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Bicalutamide versus LHRH

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User
Posted 05 Dec 2019 at 00:22

I came across a paper from 2008 which suggests that bicalutamide (an androgen receptor blocker) compares favourably to LHRH agonists (such as Zoladex) in preventing progression in locally advanced cases.

Treatment has moved on since then, but does anyone have any views on this? 

Are androgen blockers better or worse than chemical castration, or even should the two be used together?

User
Posted 05 Dec 2019 at 00:22

I came across a paper from 2008 which suggests that bicalutamide (an androgen receptor blocker) compares favourably to LHRH agonists (such as Zoladex) in preventing progression in locally advanced cases.

Treatment has moved on since then, but does anyone have any views on this? 

Are androgen blockers better or worse than chemical castration, or even should the two be used together?

User
Posted 05 Dec 2019 at 01:30
Bical stops working much sooner than GnRH or LHRH and even becomes destructive as the cancer cells can learn to feed from it. Generally, for long term HT users, it is better to hold back bical for when the LHRH / GnRH starts to fail, as it can boost the LHRH for anything from 6 - 24 months.

For men having limited time HT in conjunction with RT, it is down to oncologist preference and CCG priorities.

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

User
Posted 05 Dec 2019 at 09:16

Originally Posted by: Online Community Member
Bical stops working much sooner than GnRH or LHRH and even becomes destructive as the cancer cells can learn to feed from it.

That's true when someone has become castrate resistant on LHRH, but some people are given bicalutamide for 2-3 years as primary HT, and I'm not aware there's any such effect then. I also have wondered why it is sometimes chosen in such circumstances.

One reason to use bicalutamide is that it's a daily tablet whose effect dies off quickly when you stop, so it was given in my case because a choice between HT and RP had not yet been taken for a long time due to extended diagnostic testing, and in the case of RP, I would stop it. When I chose RT, I then switched to LHRH.

While all the HT drugs have pretty much the same list of side effects, the likelihood of each one varies between them. Bicalutamide is infamous for causing gynecomastia (breast growth and pain), so much so that Tamoxifen is often given with it from the start (excluding periods < 3 months), whereas that's less frequent on the LHRH drugs, but can still happen.

User
Posted 05 Dec 2019 at 10:54
When I spoke to the Consultant with my friend whose Bicalutamide therapy stopped working after two years, he told us “You’re lucky, Bicalutamide usually only works for twelve to eighteen months’.

Cheers, John.

User
Posted 05 Dec 2019 at 11:10
Andy, I asked my oncologist why he'd put me on 150mg bicalutimide as a primary HT and he said that it was his view that it had fewer side-effects than injections.

Chris

User
Posted 05 Dec 2019 at 12:37

It's been mentioned before but different oncologists and even treatment centres have different approaches. My brother, whose PSA started to rise after High Dose Brachytherapy is on bicalutamide as we speak. He has had no other HT treatment and neither has an alternative been suggested. That said, after 2 years I gather his PSA is creeping up and he has been told something else will be used thereafter.

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User
Posted 05 Dec 2019 at 01:30
Bical stops working much sooner than GnRH or LHRH and even becomes destructive as the cancer cells can learn to feed from it. Generally, for long term HT users, it is better to hold back bical for when the LHRH / GnRH starts to fail, as it can boost the LHRH for anything from 6 - 24 months.

For men having limited time HT in conjunction with RT, it is down to oncologist preference and CCG priorities.

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

User
Posted 05 Dec 2019 at 09:16

Originally Posted by: Online Community Member
Bical stops working much sooner than GnRH or LHRH and even becomes destructive as the cancer cells can learn to feed from it.

That's true when someone has become castrate resistant on LHRH, but some people are given bicalutamide for 2-3 years as primary HT, and I'm not aware there's any such effect then. I also have wondered why it is sometimes chosen in such circumstances.

One reason to use bicalutamide is that it's a daily tablet whose effect dies off quickly when you stop, so it was given in my case because a choice between HT and RP had not yet been taken for a long time due to extended diagnostic testing, and in the case of RP, I would stop it. When I chose RT, I then switched to LHRH.

While all the HT drugs have pretty much the same list of side effects, the likelihood of each one varies between them. Bicalutamide is infamous for causing gynecomastia (breast growth and pain), so much so that Tamoxifen is often given with it from the start (excluding periods < 3 months), whereas that's less frequent on the LHRH drugs, but can still happen.

User
Posted 05 Dec 2019 at 10:54
When I spoke to the Consultant with my friend whose Bicalutamide therapy stopped working after two years, he told us “You’re lucky, Bicalutamide usually only works for twelve to eighteen months’.

Cheers, John.

User
Posted 05 Dec 2019 at 11:10
Andy, I asked my oncologist why he'd put me on 150mg bicalutimide as a primary HT and he said that it was his view that it had fewer side-effects than injections.

Chris

User
Posted 05 Dec 2019 at 12:37

It's been mentioned before but different oncologists and even treatment centres have different approaches. My brother, whose PSA started to rise after High Dose Brachytherapy is on bicalutamide as we speak. He has had no other HT treatment and neither has an alternative been suggested. That said, after 2 years I gather his PSA is creeping up and he has been told something else will be used thereafter.

 
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