I'm interested in conversations about and I want to talk about
Know exactly what you want?
Show search

Notification

Error

Prices of androgen deprivation HT drugs?

User
Posted 09 Jan 2019 at 11:15

Any idea of the respective costs to the NHS of Bicalutamide, Abiterone and Enzalutamide?

Are there any other ’chemical castration’ drugs commonly used?

Thanks.

Cheers,  John.

User
Posted 09 Jan 2019 at 15:00

Bicalutimide costs peanuts - its patent has expired and it's available as a generic medicine.

Abiraterone costs about £24 per day (source: NICE)

Enzalutamide costs £98 per day (source: NICE)

Cheers,

Chris

EDIT: The price given above for Abiraterone is per tablet, but the NICE website doesn’t say what dosage tablet! I see that normal dosage is either 2x500mg or 4x250mg tablets a day, so that makes the cost either £48 or £96 a day.

 

Edited by member 09 Jan 2019 at 17:21  | Reason: Not specified

User
Posted 09 Jan 2019 at 15:58
Zoladex is £235 per 3 month injection

Prostap is £225 per 3 months

Decapeptyl is about £240 per 3 months

Degarelix is about £100 per month

In comparison, Radium 223 costs £50,000 for 6 treatments but is limited - you don't take Radium for years and years whereas some men will be on Prostap etc for 10 years or more.

These are all the negotiated prices to the NHS; private patients may pay more or less.

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

User
Posted 09 Jan 2019 at 17:43
Thank you folks.

Just asking, as I am taking a friend in his late eighties whose course of Bicalutamide has failed after two years, to see a uro-oncologist on Friday, and I hope that any alternative prescription will be patient-based, rather than cost-based.

Cheers, John.

User
Posted 09 Jan 2019 at 18:28
I have never heard of a man being refused HT due to age / cost benefit. There are good clinical reasons for hesitating to put a very elderly man on LnH or GnRH so some older men will still opt for surgical castration although, as you will realise, anaesthesia is also not to be embarked on lightly with very old people who have other health conditions.

It would be useful to ask the onco why your friend has only had anti-androgens up to now ... for example, was that your friend's original preference or a clinical decision?

Assuming no complicating factors that you are unaware of, I expect that he will now prescribe Prostap or Zoladex and your pal's PSA should be back under control very quickly.

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

User
Posted 09 Jan 2019 at 19:03

My old mate (who is still all there) has been very supine about his cancer, with a ‘doctor knows best’ attitude, so common amongst people of his generation. He’s not really sure if he’s ever had an MRI scan, doesn’t know which HT implants he has every three months, etc., etc.

So we will find out what’s what on Friday. He is very lucky anyway as he has got no symptoms of his PCa, nor any side-effects from his hormone therapy over the last four years since his diagnosis.

It must be very difficult for oncologists to decide treatment plans for geriatrics, as my pal wouldn’t want any invasive treatment or biopsies, but he is well apart from inevitable arthritis, and I wouldn’t be surprised to see him live to a hundred. That’s if I’m still around😉.

Cheers, John.

Edited by member 09 Jan 2019 at 19:27  | Reason: Not specified

User
Posted 09 Jan 2019 at 19:28

I haven't reached the stage of needing enzalutamide, and hopefully never will.  At a cost of £98 per day, I was just wondering how long a man is generally prescribed this particular medication - months, years?

Ulsterman

User
Posted 09 Jan 2019 at 20:45

Originally Posted by: Online Community Member

He’s not really sure if he’s ever had an MRI scan, doesn’t know which HT implants he has every three months, etc., etc.

Ah, sorry - ignore the last bit of my previous post. I assumed from your previous comment that he had only had bicalutimide for the last two years. Useful info on Friday then will be to find out when they added the bical - the obvious next step is to stop the bical and hope for the withdrawal response. 

You could ask whether his testosterone is being measured and if so, what his current level is. 

Bicalutimide and Enza don’t lead to chemical castration. 

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

User
Posted 10 Jan 2019 at 02:49
He was on implants only for two years, then put on Bicalutamide which after two years stopped working and his PSA incread from a low figure to 8.

The urologist told him to stop the Bicalutamide and in three months his PSA has risen to 20.

Cheers, John.

User
Posted 12 Jan 2019 at 13:56
I took my friend to see the urologist, who was not best pleased when he found Chris had been referred him as a two-week emergency case in case he had prostate cancer, when in fact he has had it for around five years.

‘When will these GPs get their act together?’ he muttered, whilst glaring at his computer screen. (I could have told him a few things about GPs, but decided not to on this occasion).

‘How would I know, he’s not even my patient!’ When I asked if Chris had ever had an MRI scan. Not the best ‘bedside manner’.

When he calmed down, he arranged an ‘urgent’ CT scan, which radiology tell me takes up to four weeks. He said a CT is better than mpMRI for potential lymph node metastases. He discussed the possibility of Abiraterone and Docetaxel in the future, and in the meantime prescribed 1mg of Diethylstilbestrol, which Dr Wikipedia tells me harks from 1938 and is rarely prescribed nowadays due to to its hideous side effects including ‘cardiovascular morbidity’ = death?

I have told Chris to stop taking them if he has any hint of side effects at all. In fact he’s been very lucky as he’s been on Zoladex for over four years, and Bicalutamide for two, and his only side effect has been the reduction in his PSA from over 300 to under 10.

In fact the urologist said Casodex usually only works for an average of twelve months, before the cancer becomes resistant, so Chris was lucky again.

Chris is a sprightly 87 year old, with a bit of hip trouble and backache, but otherwise a walking miracle.

Cheers, John.

User
Posted 12 Jan 2019 at 14:27

"I have told Chris to stop taking them if he has any hint of side effects at all." 

Oh these amateur Google doctors .... you should have more faith. Stilboestrol is a really good suggestion; Devonmaid's husband has done really well on it for about 6 years despite a G10 diagnosis with lymph and bone mets in 2010 and ADT failure in 2013.

Most PCa treatments have risks, including cardiac damage  

Edited by member 12 Jan 2019 at 14:32  | Reason: Not specified

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

User
Posted 12 Jan 2019 at 14:49

In fact the ‘hideous side’ effects of DES mentioned seem to only occur in doses above 1mg, and Chris is only on it until the results of his CT scan come through.

It would have been really helpful if the urologist explained to us the function of the tablet, so I didn’t have to look it up, but clearly he was not in any mood to do so. We hope we get to see him next time anyway, and that he’s in a better frame of mind. I might then tell him something about ‘these GPs’.

Cheers, John.

Edited by member 12 Jan 2019 at 20:07  | Reason: Not specified

User
Posted 15 Feb 2019 at 02:19
Well, good old Diethylstilbestrol has had an effect, with no side-effects in the patient other than a reduction of four points in his PSA, down to 18. The CT scan showed nothing untoward, save what they think is a benign kidney tumour!

We await the next PSA test in three months, and if there is any rise Chris will be referred to oncology from urology, with a view to switching to the likes of Abiraterone and Enzalutamide.

Cheers, John.

 
Forum Jump  
©2019 Prostate Cancer UK