Which Option???

User

Posted 08 Jan 2024 at 01:09

Hi All,

Wow, this decision-making process is like walking down a minefield, especially when your own DX seems to throw some unexpected results at you.

I do not want to bore the daylights out of everyone, but I'm just putting it out there for anyone to provide their own insight, especially if it's based on data or experience. My Bio says it all but here's my dilemma.

I have Gleason 8 and all tests reveal that it has not metastasized. I want to enjoy an 8 week overseas holiday (pre planned well before DX) but do not want to have too many difficult side effects to deal with, but at the same time, I want to keep the PC from spreading (if possible)

As yet I have had no treatment.

I have 2 options ( well I think I have)

Option1, is to do 14 days on Bicalutamide tablets and then start a 3-month injection of Elgard ADT a few weeks before the holiday.

Option 2 is to stay on the Bicalutamide tablets for the entire time pre and during the holiday (total of 3 months) and then on my return start ADT which will be followed by RT.

Which of these 2 options would be the best to take so I will enjoy the holiday without feeling too ill but at the same time will also hopefully keep a lid on the spread of the PC? I realize that Bicalutamide is not as strong as Eligard but neither are the SE's, - so the question is - will it keep the PC at bay and can you safely stay on these tablets for 3 months?

Keep in mind that according to my latest MRI, my PC has not grown in 6 months, but of course, that could change.

Any feedback would be appreciated.

User

Posted 09 Jan 2024 at 19:55

Hi MS8. Looks like most people missed your post, probably because it came through in the early hours. I know nothing about Elgard but I have experience of 6 months on 150 mg Bicalutamide as part of my salvage treatment following prostatectomy. So, no problem continuing with it for three months, although you may start reaching the breast budding, sore nipples (gynaecomastia) stage by then. This can be treated with Tamoxifen. As you probably already know, PCa is a very slow growing cancer so a month or so is neither here nor there. In any event and the Bical should do a good job stopping it in its tracks in the short term at least. One thing to consider if you are tolerating Bical well enough the starting of another hormone therapy may not give you such a smooth ride. Probably not what you want on your holiday, however we do all respond differently to these drugs. Have you discussed these options with your Onco?

User

Posted 09 Jan 2024 at 21:12

I hadn't heard of Eligard, but I take it it is an LHRH agonist like Zoladex. In which case the main issue is a short term reaction after starting it, which oncologists avoid by starting you on Bicalutamide and keeping you on that for the first two weeks of ADT. I did that (with Zoladex) and had no problems.

In my experience the difficulties with ADT build up with time, and wouldn't (and didn't) affect going on holiday. The only possible issue is an eventual shortage of stamina and need for more sleep but those weren't such as to stop me going on several activity holidays.

User

Posted 09 Jan 2024 at 21:17

No idea which is the best option to take or if either are the right choice. I was on 150mg dose of bicalutamide for six months in conjunction with SABR treatment to a lymph node tumor,10 weeks after starting the bicalutamide and 5 sessions of SABR treatment my PSA had dropped from 6.2 to 0.32. My oncologist rejected any suggestion of using tamoxifen, I did develop tender nipples and a breast buds. Six weeks after completing the bicalutamide the tenderness and swelling has gone away.

Your drop in PSA is interesting. My GP missed a PSA of 6.9, by chance three years later another test revealed a rise to 7.7 and four months later just before surgery,it had reached 10.

Hope you find a suitable resolution to your situation.

Thanks Chris

Edited by member 09 Jan 2024 at 21:18 | Reason: Not specified

User

Posted 10 Jan 2024 at 01:34

Originally Posted by: Online Community Member

Hi All,

I have 2 options ( well I think I have)

Option1, is to do 14 days on Bicalutamide tablets and then start a 3-month injection of Elgard ADT a few weeks before the holiday.

Option 2 is to stay on the Bicalutamide tablets for the entire time pre and during the holiday (total of 3 months) and then on my return start ADT which will be followed by RT.

Many oncologists would only be prepared to give the 1 month injection the first time, just in case of severe reaction so I think in reality you choice is between option 2 and an option 3 - 14 days bical, followed by an injection (4 week dose) and then a second injection (12 week dose) 4 weeks after that. Would that work with your travel plans?

You have commented on the SEs of bical possibly being milder - that's true in some ways but the risk of breast growth / breast pain and breathlessness is much greater with bical than with the injections and not all NHS Trusts will provide tamoxifen or RT to the breast buds.

Edited by member 11 Jan 2024 at 17:45 | Reason: Not specified

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

User

Posted 10 Jan 2024 at 07:12

I was Gleason 8(3+5) and was only on Bical for a month or two whilst they decided I was suitable for surgery. I got sore boobs which lasted for 6 months. I just managed to miss any HT injections. Pathology of the prostate was raised to Gleason 9(4+5) but apparently this increase could have been caused by the Bical.

Edited by member 10 Jan 2024 at 07:13 | Reason: Typo

User

Posted 11 Jan 2024 at 17:17

Hi,

I don't want to effect your holiday but 7yrs ago when my need for an op became apparent I'd already booked a 4wk holiday to your area. I was hoping I could have the op in good time to go. As time went by payments became due so until the date was known I cancelled first the apartment losing the deposit, then an internal flight giving me a part refund, although the main airline said I could cancel the day before flight as long as I was just postponing it.

Anyway I had the op on the 16th December and took off on the 12th Feb after my first post op appointment. If the post op appointment had been a few weeks later I'd have probably tried for a phone appointment I think now. But at the time I might have put the holiday back. I had a strict policy that my treatment was far more important than anything else and I was very keen to be treated.

It cost me a bit more to buy short notice internal flights but the apartment was actually cheaper and I realised that I didn't really need to have cancelled it as they'd have put it on hold. I was thinking I'd go later if the op had been later. As a retired person the date wasn't really an issue for me.

In conclusion depending on your situation and what sort of holiday you're taking there are tunes you can play with postponing and cancelling. I'm not sure what your insurance will make of it, I didn't make a claim as I always use a high level of excess and it didn't seem worth it.

Good luck and I hope you get good decisions.

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