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Breast growth with bicalutamide and tamoxifen

User
Posted 14 Oct 2018 at 19:49

I've been on 150mg bicalutamide for two months now, with 20mg a week of tamoxifen to suppress breast enlargement, but I am seeing noticeable (although not dramatic) enlargement nonetheless. Do you think I should see my oncologist again, or just ask my GP to increase the tamoxifen to, say, 10mg a day? Are there any side-effects of increasing the amount of tamoxifen?


Cheers,


Chris


 

User
Posted 15 Oct 2018 at 13:34

I started Bicalutamide in December ‘18, after a rise in post-op PSA (from 2014 RP operation)


 


i was very concerned about breast growth, was initially refused Tamoxifen, then prescribed weekly in January ‘18 then increased to 10mg dsily in May 2018


the increase to daily stopped the growth, and almost elimnated the pain - not quite so much but so much better


unfortunately I have small man moobs now but will look at surgical options after i stop the Bicalutamide in December 2019

User
Posted 15 Oct 2018 at 13:58
I've now spoken to my oncologist, and he's suggested upping my tamoxifen dose to 20mg twice a week, so I'll try that for a while and see how it goes. He said I could go up to 20mg/day, but tamoxifen has its own side-effects, of course, so I'd rather not take more than is necessary.

Chris
User
Posted 15 Oct 2018 at 14:01

Forgot to add this link


 


https://community.prostatecanceruk.org/posts/t14446-Bicalutamude-and-breast-pain-growth---how-soon


 

Edited by member 15 Oct 2018 at 14:08  | Reason: Not specified

User
Posted 15 Apr 2019 at 12:34

I've been looking at tamoxifen dosing, and how it works.


When I started developing tenderness and breast buds, I asked for it, and got a prescription from oncology for 20mg daily, but with the suggestion to try 20mg twice a week to start with. I didn't ever speak with whoever prescribed it, so was somewhat short on any more detailed instructions.


The 20mg twice a week only relieved the tenderness (which I didn't much care about anyway) for that day, and the breast buds continued to grow. I adjusted the dose up in steps to 20mg/day, and that did work, but by that time the breast buds had grown, and it took time for them to shrink.


I subsequently tried modifying the dose according to symptoms, but the results didn't match what I expected.


This caused me to go off and do some research on tamoxifen dosing, and it's much more complicated than I had imagined, but I'll go through it, because it might be useful to understand this for some people.


The active ingredient is tamoxifen citrate, 3/4 of each tablet (the rest being inactive things to make it into a tablet). When you take a tablet, it takes 5-7 days for your liver to breakdown half of the tamoxifen citrate (this is known as the chemical's half life), according to manufacturer data. They also give some other figures of blood concentrations after many months, from which I could work backwards to 5.4 days half life. This means if you take one tablet, 5.4 days later, half of it is still in your system, and after another 5.4 days, 1/4 of it is left in your system, and after another 5.4 days, 1/8th of it is left in your system, etc. This type of logarithmic decay is typical of the way most drugs are removed from the body (alcohol being a notable exception), although all drugs have different half lives.


Since the half life is quite a bit more than the dosing frequency (certainly for daily doses), this means the quantity of tamoxifen citrate in your blood once you've been on it a while will actually correspond to several day's dosage, because several days worth add together before they get removed by the liver. The dose is calculated to take this into account.


However, tamoxifen dosing is more complicated than this simple model. Tamoxifen citrate is metabolised (broken down) by the liver mainly into N-desmethyl tamoxifen. This works just as well as tamoxifen citrate to block estrogen, so although the liver has broken down half the tamoxifen citrate in 5 days, the breakdown product continues working as an estrogen blocker.


It gets even better... The N-desmethyl tamoxifen has an additional half life of about 14 days meaning almost 3 times as much builds up in the body as the original tamoxifen citrate, so it is actually the N-desmethyl tamoxifen which is the main estrogen blocker, rather than the tamoxifen citrate.


This combination is known as a biphase decay, because it relies on the half life decay of a second follow-on decay product.


However, because of this biphase decay, and in particular because it's the metabolite which produces most of the estrogen blocking effect, it takes a long time for the active concentration level to build up in the blood. I modeled this in an Excel spreadsheet, and it takes 3 months to build up to the final stable blood concentration level, and probably at least 2 months to get near enough to be working well.


Now, this probably works fine if you start taking it when you start on HT as you won't need it to be effective for a few months, but if you start taking it in response to breast pain and growth as I did, this allows quite some considerable time before it builds up a strong enough concentration in the blood to stop growth, and start reduction.


Using my Excel spreadsheet model, I can play around with dosing and see the impact it has on blood concentrations. For a target concentration level corresponding to 2 x 20mg/week, you can get there in 8 days by starting off with 20mg/day for the first 8 days, and then dropping back to 2 x 20mg/week, and this is probably what I would have done if I'd known this at the outset. (I did end up doing something not very dissimilar to get the effect I wanted, but I didn't realise I could have pulled the dose back down so quickly after 8 days, not knowing the mathematical model behind the dosing at the time.)


Now, this is totally non peer reviewed private research, so I'm certainly not suggesting anyone else should try this, particularly if your oncologist has prescribed a specific dose (mine didn't). But you might talk with your oncologist if you are starting out on tamoxifen due to breast pain/growth having started. I couldn't find any such research on dosing, probably because use in men for gynaecomastia is not covered anywhere near as well as use for breast cancer treatment.


I have another interest in making my dose as small as I can get away with. My liver is not overly happy with tamoxifen, which has raised my alanine aminotransferase levels. This means tamoxifen could give me non alcoholic fatty liver disease (NAFLD) with long term use. There are other potential side effects from it too, such as blood clots. I don't want to have to come off it, so I'm hoping minimising my dose will keep me safe on it, and the mathematical modeling may help me do this.


50% of women taking tamoxifen after breast cancer treatment for 5 years to reduce chance of recurrence do end up with fatty liver disease. There is also an interesting correlation in that those women who do get NAFLD are also only half as likely to get a breast cancer recurrence as those on tamoxifen who don't get NAFLD, although the mechanism behind this correlation are not known.


[EDIT 18/4/2019: Correct description of N-desmethyl tamoxifen blood concentration.]

Edited by member 18 Apr 2019 at 16:31  | Reason: Not specified

User
Posted 15 Apr 2019 at 21:26
Not all CCGs permit the prescribing of Tamoxifen to men on HT. In some of those that do allow it, it is only to be prescribed when a man first starts on the HT and is not prescribed as an afterthought. The general thinking is that once breasts start to grow, Tamoxifen cannot reverse that although your experience seems to be different, Andy.

My OH was refused Tamoxifen or RT to the breast buds prior to starting HT; it's not funded in our area (or at least, it wasn't in 2012).
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 15 Apr 2019 at 23:06

I read lots of research papers on it when I was diagnosed and started on HT, so I was well prepared with the questions and requests. Body image and not growing boobs was one the few concerns I identified on my Macmillian holistic needs assessment. My mother has large breasts, so I suspect there's a reasonable chance mine would be too if allowed to grow.


I initially asked for the one-shot RT blast, as mentioned in the HT handbook they gave me, but my CCG doesn't do it, and Mount Vernon don't even do it privately. The research papers I read said that had to be done within a month of starting HT and before growth started. I made inquires about doing it privately elsewhere, and they would only do it after growth started, so that was inconsistent. It only has about a 50% success rate, and it causes heart muscle damage in 1-2% of cases (although this hasn't been known to cause any issues and only comes to light up if the heart is being checked for some other reason afterwards). In retrospect, I think I'm glad I didn't go this route. It might still be open to me if I had to stop the tamoxifen for any reason, but would have to be done privately.


I asked my GP for tamoxifen as a prophylactic. He wanted it initially prescribed by a consultant. I asked the Macmillan nurse, and they said they don't normally do it as a prophylactic. I was going to ask at my next consultant meeting, but breast growth beat me to it, and so I had to ask the Macmillan nurse again saying growth started, and they got me the prescription to collect next day (might even have been same day). My GP then immediately added it to my repeat prescriptions. In one of the research papers I read which looked at the cost justification, it was a complete no-brainer, with tamoxifen being very cheap, and a 5 year course worked out at £125 (that's some years ago, probably nearer 2012 than 2019, might be more now). The success rate is claimed as 70% (and I suspect it probably reduces the effect even when not a complete success).


Research papers I read indicated tamoxifen can reverse breast growth up to a year old, but works more effectively the newer the growth is, and certainly it worked on my recent growth surprisingly well (although not immediately as I explained above). I think that if I'd got the initial dose right as shown in my subsequent dose modeling, it would probably have reversed the growth in about the same duration as the growth happened. As breasts get bigger, they also form fibrous tissue to support the glands, and tamoxifen cannot reverse the growth of the fibrous tissue. I never found out if it can reduce growth of breast fat tissue, mine didn't get that far and none of the research papers went into that level of detail.


It's also used to reverse gynecomastia which some teenage boys get when entering puberty due to a hormone imbalance between testosterone and estrogen at that time, usually caused by being overweight.

User
Posted 16 Apr 2019 at 08:42

Andy62


I'm also having some issues with my ALT ad GGT levels since finishing chemo last October. However I am not taking Tamoxifen as my Moobs were following family lines and were quite pronounced anyway. I am on Prostap3 HT since last June and the active ingedient is  Leuprorelin which apparently according to the Macmillan website page on Prostap can cause liver problems. 


Having a Ultrasound scan on my liver today then bloods and Onco early next month so will see what he says.


What HT are you on?

User
Posted 16 Apr 2019 at 10:24

Hi AndyLoates,


I was on 50mg bicalutamide for 6 months (this didn't reduce PSA much and has now been recognised as having been the wrong dose), and changed to Zoladex 8 weeks ago (which brought PSA down from 47 to 5.29 in the first 6 weeks). Breast buds started growing 11-12 weeks into the bicalutamide (one urologist expressed surprise it was that quick), which is when I started the tamoxifen.


When I got the high alanine aminotransferase (ALT) reading, I had just had a full body MRI scan to look for any mets which included a detailed examination of the liver (which was OK apart from 2 cysts, which is apparently very common), so they're not going to do a liver ultrasound to check for NAFLD at the moment (which would be the normal followup to a high ALT reading). My GP is happy for me to manage my tamoxifen dosing, and when I think I've got it stable in a month or two, he's given me a form to get another liver function test done. He included GGT on that form which I haven't had done before (apparently, GGT is not normally included in standard liver function tests if you are a non-drinker like me).


Raised ALT is an alarm bell for fatty liver disease (typically an issue for drinkers). Tamoxifen causes non-alcoholic fatty liver disease (NAFLD) in about 50% of women who take it long term (those doses would be 20mg/day or more), but tamoxifen also causes raised ALT without NAFLD, so ALT cannot be used to check for NAFLD when you're on tamoxifen, and other methods such as ultrasound and platelet count need to be checked too.


You made me go and reread the side effects of Zoladex, and it lists liver problems, and googling suggests raised ALT is a possibility, so I might look in to this some more, thanks.

User
Posted 18 Apr 2019 at 09:26
Hi Chris

I was also on Bicalutamide 150mg, and found for me that 10mg tamoxifen did work. I started a thread about it some time ago - https://community.prostatecanceruk.org/posts/t13232-Tamoxifen---a-good-thing Not as deeply researched as Andy's findings, but hopefully of some use for you.

Two years down the line, there has been some breast reduction though not complete. Certainly manageable though. Looking back, if I had the choice again (I know, postcode lottery,,,) I would certainly go for 10mg Tamoxifen daily based on my experience. As for other side effects, fatigue was the killer for me. First it was the RT, then the dreaded Bical. It may be that the Tamoxifen contributed to the fatigue as well, but I have no evidence for that.
User
Posted 18 Apr 2019 at 10:34

Hi Chris,
Your timeline from starting taking it to observing effects is a really good match to my theory about the long length of time (2-3 months) it takes to build up to the stable working level in your blood.


I wonder why they don't suggest an initial boosted dose to get to the working level much faster if you are starting it with gynaecomastia symptoms already? I suspect the long lag isn't well known.

User
Posted 18 Apr 2019 at 18:33
Which "Chris" is this addressed to, Andy? If it's me, it's very kind of you, but I'm not having any problems!

Best wishes,

Chris


User
Posted 08 May 2019 at 22:18

In my experimenting with tamoxifen dosing, I haven't taken any for 4 weeks now. Based on my dosing before that period and my calculation of the half-life of the drug, my body should be down to the level representing a continuous daily dose of 3.2mg, which is just slightly more than 20mg weekly, but of course it's still reducing. (A shame I can't post the graph here.)


I've been ready to go straight back on it the moment I get any breast pain or can feel growth, but that hasn't happened as yet. I'm quite pleased it looks like I might not need it continuously for it to be effective, but I haven't yet found out how often I will need it, and at what minimum dose to be effective.


Still lots of unknowns, such as...


It took 11 weeks for pain/growth to start after starting on HT (bicalutamide). When the concentration of tamoxifen in my blood gets low enough (because I'm not taking it at the moment) to allow gynecomastia to start again, does it start another 11 week delay before the gynecomastia, or start immediately?


I did see one reference to breast growth coming in spurts and not being continuous. Maybe the 11 weeks was just the length of time to the first growth spurt, and it could be something completely different next time?


I've since switched from bicalutamide to Zoladex. Will that be better or worse for causing gynecomastia?


Eventually, I might be able to answer some of these, at least for me, providing my onco is as happy as my GP is for me to carry on experimenting on me.

Edited by member 08 May 2019 at 22:35  | Reason: Not specified

User
Posted 19 Jun 2019 at 00:44

Just following up the above post.


I had decided to try and minimise my tamoxifen dose, because it does have some potentially nasty side effects, such as DVT, raising risk of heart problems, and liver toxicity.


A full blood count (FBC) and liver function test (LFT) showed my liver didn't like Tamoxifen, and it was very likely to give me non-alcoholic fatty liver disease (NAFLD) with long term use. This is indicated by raised alanine aminotransferase (ALT) levels in the LFT and reduced platelet count in the FBC. Around half the women who take Tamoxifen do get NAFLD. I've found no data for men, but I would assume it's probably similar, except they tend to be on a lower dose, but it was showing up for me in spite of the lower dose. My Gamma-glutamyle transferase (GGT or gamma-GT) level was not raised, which means it's unlikely the NAFLD would turn into cirrhosis in my case, but that does happen to around 20% of people with NAFLD.


Anyway, both my GP and my consultant looked at my work on Tamoxifen dosing and were happy for me to continue to minimising dose by adjusting to symptoms. This means I've actually been off it for 10 weeks now, and my ALT and platelet counts are almost back to normal (there's a delay in the liver's recovery anyway, and it takes around 3 months to get Tamoxifen out of your system after you stop taking it). When breast growth next happens (it happens in bursts), I will go back on it instantly, 8 days at 20mg/day, then switching to 20mg twice a week, and I'm expecting I'll only need to do that for 2-3 weeks to stop and reverse any growth, before being able to go back on to a Tamoxifen holiday. That should avoid too much liver damage.


Zoladex was another potential cause for raised ALT, but given it's come down significantly when stopping Tamoxifen but I'm still on Zoladex, Zoladex was not the cause in my case.

User
Posted 05 May 2020 at 08:43

Andy


i am very interested in your modelling of Tamoxifen, as I am due to art on it soon - recently diagnosed Gleason 3+4, but ADT intended temporarily solely due to delay because of Covid19.


I am researching side effect therapy, including PDE5 and Tamoxifen.


Please could I ask for a copy of your spreadsheet ? I would like to explore the preloading strategy, and try to get additional 20mg per day for the ?8day startup (currently they are talking 20mg x2 pw).


I would be really grateful if you could pm me, I can’t contact you by pm as I have only recently started responding to posts here.


many thanks


Strad

User
Posted 05 May 2020 at 09:12

Strad, I'll PM you.


However, a couple of points...


This has has no consultant review. A researcher who knows about use of Tamoxifen with ADT looked over it and found it interesting, commenting that she didn't think anyone had looked at this before. So I can't, and don't recommend this action to anyone else. It's just something I use myself.


If you start taking Tamoxifen at same time you start taking bicalutamide, the initial dose escalation is not beneficial because it takes some months for gynecomastia to start (if it does at all), by which time you will be up to steady state tamoxifen level anyway.


The initial dose escalation is only beneficial if you hold off Tamoxifen and only start taking it when you start observing or feeling gynecomastia.

User
Posted 05 May 2020 at 11:57
Perhaps also worth noting that for me (I started this thread) breast growth only began about a year into HT, despite Tamoxifen. What stopped it in its tracks for me was two doses of breast bud RT (suggested by my oncologist).

Best wishes,

Chris
User
Posted 05 May 2020 at 12:55
Also that some CCGs will not fund either treatment for men on HT.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 05 May 2020 at 13:40

Tamoxifen is around 70% effective at preventing breast growth/pain, so doesn't work for everyone.


There's a wide range of doses too. I seem to recall NICE recommends 1 x 20mg/week, but there seems to be fairly universal acceptance that mostly doesn't work. Most people are given something between 2 x 20mg/week and 20mg daily.


The radiotherapy blast is even less successful at around 50%, but excellent if it worked for you.


I don't believe cost of Tamoxifen is of any consequence in deciding on its use - it's one of the cheapest drugs available (providing you have the 20mg tablets - the other tablet sizes are way more expensive). Total cost for 3 years would be about £45. It's more likely any refusal would be because the onco didn't know, although that's much less of an issue now than it was 2 years ago.

User
Posted 05 May 2020 at 16:51

Current decision document for the 3 CCGs in the area where we live, providing rationale for why it isn't offered to men on HT:


"Treatments for painful or embarrassing gynaecomastia include an antioestrogen, such as tamoxifen (unlicensed indication), or surgery (liposuction or mammoplasty). However, although idiopathic gynecomastia is highly prevalent with hundred of millions of affected men, unfortunately, there is no proven medical therapy for this condition and the quality of the research using medications is very poor. As an example, the best publications available, for tamoxifen include only 332 individuals and of those only 10 (<3%) were studied in randomized trials ... The increased use of antiandrogens as monotherapy for prostate cancer is leading to an increase in the number of patients affected by gynaecomastia, and surgical excision is likely to be the most appropriate treatment where assessed as such by a breast specialist."


 


Dated 2019

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 06 May 2020 at 07:32

Strange that they don't mention breast bud RT at all, Lyn. It worked really well for me and was only two sessions, so I can't imagine it's a very expensive treatment. Even if it does only have a 50% success rate, that's 50% fewer surgical procedures that would be needed! 


Chris

Edited by member 06 May 2020 at 07:35  | Reason: Not specified

User
Posted 10 Jul 2020 at 19:52

I'm quite surprised reading about all this and it makes me wonder if my hospital's Oncology dept. knows anything about anything at all! I was put on Bicalutamide for four weeks and two weeks into it, was started on Prostap 3 injections, which I am still on. I was told that the Bicalutamide would stop any breast growth, which could be caused by the HT implants. (I was supposed to go onto implants, but my surgery said that they preferred giving injections, hence the Prostap 3). Unless I heard something wrong and have explained this the wrong way around maybe? But I have had no breast growth at all, not a jot, which I am glad about. Maybe it's dependent on each individual's case? I don't know, but nor have I had any side effects from either medication, with certainly no fatigue at all. As to hot flushes, I occasionally (once a month) feel like I'm glowing, as though it's a really hot day, without it being hot, but that could just be me, I really don't think it's a side effect. Sorry to butt in here, but just thought I would add my case, if it's of any interest to anyone.

User
Posted 10 Jul 2020 at 22:14
Bicalutimide is more likely to cause breast growth; it is less common with Prostap and Zoladex so if you were only on the bical for 4 weeks, you shouldn't have a problem, Ross.

Have you had your testosterone tested while you have been on the Prostap?
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 10 Jul 2020 at 22:21

Bicalutamide doesn't stop breast growth, quite the opposite - it tends to cause it, but not if only taken for a month.


The bicalutamide is an anti-androgen and blocks testosterone from getting to the androgen receptors (AR), so in effect, it stops your body from being able to use testosterone.


It's given because when you start taking Prostap (or any other GnRH Agonist, such as Zoladex or Decapeptyl), for first couple of weeks it causes a testosterone flare, before switching off testosterone production from around week 3. The bicalutamide prevents the cancer cells (actually all cells in your body) from being able to use testosterone during the flare.


(Bicalutamide is also used as a hormone therapy in its own right.)

User
Posted 12 Jul 2020 at 21:31
In my case the breast growth didn’t really kick off until I’d been on bicalutimide for nearly a year. It’s extremely unlikely to occur after only four weeks.

Best wishes,

Chris
User
Posted 15 Jul 2020 at 17:24

Well they obviously told me things the wrong way round again! I've never had a single Testosterone test Lyn, just PSA tests. But nothing much has happened breast growth wise, thank goodness! Having just finished my Radiotherapy last Tuesday, I'm noticing that 'glowing' sensation quite a bit more now, it's happened four times in the last week, so no doubt IS a side effect! Must be caused by the RT somehow? As I've never even noticed it before.

User
Posted 15 Jul 2020 at 21:58
Hot flushes are a common side-effect of the HT, Ross. Nothing to do with the RT.

Best wishes,

Chris
User
Posted 18 Jul 2020 at 19:43

Originally Posted by: Online Community Member
In my case the breast growth didn’t really kick off until I’d been on bicalutimide for nearly a year. It’s extremely unlikely to occur after only four weeks.


It took 3 months for me. Agree it's not going to happen in 4 weeks.

User
Posted 09 Feb 2021 at 21:48

Well, I’ve now gone from feeling positive to depressed... why?


I spoke to my oncologist today, going through the process of deciding what treatment to take for my pc. Intermediate, Gleason 7 (3+4). 
It was explained to me that the brachytherapy (for me) would work best with ht treatment, that being bicalutamide 150 1 per day, + tamoxifen 20mg 1 tablet twice per week. It was explained that the bic blocks testosterone, and the tam stops boobs growing.... so I left thinking ht does not sound that bad.


then I read all these messages about these hormone drugs and now I’m feeling sick.... I seriously do not know what to think or do now.....


is anyone out there doing ok on ht and brachytherapy?

User
Posted 09 Feb 2021 at 22:20

Yes quite a few on this site have either had or are currently on HT. First thing to note is that you will almost certainly be on it temporarily. Ask how long they think you will be on it, two years is a common time but it could be as short as six months, sometimes it is three years. Sadly if your cancer were incurable (which yours is not) then it can be for life.


I'm slightly surprised that it is bicalutimide that is usually only for the first month and is then followed by three monthly injections of Zoladex or another drug.


Anyway I didn't find two years of HT to be dreadful, having said that I'm glad to be off it. 

Dave

User
Posted 09 Feb 2021 at 22:34

Hi Dave... I’ve been told 3 months for the hormone therapy, then seed implants while continuing with the ht.. so total time on ht is 6 months (also told radiation will die out in 3 months).


the total time for my ht bracket treatment is 6 months and been told all the effects will be over after maximum of 9 months....

User
Posted 09 Feb 2021 at 22:35
Being on Bicalutamide and Tamoxifen is ENTIRELY different from being on castrate level injectable hormone therapy. Yes Bicalutamide is a type of hormone therapy but for many much much softer with far less side-effects. I had Bicalutamide for 11 months along with Tamoxifen but fatigue was the main issue and that was only acute for a few weeks. Yes I had breast soreness but zero growth. My libido didn’t suffer in the slightest. I can’t gauge erectile function as it was so soon after surgery that I didn’t have recovery anyway.
To make it clear , Bicalutamide is HT , but it slightly lowers testosterone, but mostly hides testosterone from the cancer. Injectable HT is different and is the equivalent to having your testicles removed - it simply stops all testosterone production and so starves the cancer entirely. Many people cope fine on Bicalutamide and Tamoxifen, whereas injectable HT is way more serious. Hope this helps and good luck

If life gives you lemons , then make lemonade
User
Posted 09 Feb 2021 at 22:53

I don't think you should worry about 6 months on bicalutamide. The side effects are less than for the injectable HT drugs, and the recovery faster. Taking the Tamoxifen from the beginning will probably prevent any breast tissue growth or pain. Bicalutamide did stop nocturnal erections for me, but not erections on demand - you must remember to have erections on demand if you aren't having nocturnal erections. You can try also asking for PDE5 inhibitors (Tadalafil is a good choice for this case).


Bicalutamide actually pushes your testosterone up by around 50%, but this doesn't matter as all the androgen receptors are blocked, so it can't be used.


(Androgen = collective name for all male sex hormones, of which testosterone is the best known.)

User
Posted 10 Feb 2021 at 06:20
I was diagnosed last March Gleason 3+4, but right margin threatened (Ie close to edge and danger of breakout) so urologist said early treatment advised and he wanted me to have HT as a COVID stopgap measure.

GP prescribed short burst of Bicalutimide then Zoladex. I thought side effects sounded dreadful and deliberately delayed start until I knew what was likely.

I wanted Brachytherapy, and was lucky to get fast phone consultation with consultant. As soon as I mentioned Zoladex, she virtually erupted “no, no, not Zoladex, not Zoladex ” explaining that as a short term measure it was likely to have “undesirable permanent consequences”.

Her letter to GP said treatment should be Bicalutimide + Tamoxifen + Sildenafil, but she didn’t say I HAD to have HT, inferred the delay till treatment due to Covid might be short.

I was lucky. Brach appointment offered very quickly and treatment done only a few weeks later (I suspect I got a slot due to a cancellation but my refusal of HT may have helped).

I was told that if my prostate had been enlarged they might need to use HT to shrink it (if enlarged, bones can get in way of procedure.) But as my prostate wasn’t enlarged, I didn’t need HT.

Do you know WHY you need HT? I would have accepted the Bicalutimide cocktail for shrinking reason.
User
Posted 10 Feb 2021 at 08:22
I was on bicalutimide for 18 months in total, and the side-effects weren't too bad. Yes, as this thread says, after about a year I started getting some breast growth, but two zaps of radiation to the chest stopped that. If you're only going to be on bicalutimide for six months, and you're taking tamoxifen alongside, that's not likely to happen to you. Don't get depressed about it - you're on a curative treatment path and you'll get through it.

Chris
User
Posted 10 Feb 2021 at 08:42

Hi stead, I was told that to have the best possible outcome for brachytherapy was to have the bicalutamide and tamoxifen to start, first 3 months. Then continue after seeds placed, so total 6 months.


In fact, the consultant said those two drugs are worth about 10% improvement to the brachytherapy, and was pretty adamant that she would not offer the brachytherapy on its own!


it’s very reassuring what you have explained, so thank you for that...

User
Posted 10 Feb 2021 at 08:44

Thanks Chris, for taking the trouble to reply and advice, much needed, I can tell you!

User
Posted 10 Feb 2021 at 08:47

It's just the hormone therapy (Bicalutamide) which gives the improvement in outcomes.


The Tamoxifen is just to avoid a side effect of the Bicalutamide.

User
Posted 10 Feb 2021 at 09:12

Thanks, Andy! I was not expecting those two drugs to be part of brachytherapy, so I didn’t have questions ready at the time of my consultation. Then I read the posts that really were not relevant to my situation, which resulted in me going to bed filled with doom & gloom.


You, and the other guys like your kind self, have got me back on track this morning... thank you so much!

 
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