My boyfriend was diagnosed with pc in March of 2007. He had a radical prostectomy in April. His first psa reading following surgery was .008 His second one ( I believe it was 6 weeks later) was .1 and the third was also .1 His blood pressure was so high from worrying that the reading was too high, that his doctor suggested he have a prostacint done just to relieve his mind. He got the results the other day, but his doctor said the prostate bed was free of any cancer but there were two small areas that he didn't believe were cancer but couldn't explain what they were either. The doctor put my boyfriend on 50 mg of casodex. He said it was strictly for prevention. All that I have read so far about Casodex leads me to believe that it is only used when cancer is definitley present, not for prevention! What can you tell me (if anything) about this scenario? Casodex seems like a VERY strong drug that shouldn't be used unless absolutely necessary and I don't think a .1 psa would warrant that. Please tell me anything you can. I'm so worried I can't stand it!
Thank you for any help you can offer
Casodex is a form of anti-androgen therapy. Some patients receive it after definitive therapy (surgery or radiation) as additional therapy (because these patients are believed to be high-risk). This practice is still controversial, not because of safety issues, but because the gains from treatment did not impact survival.
Another group of patients receive it, if after surgery or radiation, there is an observed rise in PSA. There is no consensus as to the timing of when to start it. Some doctors even decide to start it due to the anxieties of the patient. When the PSA is rising, it is likely there is residual cancer. The term prevention was probably used to mean, prevention of progression.
If the PSA is stable at 0.1, perhaps it is too early to start. You need to discuss the goals of treatment with your doctor.
Thank you so much for your input. I really appreciate it. I'm rather sure my boyfiend's doctor started him on casonex because of his HIGH anxiety. I don't agree with this, but it seems to have lessened his concern and worry so I guess it did have somewhat of a positive outcome. If after the recommended six months of casonex his psa is still .1, I am going to try to talk him out of continuing taking it, Do you think this is the right course of action?
If the PSA remains the same after 6 months, 2 possibilities exist: that the drug is not necessary or that it is keeping the levels low. In all likelihood though, there would be a drop in the PSA. If he has made a decision to take the medications there is no clear reason to ask him to stop, unless there are side-effects that may be intolerable. Be wary that asking him to change may also mar his confidence in seeking medical help and he may discontinue all consultations. Perhaps the best approach is to discuss discontinuation during the consultation with the doctor on a follow-up day with a repeat PSA (at the planned monitoring interval), this would force him and the doctor to re-evaluate the goals of treatment.
Thank you so much for all your thoughts on this. He will be having another psa test in about 2 weeks. If his level has dropped, there will be uncertainty whether it dropped naturally or because of the Casonex. Wouldn't it have made more sense to have a few more tests done before starting him on Casonex? I'm not a Doctor, but I think a few more tests were in order before medication was prescribed. Am I being unreasonable? The Doctor more or less assured him that in all likelihood, the cancer was eradicated, but with this course of action, I'm thinking that he's keeping the truth from us. I hate second guessing him, but that's how I feel. I know I'm starting to rattle on. Sorry. This is such a worrisome time in our lives. I will just wait for the next psa and put my faith and trust in the professional. Thanks so much for replying to my query.
Hi. I think the major issue is not about not knowing enough about what is happening, but the existence of no clear, single therapeutic goal. The first problem (not knowing enough about what is happening) can be corrected by performing an appropriate definitive test (as you have suggested). The other issue exists because there is a knowledge gap between what the treatment is expected to do and what meaningful outcome this translates to. It is known that casodex will keep the PSA low. It is not known if these patients with PSA controlled are better-off than those who have uncontrolled PSA rises (will they live longer, are they more active, happier with their daily lives?). This knowledge gap will only be solved slowly, over the accumulation of more experience. So, a value judgement will ultimately be called for, whether the patient is more comfortable with trying the treatment anyway over the scenario of no treatment. I think the feeling that the doctor is hiding something from you, stems from not having specific goals. But the problem here is exactly that. The goal is uncertain with the available treatments that exist.
Thanks again for the information you've provided. I will try to be as supportive as I possibly can to my boyfriend while sharing with him all I've been reading and learning about prostate cancer. I will also be praying that the outcome of all this is positive and that we have many years together. I will keep you posted. Thanks again.
Discuss the treatment with your doctor. Patients who receive chemotherapy are generally believed to be non-responsive to hormones already. There is emerging evidence however, that there may be hormonal treatments that can be given after chemotherapy. The medication however is not Casodex but is Abiraterone and this particular drug seems to be more efficient in its capability of targeting the hormonal axis than drugs like Casodex.
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