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Post ADT Question-Avodart or Not?

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Prostate Cancer
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Posted 7/10/2013 11:14 AM (GMT -6)
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!!!!   
Posted 7/10/2013 11:48 AM (GMT -6)
What would Avodart alone do?
Posted 7/10/2013 11:52 AM (GMT -6)
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."
Posted 7/10/2013 12:45 PM (GMT -6)
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
Posted 7/10/2013 1:32 PM (GMT -6)
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.
Posted 7/10/2013 1:43 PM (GMT -6)
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...

Posted 7/10/2013 1:58 PM (GMT -6)

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

 

Posted 7/10/2013 2:09 PM (GMT -6)
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".
Posted 7/10/2013 2:32 PM (GMT -6)
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.
Posted 7/10/2013 2:50 PM (GMT -6)
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.
Posted 7/10/2013 2:51 PM (GMT -6)
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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