Should I switch from Elagard to Casadex?

This is my first post to what looks like a great forum!  Have to make a major decision on treat in next month or so and thought it'd be a good idea to get some other opinions.  Background info is as follows:

I was diagnosed with prostate cancer last February, PSA of 11, Gleason score of 8.  Robotic Laproscopic Surgery not an option due to previous hernia repair.  Had external beam IMRT enhanced by use of gold tracking seeds to allow adjustment of beam for gland movement prior to each treatment.  Started Elagard (6 mo. injection) 1 mo. prior to begining radiation.  Took Casadex for 1st month to offset effects of initial hormone surge. PSA had increased to 17 at time of initial Elagard shot, decreased to 1.0 after 1 month.  Finished 8 weeks of daily radiation treatments in August, at which time PSA was non-detectable, where it has remained ever since with checks every 3 months.  Urologist originally said I would be on the hormone treatment for 2-3 years, as Gleason 8 indicated cancer had probably escaped gland. At last visit ~3 months ago, he said that because PSA came down so far so fast, although you never want to say never with cancer, the PSA trend was a very good sign, and the cancer may not have escaped the gland as originally feared, and I may even be cured!  Although I'm very thankful for this good result to date, I now have ED which is not responsive to viagra, etc. I'm only 67 and was a pretty active guy with no ED problems before all this stuff hit. I'm due for next 6-month dose of Elagard at next 3 mo. visit. IF next PSA check is unchanged, am considering going off the Elagard and going on Casadex for 3 months to see if hormones return enough to help with the ED.  The medical oncologist who urologist referred me to and who recommended the excellent radiation oncologist I went to, said the switch to Casadex was a viable option.  Will obviously discuss with urologist first, but wanted to get some opinions from others in the meantime. 

 Am I nuts to even consider changing treatment when it appears to be working well?  The hot flashes aren't all that bad and I still have quite a bit of energy, but sure would like to have a shot at improved libedo, etc. if it doesn't pose significant risk of the cancer returning!

Any advice or stories of others experience would be appreciated!

My opinion only:

Intermittant hormone ablation therapy is being utilzed more and more to improve quality of life issues. There are few studies that indicate whether intermittant hormone ablation therapy has any adverse impact vs continual therapy. I believe that you should partner with your physician on this and if he/she is uncomfortable you may want to dig a bit on some of the actual studies that have been done and discuss it with him/her. If the cancer is not total cured, you have to expect that at some time your psa will rise again and that hormone ablation thereapy would need to be restarted.

As to impotence, the lack of testosterone from hormone ablation likely will eliminate most, if not all sexual drive. That is why Viagra is not working---Viagra only works if you are both mentally and physically stimulated. The radiation thereapy likely resulted or will eventually result in impotence; however, without hormone ablation,Viagra should work to various degrees.

 Good luck to you,

Joe 

  

 

Like many aspects of  Prostate Cancer there are no clear cut answers to your question.

I always suggest that anyone interested in hormone therapy read the publications by Dr Charles Myers or the book by Lee Nelson MD. Both of these doctors have undertaken radiation and hormone therapy for their own high risk PC some years ago.

There have been several studies which have shown greatly improved 5 year survival rates with 3 years of hormone treatment combined with radiation in intermediate and high risk situations.

Here's what Dr Nelson thought about his own treatment option: " I chose to use androgen blockade for 27 months. At two years nearly 30% of men have permanent shut down of testosterone production. At three years, obviously it's higher. Twenty-seven months seemed like a reasonable compromise to me. However, if cure had been my only consideration, I would have stayed on hormones for three years."

Thanks for the great feedback!  I found one very good article by Dr. Myers in which he strongly favors intermittent hormonal therapy as opposed to continuous hormone blockage and claims that it appears to lower the risk of developing hormonal resistance. He also mentioned that it was important to monitor testosterone and dihydrotestosterone, which my urologist did say he wanted to check prior to next visit.

 Have not been able to find any books by Lee Nelson MD.  Do you happen to know titles of any books by him?

 

On 5/14/2009 Bluefish1 wrote:

Thanks for the great feedback!  I found one very good article by Dr. Myers in which he strongly favors intermittent hormonal therapy as opposed to continuous hormone blockage and claims that it appears to lower the risk of developing hormonal resistance. He also mentioned that it was important to monitor testosterone and dihydrotestosterone, which my urologist did say he wanted to check prior to next visit.

 Have not been able to find any books by Lee Nelson MD.  Do you happen to know titles of any books by him?

Dr Lee Nelson's book was published several years ago, however  it is still one of the most comprehensive and best publications, especially for someone in your situation.

I understand that the book "Prostate Cancer Prevention and Cure" by Lee Nelson MD is still available from Amazon. 

Dr Charles Myers contends that most men diagnosed at 'hormone resistant" are not.

His book " Beating Prostate Cancer: Hormonal Therapy & Diet can be ordered from his website.

In his book, Dr Myers covers your question on how long to continue with hormonal therapy, and yes he does say that if the goal is to lower androgen levels it seems obvious to measure testosterone an dihydrotestosterone levels to see if the medicatiion is working.

 

 

 

Have now read both Dr. Meyers and Dr. Nelson's books and had followup visits with radiation and medical oncologists. I was particularly impressed with Dr. Meyers work.  Have now been on Eligard for a little over 12 months.  The radiation oncologist said that when radiation is given alone, the results were a gradual reduction in PSA for about 18 months because the radiation effects continue to kill cancer cells for that length of time.  Her concern was that if I stopped hormone therapy at this point, that PSA would mostly like spike up to what it would have been had I just had radiation alone.That rationale, plus the fact that I was a Gleason 8 with a fairly agressive cancer, convinced me to continue the Eligard for another 6 months, at which point I will revisit the issue again. Testosterone level is zero and PSA is < 0.1, so my medical oncologist said there was no need to check DHT levels at this time, but any increase in PSA would warrant checking both testosterone and DHT and possibly begin the use of Casodex and maybe Proscar, as recommended by Dr. Meyers.  Am also trying to switch to the Meditereanian diet and vitamin supplements as recommended by Dr. Meyers.  At this point I plan to get PSA checks every 3 months and let the results determine the future course of treatment.