination did reduce the prostate size initially to 45.5cc but I had trouble trying to get it reduced any further so I switched from the Albatherm HIFU procedure to the Sonablate HIFU system which could treat prostates upto 50cc.

 

On 3/29/2008 Sobbactor wrote:

First let me say to you, I wish you all the best in the journey that lies ahead of  you. I was diagnosed approximately 15 months ago with advanced prostate cancer. My PSA went from 0.2 (approx) to 17.6 in one year. Biopsy revealed that the cancer was out side the prostate gland already, and my Gleasons was 9, my cancer at stage 4. Prior to surgery, I was put on hormone therapy, Lupron, and Casodex. I had serious side effects resulting from the Lupron. Anger, mood swings, depression, hot flashes and more. Following my radical prostatectomy, I was told the Cancer had spread to two of six lymph nodes that were taken and dissected. I was also placed back on the  hormone therapy, (Lupron and Casodex again), and the side effects returned. Following surgery my PSA was still 3.5. After a couple months it had dropped back to 0.2. The side effects became so intense, I opted to discontinue, the Lupron. My Oncologist also discontinued the Casodex at that time as well. Shortly after discontinuing the meds, my PSA rose to 3.6, four weeks later, it went to 4.8. I've since increased the Casodex to 3 per day, but have not yet returned to the Lupron depot. While on the Casodex I have not seen as much of the side effects as with the Lupron/Casodex combination. However in two more weeks I will have to have another PSA test done, at which time if the numbers have gone up again, I will have the choice to make again, as to whether or not I will return to the Lupron therapy. At this point I don't know. I think it important to know that my PSA went from 0.4 to 0.2 in one month, and then from 0.2 to 3.6 in only four weeks. In four more weeks, the numbers went from 3.6 to 4.8. So, the point being, the Lupron did work better with the Casodex than the Casodex has worked alone, although I will know in a couple weeks if the triple dose of Casodex has done the job by itself. It's also important to know that it takes time for the medicine to build up in the system; which is the reason I have still opted not to return to the Lupron yet, but I am waiting to see if the larger doses of Casodex will have the same effects on the Cancer that the Lupron and Casodex combination had. I know this does not necessarily answer your question, but the information may help you. I have also been prescribed a mood stablizer (Lexipro) in order to counter the effects of the depression. All the best.

Please check out (www.immunemedicine.com) because I had stage D prostate cancer in October 1998 and after 9 years I no longer have any signs of cancer, beleive me this treatment works.