Cyproterone or Bicalutamide

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User

Posted 27 Jan 2020 at 16:43

Following radio therapy which was initially successful and after about 24 months had passed my oncologist agreed to stop 12 weekly Zoladex implants and a daily 50mg Cyproterone. After about 8 months PSA started to climb again after a scan I was told the cancer had metastasised into the groin are for which no treatment was available and I was restarted on the 12 week zoladex implant and a daily cyproterone. I was told I had a 10 year life expectancy which would take me up to 80.

In September 2019 cyproterone supplies dried up and I was switched to a daily Bicalutamide instead whilst continuing the zoladex implants. After a few months I started to develop small itchy spots randomly on my skin which then escalated to a large patch on my torso about 8cm by 6 cm. My GP who has a specialism in dermatology thought it might be the Bicalutamide and as I had about one months supply of Cyproterone left over we agreed I should switch back over and see if things improved. 10 days on the rash has become less angry and appears to be receding. I am tempted to ask my GP to switch me back to repeat prescriptions of Cyproterone but an a little worried that supplies may dry up again. Any suggestions on what to do or an alternate drug. PSA is steady at 0.4 and has been for 12 months.Thanks for any help that you give me.

User

Posted 27 Jan 2020 at 17:11

Itchy skin is a common side-effect of bicalutimide. My GP prescribed me a steroid skin cream called betamethasone which, for me, is extremely effective at clearing it up. For me, the skin rash occurs every so often on my lower legs, but a couple of days' treatment with the steroid cream clears it up.

Best wishes,

Chris

User

Posted 27 Jan 2020 at 20:22

I'm not clear why you are taking the Cyproterone with the Zoladex, when I presume you are not castrate resistant yet.

It's sometimes used when starting Zoladex to avoid problems with the testosterone flare, but in that case, it's stopped a couple of weeks after the first Zoladex implant. Bicalutamide also works for this (they are both anti-androgens), but in neither case do you continue with them long after starting Zoladex.

It's sometimes used to reduce hot flushes when on Zoladex. Bicalutamide won't work for that (as far as I know).

Bicalutamide is sometimes added later when your cancer becomes castrate resistant.

I can't think of a reason to use Cyproterone with the Zoladex so early, where Bicalutamide would be an effective substitute.

User

Posted 28 Jan 2020 at 15:43

Thanks Chris. Very Helpful. As I don't have the problem with Cyproterone then I might try to get my doctor to write me a prescription for it.

User

Posted 28 Jan 2020 at 15:49

Hi Andy62,

The cyproterone were originally prescribed to counter hot flushes.

I have not been diagnosed as castrate resistant.

Is there a long term problem if I continue to take cyproterone to reduce hot flushes?

Due a PSA test in a month followed by a review appointment so will discuss this then.

User

Posted 28 Jan 2020 at 20:37

The bicalutamide will not stop hot flushes as far as I'm aware.

If you didn't get hot flushes while you were on the bicalutamide, it may be that you aren't getting hot flushes anymore. In that case, I would suggest dropping the bicalutamide and cyproterone, but first check with whoever prescribed the cyproterone in case this was not the reason it was prescribed.

It sounds to me like whoever switched you to bicalutamide thought you were taking cyproterone as an anti-androgen (for which bicalutamide would be a substitute), but you were actually taking it as a progestin to prevent hot flushes, and bicalutamide is not a progestin (as far as I know).

Cyproterone is liver toxic, so you should be having periodic liver function tests while you're on it to check your liver is coping. Also, because it's an anti-androgen, it might reduce the effectiveness of adding an anti-androgen later (such as bicalutamide) if you become castrate resistant. As far as I know, this is a theoretical risk, not something known for sure.

So generally, if you don't need it for hot flushes (and it sounds like you might not), it's better not to take it. All of the hot flush suppression medications are a bit nasty in terms of liver toxicity.

But just to emphasise again, you must check with whoever prescribed them first before you stop taking them.

Edited by member 28 Jan 2020 at 20:47 | Reason: Not specified

User

Posted 29 Jan 2020 at 00:36

As you are due a PSA test, be aware that stopping the bicalutimide may have caused a temporary rise in PSA reading. I wouldn't want your medics to misinterpret because they didn't realise you had been on and then off it.

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

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