Dr. Anthony D'Amico of Harvard and Dana-Farber fame, knows a thing or two, because he's seen a thing or two.
He has me on 7 months of Casodex, which started one month before my 6 months of Eligard (Lupron). I understood Casodex is mild compared to Lupron, and 'could' have a multiplying effect. So far, so good.
Here's what I've found on the internet. Maybe someone can confirm if I'm on the right track. Apologies if I'm telling you what you already know:
When a nonsteriodal antiandrogen (NSAA, e.g. Casodex) is added to treatment with a gonadotropin-releasing hormone (GnRH, e.g. Eligard/Lupron) for the full ADT period (v. just 30 days to prevent flare), it's called maximal androgen blockade therapy (MAB). GnRH suppresses testosterone production from the testes, but a little bit of T, of adrenal origin, remains in the blood plasma. The idea is that the NSAA will neutralize this extra T by blocking the androgen receptors. Because of the increased risk of SEs, esp. breast tenderness, MAB is not SOP in conjunction with SRT. (MAB really is a nod at the technical term for this problem, MAnBoobitis.) Also, though I'm a pretty poor consumer of studies, it's looking to me like there's no clear evidence MAB produces better outcomes than ADT monotherapy with SRT. Soooo, I'm curious whether Dr D'Amico routinely combines MAB with SRT or only for particular pathology profiles.
Age 60 at dx
Dx July 2017 after biopsy G8 (4+4), 5/13 cores, bone scan clear
RARP Aug 11, 2017 (Dr Patel)
Post surgery pathology: pT3a, tumor 30% of gland; EPE+, SV- and 3 lymph nodes clear
PSA 1/2016, 2.9; 4/2017, 7.2; 9/2017 (first post-RARP), 0.13; 10/2017, <0.05, 1/9/2018, 0.09, 1/31/2018, 0.10, 2/9/2018, <0.05(!?), 2/23/2018, 0.08.
Eligard start 3/2/2018. Early salvage WPRT 3/12/2018, 75.6Gy