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Still creeping up

User
Posted 06 Sep 2022 at 13:36

Afternoon all, just had phone consult with the onco today, PSA has climbed a bit from 2.97 to 3.2. Testosterone still being supressed by the Decapeptyl. Consultant has said he would like to try adding Bicalutamide for 3 months alongside the HT injections to hopefully kick it back downwards again and he would prefer to hold Enza in reserve for a while yet.
Anyone else having Bical alongside the jabs?

Good luck to everyone coping with the insidious big C

User
Posted 06 Sep 2022 at 18:09

Hi my husband started Bical in July as his PSA was creeping up it went from 0.5 in November 21 to 1.2 in July 22 so they added in Bical along with his Prostap3 injection. He’s just had the results of his 6 weekly blood test and his PSA has dropped to 0.4


 He’s not experiencing any side effects as of yet.


 Hope this helps


 thanks

User
Posted 09 Sep 2022 at 16:55

Originally Posted by: Online Community Member


Hi my husband started Bical in July as his PSA was creeping up it went from 0.5 in November 21 to 1.2 in July 22 so they added in Bical along with his Prostap3 injection. He’s just had the results of his 6 weekly blood test and his PSA has dropped to 0.4


 He’s not experiencing any side effects as of yet.


 


Hi DavTrav, glad it seems to work ok. Onco said he's happy to leave it 3 months till next bloods and consult at present 😐

Good luck to everyone coping with the insidious big C

User
Posted 09 Sep 2022 at 21:13

It's quite common, known as a double blockade. It typically pushes PSA down for a while, usually around 6 months, but a friend has now had bicalutamide working for over 2 years.


It eventually fails because instead of acting as an androgen receptor antagonist (anti-androgen), the androgen receptors learn to mutate and start using Bicalutamide as an agonist, i.e. instead of Testosterone, so your PSA starts going up again. Then when you are taken off it, your PSA drops again as those mutated androgen receptors stop working (which is called anti-androgen withdrawal syndrome, AAWS). Eventually your PSA will bottom out and start going up again, and then they'll consider one of the newer hormone therapy drugs to start doing the double blockade again.

Edited by member 09 Sep 2022 at 21:16  | Reason: Not specified

User
Posted 09 Sep 2022 at 22:45
Thanks Andy, a good explanation easily understandable. I wonder if it would be feasible to do a month on/month off with Bical to delay the mutation?

Good luck to everyone coping with the insidious big C

User
Posted 09 Sep 2022 at 22:58
A month on, month off would work with the cancer rather than against it - each time you stop the bical, the cancer thinks it is being given a feast. Unfortunately, you only get the AAWR once.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 10 Sep 2022 at 08:21

The alternating action of depriving Testosterone and then exposing Testosterone as an idea to extend the time for which hormone therapy works has been around for a while, and there is something call bipolar hormone therapy which does exactly this. In practice, this is done by staying on hormone therapy all the time, but delivering Testosterone for the alternate periods (because hormone therapy takes too long to switch off if you just withdraw it).


In practice, it hasn't shown to be effective, but I think it's only been tried near end of life, because it's probably considered somewhat risky and hence too unethical to try from the outset.


The nearest equivalent which is in use it intermittent hormone therapy, where those with slowly rising PSA are able to take holidays off hormone therapy, and only restart when PSA rises to a predefined level (per patient). In patients where this is viable, they generally spend longer off hormone therapy than on it, and it doesn't shorten life (although I don't know there's any evidence it extends it either, but it can give more quality of life).

User
Posted 10 Sep 2022 at 11:01

Originally Posted by: Online Community Member
A month on, month off would work with the cancer rather than against it - each time you stop the bical, the cancer thinks it is being given a feast. Unfortunately, you only get the AAWR once.


I knew my musing would have already been looked at and dismissed 😔 Hey ho, keeping fingers crossed 🤞

Good luck to everyone coping with the insidious big C

User
Posted 10 Sep 2022 at 20:07
sorry 😢
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 13 Sep 2022 at 16:46

Just received 3 months supply of Bicalutamide to be taken at 50mg once a day. Got a call into the local Urology cancer nurse team to ask if it would be worth having a blood test before starting to take them, just to get a baseline of liver and kidney function readings (as they seem to be relatively frequent side effect problems) ?


Also, would it be prudent to look at having a blood test monthly instead of 3 monthly?


I know it seems like second guessing the onco doc, but it's a rather scary step down the treatment path for what seems a small (less than 0.25) increase over a 4 month period?

Edited by member 13 Sep 2022 at 16:46  | Reason: Not specified

Good luck to everyone coping with the insidious big C

 
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