lampman

Dickiedo:I have posted my case below....I had the same questions when I was told that I would be coming off Casodex and Eligard injections in November of this year. I attached the response that I got then for your reading. I was/am a little concerned that I will see a large "bump" in PSA after I am taken off the meds. Time will tell. I too was told that I would not need to see my uro for 6 months which is up in November. I will have a PSA taken then and if all is well, the drugs take a vacation. I didn't not have surgery, but did the EBR then the meds.
LOTS OF LUCK IN THE FIGHT and keep us up to date.


Quote:
Originally Posted by lampman
... Opted for radiation treatments (43) and hormone therapy of injections of Eligard every 6 months plus 50mg. Casodex tablet every day. I have had 6 PSA tests repeated and all were <.01
or "undetectable" as the uro says. I experienced the normal tenderness of breast and swelling, but all in all, not very much discomfort. I now have been told by my uro he is planning to take me off of Casodex in May when I go for my next injection. Is this normal? If the PSA is under control, why would he wish to take me off of it? Does one develop an immunity to these drugs. Not complaining, just curious. Any time I can get off of a drug, I am for it!! Should I expect to see a rise in PSA levels? And at what level should I become concerned? Thanks to the Brotherhood out there that are going thru this, it truly does make it easier for us!

Like able5, I haven't had direct experience with radiation plus hormonal blockade, but I've been on hormonal blockade by itself on and off for eight years and have followed developments closely.

It is becoming fairly standard to combine hormonal therapy with radiation as the effectiveness of radiation seems much improved by that approach. The timing is still being researched. It now appears that three years is better than six months, but maybe the best number will turn out to be something less than three years. My impression is that often only one drug, equivalent to your Eligard, is usually used, though I personally think two would be better, including Casodex, or even three, adding finasteride or Avodart.

However, with those low PSA levels of <0.01, your combination has obviously worked extremely well for you. Possibly the doctor wants to see if you can maintain that level for a while with just the Eligard, and I suspect that, having gotten down there, you have a good shot at keeping it there - keeping control that is just as good. If not, he could start the Casodex again and almost certainly get the same response.

At some point he may suggest you stop the Eligard too. Is that the plan? The idea would be to see if you have been cured. That is the typical approach with hormonal blockade as a booster to radiation, but with cases that have some challenging features, like your PSA and Gleason, the doctor may want to continue the blockade indefinitely, or, more likely, try an intermittent progam. Hopefully you have been cured and can go off the drugs and stay off.

If you do go off, you would probably have an increase in PSA up to the normal level for after radiation. That should come from remaining healthy or recovered (from radiation) healthy prostate cells that are still making PSA. My impression is that the level is pretty low, but not as low as surgery, which ideally is less than 0.01 and at least less than 0.04 to give you a good shot at a cure.

Immunity to the drugs is another issue. It's not exactly immunity, but it is something to consider.

That's what I understand. I hope you get a response who has used the combined approach you are on.

Take care and good luck,

Jim