Do they bypass using casodex in patients for good reasons ($$$$-flow)

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zufus
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   Posted 6/13/2011 6:11 AM (GMT -6)   
Even my onco doc doesn't pooh-pooh this line of thinking and of course being the nice inquistive type whom enjoys the transparency of what is really going on in patient care, have this to contemplate.  So you are a newbie to usually a uro-doc because of the prostate issues envolved (not always a uro though).  Now when it comes the time to have the patient put on any PCa controlling drugs, the choice is often narrowed down just to Lupron and seldom are patients given casodex or its equals, prior to prevent 'T' flare issues which can be real and in some rarer cases even threatening or debilitating.
 
Is it ignorance, is it arrogance, is it for other nice reasons.  Remember these uro-docs and others go to seminars and junkets from drug companies and have salemen pushing their drug sales in fun incentive like ways (all because they love you the patient). So, at these meetings that sometimes include their question and answer sessions, I believe the subject is well known...how to maximize profits...today it is all about business...only a chump or sucker would attempt to be altruistic is the mentality (now zufus that is harsh-LOL). So, I believe they know plenty and play dumb to patients, we noticed this happen numerous times when talking about estrogenic drugs,  alternative medicines, special scannings, color doppler, knowledge of their PCa specialist competitors (who?)- Leibowitz, Scholz, Strum, Myers? Kind of like playing the foreign language cards, no comprendo (LOL). So then let's contemplate why is this happening, books and things say to prevent 'T' flare, one guy died from complications of such in Dr. Strum's book.
 
Well if the doc risks putting you on casodex or generic versions of it, the person while waiting the 14 days or longer before you get than excellent Lupron (LHRH) injection, what if the dumb patient gets a psa test somewhere?  He might find out hey it works well, my psa dropped decent already and the side effects are tolerable it seems and less doctor office visits=  NO profit syndrome setting in for the uro-doc or perveyor of the drugs. This revenue loss is huge per year, then add up the number of patients you could have doing this drug and so sad your life style is inflicted big time.  Remember we are running a business, Dr. Premoli in Argentina is using estradiol patches on his patents and getting excellent results, however here it must be illegal tongue   to consider such thinking (no profits).
 
In Dr. Strum's book he points out that in non-refractive patients (not hrpca patients), so like newbies and HT naivee patients, these two drug scenarios were found equal in effectives (do look at the comparison):
casodex+proscar  (choice 'A')    no profits for the docs period, pharma make some $$$
       vs.
Lupron(LHRH)+casodex  (choice 'B')  even with those 2 combined, which is not commonplace in patients, many just get the LHRH
 
Those patients results were almost perfectly equal, in non-refractive scenarios. Gee no wonder your uro-doc doesn't mention various choices....loss of revenue.  Just for fun try telling your uro-doc (or other supplier), hey I want casodex instead of Lupron and then listen to his argument, how valid is it...perhaps he is well trained in sales from the seminars how to handle objections.  Anyway you get to contemplate everything in PCa and the medical world, notice the new PCa drugs even for pills ('Abby') around $5000 per month, of course as the new vista in acceptable charges for your issues.  Just sayin cash is king, we need a patients lobby to set it on a straighter course, or be the door mat. Just a thought, hopefully I am totally wrong. rolleyes

Post Edited (zufus) : 6/13/2011 5:18:16 AM (GMT-6)


John T
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Date Joined Nov 2008
Total Posts : 4268
   Posted 6/13/2011 7:16 AM (GMT -6)   
Zufus,
I don't think it is a conspiracy to estract more money as much as it is a general lack of knowledge on the part of doctors. Of course there may be some unscruplus doctors, but most are just not thinking and are going by standard protol.
My Rad doctor wanted to give me Lupron; I had him call Scholz who said that Casodex would work just as well; less SEs and cheaper. I don't think my doctor was trying to screw me; he just didn't know before talking to Scholz. Don't forget that many of these doctors are urologists and radiologists trying to do an oncologist's job. We would have the same issues if the positions were reversed, but much worse as I would hate to see the results if my oncologist did radation or surgery on me.
The real issue I think is that uros and rad oncs are distributing HT treatment protocals without the training or experience in oncology. This is why we see patients with severe SEs as well as rapid time to HRPC.
JT
66 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.

Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 6/13/2011 9:19 AM (GMT -6)   
zufus, your manifestos are a little bit rambling and hard to read, but it seems that the bottom line is the recognition that administering HT, and more broadly treating PC, is best left to the experts and not physicians who dabble in a little bit of everything. The fact is that "flare" is seriously neglected by a large number of the non-expert/less-experienced physicians initiating treatment with Lupron.

There is a very good, very readable PCRI article HERE titled "Clinical Flare: A Crisis That Can Be Avoided" for those who want more. It is dated 1999, but is still very relevant.  There are still the part-time PC docs unfamiliar with this well-documented issue (flare) who haven't read the article...

zufus
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Date Joined Dec 2008
Total Posts : 3149
   Posted 6/13/2011 10:00 AM (GMT -6)   
John- no arguments from me and glad to see Scholz treating the patient as such. I feel the cashin is happening...my uro-doc is a fine example switched me from zoladex (first given for like 3/4 of yr.) then swithced me to Lupron (I said I didn't mind zoladex), well after the switching, I noticed my billing went up per shot an additional $700 more (I felt the concern and humane compassion immediately-LOL). I fired him about 7+ yrs. ago now, only thing that died was his profits off my posterior.

Andrew- I hope everyone caught the nurses verbage given to a PCa patient, she likely is told what to say to patients from the top on down. 'You will die without out this drug'?????
Oh really.....and that was more than a year ago...and far from it I see....what a coincidence of events. No one is mislead or cashed in upon, nobody plays the 'fear factor' card or slight sales tactics like 'you will die' without it this. This is from a leading cancer hospital staff too!!! Gee I hate be wrong all the time (LOL).

Casey- good you pointed out the flare thing, it is more important than patients whom question it are actually told, another item swept under the rug... docs will say not that big a deal...nobody died (ha-ha-ha from the docs end of it). (yet they hope).

compiler
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Date Joined Nov 2009
Total Posts : 7269
   Posted 6/13/2011 10:07 AM (GMT -6)   
I thought the latest standard of care was Casodex and then Lupron starting 2 weeks later.
 
John T: Does Scholz just do Casodex and then checks what happens?
 
Mel

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 6/13/2011 10:12 AM (GMT -6)   
Bob,
You make me laugh. I remember you knocking the cost of Casodex when it was 500+ bucks a month. Now that it's available off brand it's far cheaper so now it's good?.

Tony
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3984
   Posted 6/13/2011 10:56 AM (GMT -6)   
zufus -- i really hope my docotor gets a free porsche and a college education for one of his kids for treating me cool .
 
ed
age: 56
PSA on 12/09: 6.8
gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10
2/8/11 PSA <.1, T= 6 ng/dl
6/8/11 PSA .2, T = 540 ng/dl!

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 6/13/2011 10:57 AM (GMT -6)   
No I knock all rip offs as an equal opportunity (lol). I like patient choices and whatever works for a patient, cheap or expensive. What I hate is the soup n_zi method of shoving things down our throats with profits used as the primary motivation. I am not against using Lupron, I kind of endorsed the 13 month ADT3 program and then off, using only proscar thereafter...remember Rick K? He is at year 15+ and no other treatments and no PCa found on rebiopsies....darn him for not having surgery or radiation....I guess he was his own soup n_zi.

Are you happy with new Zytiga pills price tag????

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 6/13/2011 11:03 AM (GMT -6)   
I am never happy with drug prices. But I am glad we have these options. Zytiga is priced according to what they need to charge while the drug is on patent to recoup the costs of development. Like all drugs. Is it too high? Maybe. But then again if we restricted companies that develop new drugs to being unprofitable then perhaps we will stop seeing new drugs.

Pick the devil you want to deal with...

Tony
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 6/13/2011 11:03 AM (GMT -6)   
Mel,
I think Scholz will use what the situation dictates, for my purpose Casodex alone worked well. I know he uses ADT3 on other patients.
JT
66 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3984
   Posted 6/13/2011 11:46 AM (GMT -6)   
casodex = boobs. you want boobs to save a few bucks cool ?
 
ed
 
 
age: 56
PSA on 12/09: 6.8
gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10
2/8/11 PSA <.1, T= 6 ng/dl
6/8/11 PSA .2, T = 540 ng/dl!

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 6/13/2011 11:54 AM (GMT -6)   
Ed,
You are a funny man too. I was on Casodex for 28 months. Most of which was while it was still branded and 500 bucks a month. My insurrance probably paid 18 grand for this boob job. And I'm telling you I got ripped off. These are not even noticeable enough for a Walmart picture...

Tony
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 6/13/2011 12:03 PM (GMT -6)   
Ed:
 
Is there an alternative to casodex -- a non-boob alternative?
 
Mel

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 6/13/2011 12:24 PM (GMT -6)   
Mel,
I didn't have them other than what weight gain can do. I think one of the best things to do is exercise. I know some men had their breast areas radiated to prevent such growth while on estrogenic drugs (zufus being one of them). But I think that any hormonal drugs can have these side effects. But they usually don't have them unless you have been on them for years...

Tony
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3984
   Posted 6/13/2011 5:05 PM (GMT -6)   
when you reflect back on your time on casodex you'll say:  "thanks for the mammaries" cool .
 
ed
 
 
age: 56
PSA on 12/09: 6.8
gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10
2/8/11 PSA <.1, T= 6 ng/dl
6/8/11 PSA .2, T = 540 ng/dl!

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 6/13/2011 10:04 PM (GMT -6)   
F8:
 
Now that's funny!!!
 
Mel
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