Question about hormonal therapy - Casodex and LHRH

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gil_hndez
New Member


Date Joined Jan 2010
Total Posts : 3
   Posted 1/10/2010 11:15 AM (GMT -6)   
Hello to everyone and thanks beforehand to all whom respond.

My father who is 60 was diagnosed with prostate cancer back in Oct 09. At the time he had a PSA of 28 and he was given a Gleason of 7 (4+3). Because he has no insurance and does not qualify for public assistance (Medical), he had the biopsy done in Tijuana, Mx by a highly recommended urologist. At the time, the Dr. in TJ wanted to treat my father by way of castriation (removal of testosterone) and hormonal therapy.

He wanted to get a second opinion here in the States so he ended up paying out of pocket to do so.  A family friend recommend a urologist in Bakersfield, Ca so my father went to him for a couple visits while they did some test (CT scan and Bone Scan). When he got back the results, they were the same as the ones from TJ but the only thing this Dr. added was the bone scan showed that the cancer had spread outside of the prostate to the right pelvis (right iliac) and he needed to see another Dr.  He told my father to start on a daily pill of Casodex and that he would require an injection of LHRH in the near future.  He didn't give him details of when he needed the injection as he wanted to refer him to another doctor.  A "cancer" Dr again in Bakersfield.  Unfornuately t
hat Dr. would my father the time or day eventhough my father could by out of pocket but said my father needed insurance or medical in order to see him! They said they would send him to the county hospital and to start the process there but he couldn't see him now! (The bureaucracy of the US medical system starting to take shape). 
 
Anyways this was about 2 weeks ago and my father is currently at a stand still not being able to get in to see any Dr. as he doesn't have insurance or qualify for medical.   He is able to pay out of pocket for now but we know it is an expensive treatment.  He is currently apply for other programs and is also looking maybe a clinical trials. 
 
Since he is at a stand still and we are worried about the LHRH injection he will need to take along the Casodex so our question is how long after you start Casodex do you need to get the LHRH injection as we can easily go to TJ to get it from the Dr. there for about a 1/4 of th price it cost here.  Ultimately it sounds like my father will have to be going to Tj for treatment. 
 
If anyone has an answer please let us know as my dad is currently buying so time as he will most likely need to reapply for Medical or look for other public assistance or basically forget about getting anything done here and travel to Mexico to have everything done over there.

Any information is greatly appreciate.
 
Gil

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4188
   Posted 1/10/2010 11:30 AM (GMT -6)   
Casodex is usually given at least 2 weeks before Lupron to avoid testorone flare. It is not necessary to get Lupron immediately as it can be added later. Casodex should stop any growth. It would also be helpful in addding Proscar or it's generic, fenisteride; it doesn't cost much and is another type of blocker. It would also be helpful to review some of Ohio State's posts as he has had very good experiences obtaining care and drugs at very little cost without having insurance.
JohnT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 1/10/2010 11:39 AM (GMT -6)   
Gil,

Hello and welcome to HW Prostate Cancer. Sorry you need us, but glad you found us. Looks like John answered your question for you. Please keep us posted on your situation.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 in place


Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4089
   Posted 1/10/2010 1:50 PM (GMT -6)   
Gil, Welcome, I don;t have answers for you but please do keep us posted. I am sure someone will jump in quickly to give their thoughts.

Jeff T
Cajun country
Jeff T Age 57

9/08 PSA 5.4, referred to Urologist
9/08 Biopsy: GS 3/4=7
10/08 Nerve sparing open RRP- Path Report: GS 3+3=7 Stg. pT2c, margins clear
3 mts: PSA .05 undetectable

10th month PSA <0.01
1year psa <0.01
ED- 5 mg Cialis daily, pump daily, going to try MUSE next. Next step injections.
15 months out injections Caveject (success)


60Michael
Veteran Member


Date Joined Jan 2009
Total Posts : 2215
   Posted 1/10/2010 2:14 PM (GMT -6)   
Gil,
Any chance that he would be eligable for VA care? Glad your here and hopefully some ideas will continue to surface that will provide help.
Michael
Dx with PCA 12/08 2 out of 12 cores positive 4.5 psa
59 yo when diagnosed
Robotic surgery 5/09 Atlanta, Ga
Catheter out after 10 days
Gleason upgraded to 3+5, volume less than 10%
Margin slightly involved
2 pads per day, 1 depends but getting better,
8/5 1 depend at night only, now none
 started ED tx 7/17, slow go
Post op dx of neuropathy
3 months psa.01, 6 month psa.4, 6 1/2 month psa.5
Consulting with Primary Urologist for further tx.
Great family and friends
Michael


don826
Veteran Member


Date Joined May 2008
Total Posts : 1010
   Posted 1/10/2010 2:15 PM (GMT -6)   
Hello Gil,
 
First your question. My stats are similar to your father's. I took the Casodex for one month. The LHRH (lupron) was given two weeks after the Casodex. I get a lupron injection every 120 days and did not need to continue with the Casodex apparently. As John said the casodex is given to prevent tumor flare. (rapid growth of the tumor) The is a new drug degerelix (or something like that) that does not cause the tumor flare. I do not believe there is set time from the start of Casodex until the first shot other than the minimum two week delay.
 
Now, some unsolicited advice. Drop the bum you are talking to that is masquerading as a doctor. He has neither human compassion nor empathy. Like your Dad I am uninsured but the reception I have recieived from my doctors has been much better. I asked for and recieved a discount on the normal cost of the treatments and I pay in full cash for each treatment. The casodex is now available as a generic (bicalutimide (SP?)). Cost is around $500 for 30 50 mg pills. The lupron shot retails for around $3000 and I pay about $1100. I am lucky to have the doctors I have. I am astounded that your Dad has recieved such a response. I would complain to the AMA or the state. Sorry, I am about to rant here.
 
I would also question the doctor about radiation. I recieved a full pelvic dose that was intended to get at a suspected lymph node (illiac). May be that it could help with the bone mets. I eally do not know but it never hurts to ask the question. My radiation treatment was around $40,000 out of pocket.
 
Best of luck to you and your Dad.
Don 
Diagnosed 04/10/08 Age 58 at the time
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan clear and chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
Started Casodex on May 2 and stopped on June 1, 2008
Lupron injection on May 15 and every four months for next two years
Started IMRT/IGRT on July 10, 2008. 45 treatments scheduled
First 25 to be full pelvic for a total dose of 45 Gray to lymph nodes.
Last 20 to prostate only. Total dose to prostate 81 Gray.
Completed IMRT/IGRT 09/11/08.
PSA 02/08 21.5 at diagnosis
PSA 07/08 .82 after 8 wks of hormones
PSA 10/08 .642 one month after completion of IMRT, 6 months hormone
PSA 03/09 .38 six months post radiation and nine months into hormones 
PSA 06/09 .36 or .30 depending on who did the test
PSA 09/09 .33 one year after IMRT and 16 months into hormone
 
 
 


gil_hndez
New Member


Date Joined Jan 2010
Total Posts : 3
   Posted 1/10/2010 3:12 PM (GMT -6)   
GOD BLESS ALL OF YOU!  Hope he can bring to all of you good health.
 
Thanks, Don, Michael, Dave, Jeff and John.
 
Michael -  unfornuately my father never served so he is not eligible for VA treatment.  He was enlisted for Vietnam but because of a health problem during inital call up he was not allowed to serve.
 
Don - Yes we know about generic Casodex being bicalutimide.  We also checked Casodex in Tijuana and they are about $150-$200 for 28 50mg pills.  So that price is very reason and about a 1/3 of what it is here.
 
John - Thanks for the refers to the Ohio State state.  Will definately be looking into that.
 
Currently we are waiting on an answer from a program called Impact administrated by UCLA.  Here is the site: http://www.california-impact.org/ .  He will try for Medical as well.  Currently we are just in standy mode waiting for IMPACT and searching for other options.  We will also be looking into other Dr. who will take him even if we have to pay out of pocket for the time being. 
 
Any information or suggestion are deeply appreciate. 
 
Again thanks to all and God Bless,
 
Gil
 

Todd1963
Veteran Member


Date Joined Oct 2008
Total Posts : 3208
   Posted 1/10/2010 3:34 PM (GMT -6)   
Gil. Ohio state is the name of a guy who posts here. He is a great guy and is also a wealth of information. Look him up. Todd
dx:06/03/06
Age at dx: 42 age now 45
Treated for sciatic nerve pain 6 months prior to dx.
Heavy amount of blood in urine Unable to urinate 
Lung x-ray for pnumonia revealed multiple lesions in each lung
P.S.A. at time of dx. 3216.14
Began lupron and casodex
Cat scan showed large mass in the pelvic area affecting the bladder multiple nodules in both lungs and lymph node envolvement.
Bone scan revealed possible bone involvment in the pelvic area
Biopsy 12 of 12 cores positive gleason 3+4=7
P.S.A.s since lupron 2946, 1274, 532, 5.01 1.23, .09
Begining jan 08 psa .o9, .25, .44, .86, .73, 1.34, 1.49. Doubling time is a little over 3 months
Cat Scan 12/12/08 Prostate normal size and shape. No tumors detected. Left lung clear of all nodules right lung showing only benign scar tissue. Lymph nodes normal
Bone Scan 12/24/08. Clean!!! went off casodex January 4 2009
Current psa 2/13/09 .16
Latest P.S.A. 0.05 newest P.S.A. undetectable


gil_hndez
New Member


Date Joined Jan 2010
Total Posts : 3
   Posted 1/10/2010 4:03 PM (GMT -6)   
Todd,
 
Thanks ..
living1963 said...
Gil. Ohio state is the name of a guy who posts here. He is a great guy and is also a wealth of information. Look him up. Todd

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