Hi Peter,
I am not sure that casodex will automatically be the next step. It really depends on whether the Prostap is actually failing. You don't mention on your profile but is your testosterone level also tested each time to make sure that you have reached and are maintaining castrate level? You will be able to see on Yorkhull's profile that his testosterone is monitored regularly and has stayed below 1 for a long time. If your T is around 0.7 or less and the PSA is still rising then it would appear the cancer has learnt to survive without testosterone. If your T is higher than that, then the Prostap isn't working as well as it should. What happens next - adding casodex, changing HT etc - is determined by which group you fall into I think.

Edited by member 14 Aug 2014 at 13:29  | Reason: Not specified

Hi Peter,

Although my husband was in a very similar place to what you have described after being on Zoladex for about 28 months, we arranged to see his Onco when his PSA decided to treble and then double over a period of 8 weeks. His situation is somewhat complicated by acute heart failure, but all the options were discussed ... and then dismissed! Casodex had to be rejected as there were contr-indications with one of his other drugs. However, he has been taking Cyprostat for 2 years or more to rid him of hot flushes, and the decision was made to double up on that in the hopes it may have the same effect as Casodex.

As he was due a blood test within a few days, we delayed adding the extra tablet into the mix until then. As it happened, his PSA had almost halved .. all on its own! He started with the extra Cyprostat at that point and his last two blood tests have again shown a drop in PSA ... but his ALP is wandering upwards. His testosterone remains at less than 0.1 - where it has been for over 2 years. I have mentioned on here before that the body hair loss which occurred over the time he has been on HT suddenly reversed and is now back to pre-treatment level. No one, as yet, has come up with a sensible answer as to what is going on in that respect, other than it must be one of the 3 types of testosterone causing this - and yet not feeding the cancer.

Expect the unexpected!!

Cath

Thank You everyone for your replies.

I have had my appointment brought forward to the 4th Sept which is 3 weeks later than the original scheduled appointment, I don't expect there to be anymore than the usual chat and see you again in 12 weeks, my consultant seems to be focused on my PSA and has already told me that there wouldn't be any action with further treatment until it reaches around 20 as she didn't want to rush into the next stage to early?????????????.

Again I do tend to share your view Lyn that the remaining Testosterone after being reduced with HT could be trickle feeding the cancer and over a period of time there could be a significant advancement of spread and periodic scanning should be conducted to ascertain any change whilst there is any Testosterone present.

My Testosterone in the few tests I have had since diagnoses has ranged between 0.9 and 1.4 so there must be a little feeding going on, my PSA had been fairly stable at 0.5 up until last October and since then there has been 4 consecutive increases to the current reading of 6.2, while 6.2 is not a high figure it's concerning that it has been increasing for nearly a year and could take another year maybe to reach 20, in the meantime I can't help but wonder what's going on inside and this is where periodic scanning could answer those questions.

I find it very frustrating that too much emphasis is put on PSA readings as my consultant appears too, Ok I know it's regarded the best guide to Prostate Cancer activity but it is only a guide and the accuracy of PSA tests should be supported with scans in my opinion, I was diagnosed nearly 3 years ago at which time scans were done, since then apart from my 12 weekly jabs I have had diddly squat done, it's all been about PSA.

Just to add further to my rant my PSA at diagnosis was 18.2 which is quite low considering my gleason score is 4+5 all 16 cores positive, spread to my seminal glands and lymph nodes, my point is that even with a fairly low PSA there can still be some Cancer activity that may not necessarily significantly increase PSA level?????, so therefor my view is whilst waiting for my level to reach about 20 PSA what's going on inside??????????

OK I feel so better for having a winge it's always good to get it your chest "lol"

Thanks Peter.