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Castration resistant while on Zoladex

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User
Posted 03 Apr 2025 at 09:25

Good morning, has anyone become castration resistant while still on hormone treatment? My Husband has had chemo, radiotherapy and 10 rounds of Zoladex. His PSA after chemo and radiotherapy went to 0.2 from 134.6. Unfortunately his last two PSA tests have increased. 0.5 after 5 month checkup and now 3 months later it's increased to 3.9. The past few weeks he's been getting new pain in his groin, back, hip and developed a cough. Currently waiting for a scan date. Feeling anxious 😟 wondering what the possible next treatment steps could be offered. X

User
Posted 06 Apr 2025 at 20:28

Chemo and/or one of the ARPI drugs (Abiraterone, Enzalutamide, Darolutamide, Apalutamide) is normally added, but I doubt the NHS will allow any of these without being on one of the standard hormone therapy drugs like Zoladex. (Having said that, a trial has shown Abiraterone used by itself suppressed Testosterone just as well, and works without any other hormone therapy medication, something which makes Abiraterone even cheaper as Zoladex and equivalents don't need to be used with it. Abiraterone by itself hasn't been adopted in the UK or anywhere else yet as far as I know though.)

PSA rising doesn't mean Zoladex isn't working - it still will be suppressing some cancer, it's just that a new variant has developed which is not suppressed by lack of Testosterone. You don't normally stop taking Zoladex when you develop some castrate resistant cells.

It's really important to find where the cancer is, and if it's treatable with radiotherapy.

User
Posted 06 Apr 2025 at 11:53

From what I can make out, he's on a curative treatment path, with hormone therapy due to finish in around 6 months?

Rising PSA at this stage suggests the radiotherapy hasn't killed off all the cancer. Most likely, there is some which was unknown at the time which was outside the radiated area. So most important thing now is to get a PSMA PET scan to find where that is, and if it's eligible for radiotherapy treatment. It's also possible some inside the radiated area has recurred, but that's less likely while still on the time-limited hormone therapy.

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User
Posted 03 Apr 2025 at 10:50

Hi, from looking at your husband's journey, it's similar to mine in some respects (have a look at my profile).

After diagnosis in Jan 2019 with inoperable castrate-resistant Stage 4 PCa (it had spread to my spine, pelvis etc etc), I had 6 cycles of Docetaxel chemo in spring / summer 2019, followed by around 20 sessions of radiotherapy in the autumn of 2019, with ongoing Zoladex 10.8mg every 12 weeks.  This kept my PSA down for a couple of years, then it started rising again in early 2021.

I was put on Enzalutamide (Xtandi), another hormone therapy, which kept my PSA suppressed until late 2023, when it started rising again.  This was half-expected as Enza is usually only effective for 2 to 3 years.  I was taken off the Enza, and had 6 sessions of Docetaxel chemo in autumn 2024 to help slow the progress of some troublesome mets.  

Depending on what the scans show, your husband could be offered Enza, or possibly a second round of chemo.  Wishing you both the very best, I hope his current symptoms turn out to be not serious.

 

Craig

User
Posted 03 Apr 2025 at 11:26

Thank you Craig, your journey does sound similar. 

I see from your profile that Enza has stopped working and your second round of chemo was halted.

What are you on now? 

Not sure they'll offer chemo again as Tony's first round left him with no feelings in his fingers and toes which hasn't returned. However Enza sounds positive if it can give him another couple of years.

We've been reading horror stories that castrate resistant life expectancy is 12 to 18 months. Looking back we think zoladex stopped being effective in June last year.

Hopefully get a scan date through this week 

Maggie

User
Posted 04 Apr 2025 at 15:32

Hi Maggie - 

I'm only having Zoladex every 12 weeks now.  You could certainly ask about Enza or Bicalutamide.  I'm sorry to hear that the chemo caused neuropathy for your husband, but it could be worth asking about further chemo side-effects all the same. 

At the age your husband and I are at, life expectancies and prognoses really are a guess, as we're younger than the average:  the important thing is to focus on what the best treatment options are, and balance that with quality of life.

All the best to you both, and I hope the consultants can come up with a good plan based on the new scans.

Cheers, Craig

User
Posted 04 Apr 2025 at 15:39

Thank you Craig,

Wishing you all the best too. I will continue to follow you and your journey on here.

Have a lovely weekend!

Maggie 

User
Posted 06 Apr 2025 at 11:53

From what I can make out, he's on a curative treatment path, with hormone therapy due to finish in around 6 months?

Rising PSA at this stage suggests the radiotherapy hasn't killed off all the cancer. Most likely, there is some which was unknown at the time which was outside the radiated area. So most important thing now is to get a PSMA PET scan to find where that is, and if it's eligible for radiotherapy treatment. It's also possible some inside the radiated area has recurred, but that's less likely while still on the time-limited hormone therapy.

User
Posted 06 Apr 2025 at 19:19

Thank you Andy,

Zoladex is due to finish end of May however his consultant has said it's not worth taking as it's no longer working. 

Just waiting for the scan date and then they'll see what else they can offer. 

I just wondered if there was a regular treatment plan used when the cancer no longer uses testosterone to feed off.

Hopefully we won't have to wait too long for the scan fingers crossed 🙏 

User
Posted 06 Apr 2025 at 20:28

Chemo and/or one of the ARPI drugs (Abiraterone, Enzalutamide, Darolutamide, Apalutamide) is normally added, but I doubt the NHS will allow any of these without being on one of the standard hormone therapy drugs like Zoladex. (Having said that, a trial has shown Abiraterone used by itself suppressed Testosterone just as well, and works without any other hormone therapy medication, something which makes Abiraterone even cheaper as Zoladex and equivalents don't need to be used with it. Abiraterone by itself hasn't been adopted in the UK or anywhere else yet as far as I know though.)

PSA rising doesn't mean Zoladex isn't working - it still will be suppressing some cancer, it's just that a new variant has developed which is not suppressed by lack of Testosterone. You don't normally stop taking Zoladex when you develop some castrate resistant cells.

It's really important to find where the cancer is, and if it's treatable with radiotherapy.

 
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