let me cite the NCCN guidelines: "Patients with an increasing PSA level and with no symptomatic or clinical evidence of cancer after definitive treatment present a therapeutic dilemma regarding the role of ADT. [......] Early ADT is acceptable, but an alternative is a close observation until progression of the cancer, at which time appropriate therapeutic options may be considered."
The European guidelines (if you would have a European prostate cancer instead of an US one
) are clear on this: "Do not routinely offer ADT to asymptomatic men with biochemical recurrence." This is based on the existing evidence showing no benefit regarding overall survival for starting with ADT early, just with the intent to bring down the PSA value in asymptomatic patients. (Except for the underpowered TOAD study).
So there is no need for ADT at all in your case, although patient and doctor anxiety usually cause an early start of ADT. Therefore you do not need to take the drug that maybe works best against the tumor, you can either take none at all or the one which may not be as effective as Lupron but will bring down the PSA value just as well - Casodex. I did six months of Casodex following salvage radiation. Significantly fewer side effects than Lupron. You can do intermittent Casodex therapy six months on, six months off as long as you like since the guidelines allow you to do no ADT at all.
Radiating my breast was insufficient to avoid gynecomastia, I took 10mg Tamoxifen. My URO called a large university clinic to make sure he could prescribe this to me. He did not have a patient before on Casodex monotherapy. But he did not object to Casodex in my case. I came along with the relevant pages of the guideline printed out.
Post Edited (George_) : 10/13/2019 12:25:46 PM (GMT-6)