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mayrog

Information about Bicalutamide therapy please

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mayrog    0
mayrog

I was diagnosed with advanced, localised PC with PSA  >8 three years ago at age 80. Immediate therapy was Leuprorelin until PSA was <0.5 in Feb last year when it was paused. Since then, PSA has increased to 5.5 and my urologist now proposes my going back on Leuprorelin or, as an alternative, going onto Bicalutamide. He explained that Bicalutamide blocks the action of testosterone's promoting tumor growth and is normally used in conjunction with another drug to also suppress testosterone production. In my case (maybe in view of my age?) he does not consider the other drug to be necessary and this will allow me to make the most of my remaining testosterone. One downside is that Bicalutamide, when used on its own, is not covered by the PBS and will cost me $50-60 per month.

 

I'd be very grateful for comments. I'm fairly sure that the Leurprorelin would see me out OK but I'd rather avoid its side-effects if I can.

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Kezza2    1
Kezza2

According to the PBS website it is covered and max cost to consumer is $38.80.  I have never taken Cosudex, so am not aware of the side effects, but I used Lucrin Depot 3 month injections for 15 years until it stopped working and found the side effects minimal, with the exception of breast enlargement, which I can tolerate.  I am now on an abiraterone plus apelutimide trial and still receive the Lucrin every three months, and it is working very well.  Did you not tolerate the Lucrin well ??

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mayrog    0
mayrog

Thanks for comment Kezza. It was my urologist who told me Bicalutamide would not be covered if used on its own. I also note on PBS website that clinical criteria for PBS approval require that "The treatment must be in combination with GnRH (LH-RH) analogue therapy"?

 

My experience on Lucrin wasn't too but I certainly do feel that I  enjoy life more without it.

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alanbarlee    9
alanbarlee

G'day Roger (?),

Cosudex (bicalutamide - is an 'anti-androgen' that, as you say,  blocks PCa cell access to serum T / DHT. 

You're right about the PBS requirement that, for subsidised use,  it has to be used in conjunction with Lucrin, Zoladex and the like  (LHRH agonists, or possibly) with Degaralix (an LHRH antagonist).

Cosudex can be prescribed as 'low dose' (common) or 'high dose' (uncommon). It has a common side effect of enlarging the breasts and making them tender (gynecomastia) - more so when it's  the sole medication. Hot flushes seem to often occur with LHRH modifiers, with or without Cosudex.

With the combination, or it your T level is now permanently low, loss of bone density and increases in serum lipids, glucose and liver / kidney functions are important to monitor - especially if borderline (or worse) numbers are a current issue.

Cosudex alone may leave you with circulating testosterone that can protect against these side effects, but you may need to check whether or  you still have T levels that are useful to protect.

Keep in mind that the PBAC is likely to be announcing this month its recommendation for PBS pre-chemo use of another, much more effective, anti-androgen - Xtandi (enzalutamide). If the recommendation is positive, government approval can take up to another 6 months. Again, it's likely that concurrent use of an LHRH modifier would be required to get the PBS subsidy, since this is how the Xtandi trials were conducted.

Either way, you might want to review your personal preference for quality of life in all its dimensions vs. (statistical) survival time when you chat over your treatment options with your doctor.  80 is the new 60!

Cheers,

Alan  

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Russ    0
Russ

I agree with Alanbarlee's response,

But be aware of possible Liver damage potential, Liver Function must be checked.

And may interact with a number of drugs.

So be aware

Russ W

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mayrog    0
mayrog
20 hours ago, alanbarlee said:

you may need to check whether you still have T levels that are useful to protect.

 

 

Current T level is 4.4 nmol/L.  Not exactly "raging" but do you think it could be "useful"?

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alanbarlee    9
alanbarlee

G'day again - and Happy Easter!

Checking via Google, it seems that 'normal average' weight for age T is around 16 nM/L for a 75-84 year-old, vs 24 when you were a 'raging' young guy of 25 or less. T is highly variable from man to man, and from morning to evening, and as we get older it drops naturally  at around 1-2% pa - which adds up.

Your level of 4.4 is therefore around a quarter of 'average normal' for your age - probably reflecting your use of Lucrin. There is a chance (but no certainty) of some further T recovery over time. 

There is a net benefits balance to be considered, viz between treating possibly disabling PCa vs protecting your remaining (or possibly improving) T from the progressive side effects of more aggressive PCa treatment. it might be useful to consult an endocrinologist, as well as your medical oncologist to help you to decide this. I'm no doctor, and I couldn't begin to advise you on that question.

Let's know which direction you choose to go.

Best wishes,

Alan

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mayrog    0
mayrog

Many thanks, Alan - helped a lot. A happy easter to you too.

Cheers, Roger

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John    0
John

Im not sure if this information will help,but here is a brief history of my own Journey.

June 2008 At 62, diagnosed with Gleeson 4+5=9 localised. PSA 21

OCT 2008 Radiation Treatment 74 Gray , 35 treatments.

initial success but PSA rose  to 12 in Nov 2011.

Urologist gave me a choice of Twice a year very expensive medication, or a bilatereral Orchidectomy. ( i am not an australian citizen and have no health cover so air fares and the medication would have been impossible.) so I chose the latter.

Nov 2011 Had bilatereral Orchidectomy. 

Eleven PSAs later to March this year all 0.03.

 

A  Bilatereral Orchidectomy certainly stops 99% of testosterone. and 100% of your sexual Appetite.

There are no interest in Sexual matters at all, after this procedure  so its not really a problem for me, except when your mates start talking about their conquests, and a little bit of nostalgia sets in. However if you have a partner that is still active sexually this procedure is not for you. I am surprised that this procedure, is never discussed or talked about in the treatment of prostate cancer.

 

To my PSA result in March this year was added a small note, "Treated", this was after 5 years of minimum results. (Notice it didn,t say Cured). 

I live in Vanuatu and all my treatment has been done in Australia at my own expense.I will continue with my PSA tests and hope the result stays the same.

Hope whichever road you choose mayrog, you get some positive results.

 

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Roscoaus2000    0
Roscoaus2000

Thought you might be interested in my journey. At 65 in 2005 , I had a DRE and psa test. Psa 7. No abnormalities felt on prostate. Decided on no treatment as concerned about infections from biopsy. Psa increased slowly up to 27 by 2010. In 2012 it was 59 and again decided on no further investigation as I had no signs and I was physically fit. We then moved towns and retired and started cruising around the world. It wasn't until 2015 when I turned 75 I saw an md again. This was required for my drivers licence. All checks were good except psa was 1400. Still no symptoms. Later that year I started to get arthritic pains when I eat high gluten foods but this disappeared next day. Sexual function started to reduce but this was no problem as wife had diabetes and had also lost interest. During 2016 I got excruciating lower back pain whilst on a 75 day cruise. Upon return home I saw my md and he referred me for a cat scan in Sept. This showed advance prostate cancer and widely skeletal metastises. In Oct. I saw an oncologist and he prescribed Zoladex injection and Cosudex daily. I also had a full body Cat scan and a full body bone scan. These confirmed the diagnosis and were a base measurement for progress. My psa at that time was 9000.

At my next appointment after 3 months my psa had dropped to 0.76 and I had started to regain my strength. 

April 18, 2017 cat scan and full bone body scan repeated and the majority of prostate cancer is resolved. Skeletal metastises appear to have reduced in size and have not increased in number. Am awaiting result of psa.

I am covered by Medicare and can not thank the hospital staff for their treatment of me and am thankful for Australias fantastic medical system.

Today  20/4/17I saw my gp and psa is 0.11 and testosterone is 3 (normal 8-23).

Edited by Roscoaus2000
Updated info.

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