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Cancer: Prostate Message Board

Cancer: Prostate Board Index

Hi again,

Your anxiety about starting the drugs reminded me that hormonal therapy is a big deal to patients who are facing it for the first time and who realize that it is likely to have some unwanted side effects as it fights the cancer. Hormonal therapy became routine for me over the thirteen years I was on it intermittently, and I became quite comfortable with it, knowing what to expect and how to cope with the side effects. I had a bit of a favorable break on starting hormonal therapy as well: my wife and I were very worried about my serious case; our focus was on survival, and that made me [I]eage[/I]r to start hormonal therapy as soon as possible. That is not the situation for many of us, and you are in that boat with a lot of company.

Your doctor's suggestion is standard for a great many doctors who use hormonal therapy in support of radiation: a short course of Casodex (more likely the less expensive but effective generic version known as bicalutamide) with the primary objective of preventing "flare" that is often caused by Lupron, sometimes with serious effects, especially if the patient has significant spinal metastases. As you probably know now, Lupron briefly elevates testosterone (the "flare"), which can cause a temporary growth surge in any prostate cancer, before the Lupron "persuades" the endocrine system/testes that the body has too much testosterone and needs to shut down production. That happens within days to a couple of weeks, and the surge can be shut down somewhat gradually or abruptly depending on the dose of bicalutamide. With my own desire to start Lupron ASAP, a doctor agreed to give me a shot without preliminary Casodex, but only after he had interviewed me thoroughly about the condition of my back (spine), which was then problem free (some arthritis now). I did experience flare: 12/7/1999 PSA 113.6; Lupron 12/20; PSA on 12/27 of 125; subsequent plunge by about 1/3 each month, and no apparent problems then or later due to the flare. That said, an expert at the City of Hope (Duarte, outside LA) was appalled that I had not been given Casodex in advance.

It is also fairly standard, as I understand it, to use just one drug (or bilateral surgical castration) in support of radiation, and that seems reasonable to me. However, I had become a believer in combined hormonal therapy, in fact what is known as "triple therapy" over thirteen years prior to having radiation (waiting for technology to improve), and I was eager to have triple blockade to support radiation. Either combined (two drug, or surgical castration plus an antiandrogen (bicalutamide-like) drug, or triple blockade are legitimate options to single drug blockade with a short course of bicalutamide. I read an expert's statement the other day that salvage radiation was successful (curative) in about 50% of cases (and likely yielding great improvement in many more cases, often good enough for quality survival for a lifetime), but that extra hormonal therapy might be what has given me such impressive results to date, despite an initially challenging case. If you wish, I could provide more information on that, but I just did a quick scan for relevant published research on combined blockade to support radiation and was unable to find any.

Do you know how long the doctor wants you to be on blockade? Vitamin D3 plus calcium in Citracal (which I still take) would be fine for a short course, but I would be worried about bone density if I were on a course of hormonal blockade for more than a few months without a drug for bone density protection (in addition to the supplement).

Good luck with this.

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