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Enzalutamide or casodex??

Posted 18 Dec 2017 at 20:02
As I've previously commented my father was diagnosed with advanced PCa 18 months ago. He was started on prostap and 6X docetaxel. At diagnosis his psa was only 4.0 however cancer already advanced. Confirmed adenocarcinoma after biopsy. After chemo big drop in psa. However 6 weeks ago he was placed on enzalutimide alongside prostap due to psa rise to 7, however oncologist said scans showed that the metasis were still smaller than at diagnosis and have shrunk further since last scans after chemo. My question is in your opinion should enzalutimide have been put on hold for a bit due to unreliable psa and positive scans? And should he have been considered for casodex or something similar first. As always your advice and shared experiences are much appreciated. P. S. At 4 week point on enzalutimde he had a 1 point drop in psa.
Posted 19 Dec 2017 at 13:50

Hello MG11

I expect you'll get the shared experiences but asking for comments on what he should have had is a lot harder to answer and really the best placed person to do that is the consultant who has your dad's results in front of him.

I do understand your anxiety to get the best possible treatment for your dad but even if members tell you what worked for them, it doesn't follow that their treatment will help your dad.

I hope that somebody who has been down the route your dad is following will be able to advise you

Edited by member 19 Dec 2017 at 13:51  | Reason: Not specified

We can't control the winds - but we can adjust our sails
Posted 21 Dec 2017 at 20:46

Does he also get LHRH analogue as injection?
It is the first-line treatment.
If the psa is increasing, then add casodex 50 - 150 mg.
If the psa is inceasing again despite the combination, switch casodex to enzelutamide or abiraterone and continue the LHRH injection.
Where did the scan show metastases?

Posted 21 Dec 2017 at 21:22
Thank you to you both for responding.
He has prostap injection every 3 month. Mets are to pelvic bones and lymph nodes.
I was unsure as to whether prior to starting enzalutimide there may have been another option added alongside prostap as I have read that enzalutamide is for complete castrate resistant Ca. Would have thought Enzo or abi would have been introduced once other options were exhausted.
Thank you for comments
Posted 21 Dec 2017 at 22:04

MG, if your dad's PSA has risen to 7 while on Prostap and his testosterone level showed that he was below castrate level then he is hormone resistant and enza was a sensible addition. Even if that's not the case, we have a few members who are on Prostap + Enza as part of the Stampede trial - results are suggesting that outcomes are much better if Enza or abiraterone are introduced earlier than they used to be.

I am not sure of Safinamo's background or relative experience to give such advice but bear in mind that s/he only joined the forum today and hasn't given any explanation for their involvement.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
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