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Post ADT Question-Avodart or Not?

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Post ADT Question-Avodart or Not?  
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Buckeyelover
New Member
Joined : May 2013
Posts : 18
Posted 7/10/2013 10:14 AM (GMT -7)
I continue to weigh the decision on the duration of ADT. (Lupron) One side is 40 months per my radiation oncologist, or the other would be 12 months post undetectable PSA (nadir) per recommendations from Dr. Stephen Strum and Chuck Maack. Either way, the ensuing question is what to do next? One side would be stop the Lupron and then immediately begin Avodart, or just stop Lupron. Both would include monitoring my testosterone and PSA every 3-months, with the best outcome being T goes up and PSA remains at nadir. Does anyone have any experiences with this decision either way? Please let me know. Thanks!!!!    DX Dec 11: 54, POS DRE, PSA 1.6; PSA Dec 08 0.8 BX: 5/12 POS 14-46% all GS 4+5=9 BS & CT SCAN NEG DX: T3b ADT & IMRT Jan 12: Lupron 3 yr w/1 mo Casodex Mar 12: IMRT Apr 12: PSA 0.16 T 8.5 May 12: END 45 IMRT (81Gy-Tomo) Jul 12: PSA0.10 T13.5 Sep 12: PSA0.04 T5.4 Nov 12: PSA0.04 T2.5 Jan 13: PSA0.02 T11.5 Mar 13: Xgeva Apr 13: PSA 0.01 T12.8 ALL SE w/ADT. ED OK w/PDE5. VED for rehab. Depression.
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Redwing57
Veteran Member
Joined : Apr 2013
Posts : 2648
Posted 7/10/2013 10:48 AM (GMT -7)
What would Avodart alone do?
IGRT by IMRT started 6/26/13: 50.4 Gy pelvic nodes, 79.2 Gy prostate
ADT2: Lupron 5/1/13 (2 yrs)+Casodex 6/25/13 (1 yr? 2?)
Bilateral EPE per 3T MRI, but SV and LN "normal", staged cT2b/cT3
Age 55, Dx 4/16/13
Bx w/12, one side all G9=5+4 (80%, 60%), 4+5 (2 at 100%, 80%, 10%), PNI confirmed
Date PSA fPSA
3/13 5.2 12% PCA3=31
9/12 4.1 15%
history... since 2002 high/varying PSAs, w/3 neg bx
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Buckeyelover
New Member
Joined : May 2013
Posts : 18
Posted 7/10/2013 10:52 AM (GMT -7)
Per Chuck Maack, "And then I would argue/debate/insist that when going off the Lupron that you be prescribed the 5AR inhibitor dutasteride/Avodart so that the returning testosterone is inhibited from converting to dihydrotestosterone, well known as a more powerful stimulant to PC cell growth than testosterone."
DX Dec 11: 54, POS DRE, PSA 1.6; PSA Dec 08 0.8
BX: 5/12 POS 14-46% all GS 4+5=9
BS & CT SCAN NEG
DX: T3b ADT & IMRT
Jan 12: Lupron 3 yr w/1 mo Casodex
Mar 12: IMRT
Apr 12: PSA 0.16 T 8.5
May 12: END 45 IMRT (81Gy-Tomo)
Jul 12: PSA0.10 T13.5 Sep 12: PSA0.04 T5.4 Nov 12: PSA0.04 T2.5 Jan 13: PSA0.02 T11.5
Mar 13: Xgeva
Apr 13: PSA 0.01 T12.8
ALL SE w/ADT. ED OK w/PDE5. VED for rehab. Depression.
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ralfinaz
Veteran Member
Joined : Jan 2011
Posts : 735
Posted 7/10/2013 11:45 AM (GMT -7)
A couple of studies support the notion of "off cycle" maintenance with a 5AR inhibitor(Proscar or Avodart). Scholz and Strum's" study showed that the off cycle period was doubled while on 5AR maintenance (from 15 to 30 months).

It is always a personal decision, but it seems reasonable to do 5AR maintenance after a period of hormonal deprivation.

RalphV
Phoenix, Arizona
The views or opinions expressed here are my own and are not endorsed nor supported by any agency or institution. Ask your physician for medical advice.
DX at age 58 in 1992. RP; Orchiectomy; GS (4 + 2); bilateral seminal vesicle invasion; tumor attached to rectal wall; Stage T4; Last PSA Dec, 2012: <0.1 www.pcainaz.org
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JNF
Veteran Member
Joined : Dec 2010
Posts : 4101
Posted 7/10/2013 12:32 PM (GMT -7)
Meyers also uses Avodart for post-Lupron maintenance. I get my last three month Lupron shot in August which will complete my 36 month ADT protocol. This includes a daily Jalyn (Avodart and Flomax). My uro has always said I will stay on the Jalyn to hold down the DHT. He follows the SWOG high risk protocols.
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard and Jalyn started on 10-7-2010. IMRT to prostate and lymph nodes started on 11-8-2010, HDR Brachytherapy December 6 and 13, 2010.
PSA < .1 and Testosterone less than 3 since February 2011
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Buckeyelover
New Member
Joined : May 2013
Posts : 18
Posted 7/10/2013 12:43 PM (GMT -7)
JNF and ralfinaz....Thanks so much for your prospective on this. It helps reinforce the course (Using Avodart for maintenance after Lupron.) I need to take with my Uro and RO who told me ADT3 was "overkill" and have been following NCCN guidelines to the letter.....

JNF...I have the utmost respect for you to have done Lupron for 36 months. I am a weenie because the side effects have been just too much for me to tolerate anymore and so the path I'm heading down is 24 months max...

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Jerry L.
Veteran Member
Joined : Feb 2010
Posts : 3088
Posted 7/10/2013 7:58 PM (GMT 0)

I take Avodart in the off season.  Been on the off season for over 6 months.

 


11/09 Dx at Age 44 ----------- 4.03
12/09 DaVinci Surgery
1/10 T3b, G9 ------------------ <.05
2/10 Adj. Radiation ----------- <.05
3/11 PSA Rise/Scans/Spot ---- .09
on Pelvic Bone
4/11 HT / XGEVA --------------- .06
5/11 Spot Radiation ----------- <.05
12/11 - 7/13 ------------------- <.01
On IET (Intermittent Everything Therapy)

Be part of something good; Leave something good behind.
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Buckeyelover
New Member
Joined : May 2013
Posts : 18
Posted 7/10/2013 1:09 PM (GMT -7)
Jerry....if you don't mind me asking, what have the side effects been for you with Avodart with regards to ED? That is one of the BIG issues with me and Lupron.....I use a VED 5 days/week for "re-hab", take daily 5mg cialis, take weekend 20mg cialis, plus 200mg viagra to have any chance at all....My worst day in this battle was when ED hit like a light switch, and I went to my RO in a panic. She told me that was to be expected due to the radiation and ADT BUT I was lucky beacause "no worries, you can always get an implant".
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Jerry L.
Veteran Member
Joined : Feb 2010
Posts : 3088
Posted 7/10/2013 1:32 PM (GMT -7)
Buck,

Zero side effects. All systems go. I exercise a lot and I feel the best I have ever felt.

Lupron and/or Casodex can be challenging.
11/09 Dx at Age 44 ----------- 4.03
12/09 DaVinci Surgery
1/10 T3b, G9 ------------------ <.05
2/10 Adj. Radiation ----------- <.05
3/11 PSA Rise/Scans/Spot ---- .09
on Pelvic Bone
4/11 HT / XGEVA --------------- .06
5/11 Spot Radiation ----------- <.05
12/11 - 7/13 ------------------- <.01
On IET (Intermittent Everything Therapy)

Be part of something good; Leave something good behind.
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PeterDisAbelard.
Forum Moderator
Joined : Jul 2012
Posts : 6122
Posted 7/10/2013 1:50 PM (GMT -7)
If you go to Avodart.com's BPH page for Avodart they list the most common side effects.

On their webpage, the manufacturere, GSK said...
The most common side effects of AVODART include:


  • trouble getting or keeping an erection (impotence)‡
  • a decrease in sex drive (libido)‡
  • ejaculation problems‡
  • enlarged or painful breasts. If you notice breast lumps or nipple discharge, you should talk to your healthcare provider.

‡Some of these events may continue after you stop taking AVODART.

Depressed mood has been reported in patients receiving AVODART.

Prior to diagnosis I complained of several of these side effects and my uro put me on a twice-a-week schecule where I would take the Avodart on Sunday and Wednesday and would have reasonably normal libido on Tuesday, Friday and Saturday. The less frequent schedule did help with my side effects and seemed to keep my prostate from growing (controlled my BPH OK) but it is not clear, in retrospect, what role it may or may not have played in the pace of the growth of my cancer or its aggressiveness.

I know that the list of side effects looks a lot like those for Lupron or Casodex but the incidence is less than 5% with Avodart (as opposed to 90+ for the other two) and the side effects are somewhat milder when they do occur. Still, one of the selling points for surgery was the hope that I would get to stop taking Avodart at some point since I was that one guy in twenty who gets sexual side effects from Avodart.
60
Slow PSA rise 2007-2012: 1.4=>8
4 bxs 2010-2012:
1)neg (some inflammation),
2)neg,
3)positive 1 of 14 GS6(3+3) 3-4%, 2nd opinion GS7(3+4)
4)neg.
Mild Pre-op ED
DaVinci RRP 6/14/12. left nerve spared
Path: pT3a pN0 R1 GS9(4+5) Pos margins on rt
Start 24 mo ADT3 7/26/12
Adjuvant IMRT 66.6 Gy 10/17/12 - 12/13/12
Leaky but better, Trimix, VED
Forum Moderator - Not a Medical Professional

Post Edited (PeterDisAbelard) : 7/10/2013 2:53:54 PM (GMT-6)

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compiler
Veteran Member
Joined : Nov 2009
Posts : 7330
Posted 7/10/2013 1:51 PM (GMT -7)
I was on that before going to HT. We tried it. It worked great for 3 months and then the PSA took off big time.

No SE whatsoever.

Mel

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