Post ADT Question-Avodart or Not?

What would Avodart alone do?

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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

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

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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

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...

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".

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.

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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)