Search results for "anti-androgen withdrawal"

I have recently heard from an oncologist that the injection site reaction to Degaralix can be due to getting some of the injection on your skin surface, but I doubt that accounts for all cases.

There is an alternative which was approved by NICE last year, Relugolix, which is a daily tablet GnRH Antagonist (Degarelix is also a GnRH Antagonist). If you are getting severe injection site issues to Degarelix, then you could ask if you can have Relugolix instead. [Disclosure - I am a patient consultant to Accord, who sell Relugolix.]

The hormone therapy is almost certainly still working in terms of preventing growth of some cancer cells. What happens when you become castrate resistant is that new cancer mutations which are resistant to the actions of the existing drug start growing. However, the existing drug is still holding back the original cancer cells. It's only if the hormone therapy and chemo have wiped out the original cancer cells (which can happen) that the hormone therapy is no longer beneficial, but usually you stay on it.

You have to come off anti-androgen drugs like Bicalutamide, Enzalutamide, and the other *utamides if they stop working, because one way they can stop working is that the cancer learns to use them instead of Testosterone.

Edited: by member 17 Feb 2025 at 13:12  | Reason: Not specified

I have seen a study of a few men who underwent lut177 treatment in similar circumstances. One had an excellent result some had moderate success and others a failure.  There is no guarantee that it will be offered as detailed below.

Thanks Chris 

"I reviewed Christopher in clinic today. His recent PSMA PET scan has identified new left internal iliac lymphadenopathy, as well as retroperitoneal lymph nodes, and a highly suspicious left supraclavicular fossa lymph node. There is too much disease here to consider radiotherapy or SABR. I have said I think now is the time to consider further treatment for his cancer. I know Christopher has been loath to consider treatment thus far because of hormonal side-effects.

Ordinarily, the recommendation in this circumstance would be for indefinite LHRH analogues and the addition of a novel anti-androgen. I think in his case, I would use Abiraterone and low dose Prednisolone. I think this is likely to control his cancer for four to five years. An alternative would be to continue observation if he is loath to consider hormone treatment, but we would have to set a threshold or some idea of when we may consider instituting hormone treatment. I think further observation may come with a modest detriment to overall how long he may live.

The third option would be to consider Lutetium-177. This is unorthodox, but I have had one patient where this has occurred. To even consider this, he would have to have a consultation with Dr xxx down in Windsor, and it may be that his insurer will not fund this, but it is certainly a possibility that can be explored."

And don't forget to tell your guests from up North that you've got an inside loo.😂

We had an outside loo when I was 5 or 6 . Absolutely freezing cold and dark. It wasn’t even directly out the back door. They were old farm cottage’s. 

I’ll add to the congrats for your PSA Ian but so sorry to hear about your MiL. That is tough… 

Looking forward to Christmas and I’m just gonna try and relax and not think about things too deeply… 

Hoping matter todays F2F I can possibly have a chat with some travel insurance companies as I’m getting withdrawal symptoms 🤣. 

Cheers

Guys, 

Morphine is a balance between pain control and sedation. Hospices are the experts in pain control, so it would be a good idea to get a hospice involved in his care at home.

I have no experience of morphine, but I might be tempted to see if a lower dose is still effective against the pain. I suspect you would need to reduce the dose slowly to avoid withdrawal, but I could be completely wrong, and this is where hospice expertise would come in.

Hi all, got out of the habit of posting this year so back with a vengeance 😎

5 and a bit years down the line and the Decapeptyl jabs and Bical tabs are now starting to lose their effect.

3 consecutive PSA rises after my check up with the consultant this week so it appears to be time for a change of tack. Bicalutamide has been stopped, hopefully with a bit of Casodex withdrawal response.

Next up is a CT+AB scan plus a full bone scan looking to see what might be causing the rise.

Once the results are in, my approachable consultant would like to see me again, and thinks the way ahead will be either Enzalutamide or Abiraterone with Olaparib, and has given me handouts on both options to think about which way I might like to proceed.

I honestly haven't a clue so thought I would sound out opinion on here?

My understanding so far is Enza is more straightforward to take than Abi and also that the Abi/Olaparib with steroids route can potentially have more serious side effects (though I am aware not everyone gets hit with all the serious side effects). The overall effectiveness seems to be broadly similar from what I can find?

So, would anyone who is either on Enza or Abi after becoming resistant to first line HT care to share their thoughts on ease of use and/or side effects?

Edited: by member 05 Nov 2024 at 13:03  | Reason: speelin and gramma :)

Bicalutamide is an anti-androgen, blocking Testosterone from getting to Androgen Receptors.

Enzalutamide is an anti-androgen around 8 times more powerful than bicalutamide at blocking out Testosterone.
However, in the event that an androgen receptor is triggered by Testosterone (which will still happen occasionally), Enzalutamide also attempts to prevent two subsequent stages which are required for the cell to multiply, which Bicalutamide does not do.

Abiraterone switches off the small remaining Testosterone which comes from the adrenal glands. It is also an anti-androgen, but that's not its main method of working. It also switches off other essential steroids from the adrenal glands, which is why you need to take a low dose steroid to replace those.

Enzalutamide and Abiraterone can both work after Bicalutamide has failed. However, I think the current best practice is considered to be to start on Enzalutamide or Abiraterone ASAP, which is thought to give the longest protection. I have not seen any data on upfront Bicalutamide followed by Enza/Abi verses just upfront Enza/Abi.

If I was faced with this choice, I would skip the Bicalutamide.

What drug are the tablets, Bicalutamide (anti-androgen), or Relugolix/Orgovyx (LHRH antagonist)? I've not heard of Relugolix being used to protect against Testosterone flare in the UK, although I imagine it would work.

For initial radical radiotherapy, hormone therapy halves the recurrence rate in some circumstances. I think less is known about the effectiveness of hormone therapy in salvage radiotherapy.

Edited: by member 17 Aug 2024 at 15:58  | Reason: Not specified

Hi Andy 

Dr Myers himself  said that estrogen patches didnt diminish libido in men I can attest to this  bc the potent phytoestrogen my husband is taking has if anything enhanced his libido 

Estrogen castrates men and this was the given procedure as you well know before the new ADT  treatments such as Astra Zenica's  Zoladex was  rolled out

You suggest that estrogen should be an add on to ADT but I think transdermal estrogen patches should be an option in itself 

Unfortunately, Estradiol didn't help men with having a sex life, because that's down to loss of Testosterone.
Yes, brain fog can be caused by lack of Estrogens, but it's also caused by anti-androgen drugs (such as being on Bicalutamide alone) which raise Testosterone and Estrogen levels, so that one's not a simple relationship with Estrogens alone.

Cancer outcome results for locally advanced patients are due sometime around now.
Cancer outcome results for metastatic patients are expected next year.

If the results are favourable, it will still required NICE to evaluate the costings, and I have previously mentioned some possible challenges in this area even though the Estradiol drug itself is cheaper - it's likely patients on patches will need much more monitoring and adjustment of dosing.

I think a more viable way to tackle this is with using the standard LHRH hormone therapy medications, but adding a low dose Estradiol patch to make up for the missing Estrogens. That way, the Estradiol dosing is not critical to your life saving/preserving/extending treatment, but just to improving the side effect profile, and then the monitoring of it isn't critical any more. Also you can take Tamoxifen to prevent breast gland growth, which you can't if you're on Estradiol patches as your hormone therapy.

Edited: by member 21 Apr 2024 at 13:47  | Reason: Not specified

The use of some of the novel hormone therapy medications (Abiraterone, Enzalutamide, Daralutamide, Apalutamide) combined with the GnRH/LHRH injections for time-limited HT is increasing in the case of curative time-limited treatments for high risk disease. However, as you say, we've not seen this in the UK except for trials, and the case where these have been used instead of chemo for N1 (local lymph node) involvement.

I haven't been following this as it's not available in the UK, but there seems to be some thought that getting Testosterone levels very low (lower than the GnRH/LHRH injections sometimes achieve) may be beneficial in high risk cases, and this is where Abiraterone can help. It is also an anti-androgen, but it's main reason for use is to block other ways Testosterone is manufactured. The GnRH/LHRH injections only stop Testosterone produced by the Testicles - it's also produced by the adrenal glands, and the cancer cells can mutate to produce Testosterone or DHT themselves all of which Abiratrone interrupts.

Edited: by member 14 Apr 2024 at 10:00  | Reason: Not specified