Prostrap v Bicalutamide

Hello Brizzy. My husband stopped ht after 18 months of taking it and having RT after the first 3 months of HT. he was T3aN0M0 Gleason 4+3 He was initially told 3 years of Ht, then 6 months then 2 years. By 18 months he was at rock bottom mentally and physically. His PSA was ranging between 0.03 and 0.04.  He was advised to stop the Ht and was told to expect a PSA bounce. 6 months after stopping his PSA was 0.2. The oncologist was concerned and he will have a repeat PSA after 3 months and not 6 months. 

we discussed what would happen if his PSA shows another rise and she said it would be a return to ht. I asked if he could try another brand as the decapeptyl side effects had been so severe and she suggested bicalutamide. The problem with that is the bicalutamide gave him painful moobs and hot flushes when he took it for 4 weeks at the start of treatment! We didn’t explore further.

Basically, I can understand the need to prescribe these drugs but the side effects can be very difficult. Since stopping the ht 8 months ago, my husband has recovered from the low point but I would still argue he has a fair way to go to get to his pre cancer norm.

That said, I am worried that he finished ht too early, giving the cancer time to rear its ugly head!

I obviously can’t advise you but I do understand your dilemma. Do you take the risk of coming off ht early or do you live the next year feeling really lousy with little quality of life? Do you give bicalutamide a try? You can take guidance from your medical team but, at the end of the day, the decision is yours to make - unfortunately. I think my husband needed this break but I am dreading that he will have to go back on ht for the rest of his life.

I do hope you and your medical team can arrive at a decision that is the right one for you. If you are like us and finish early, you will, I think, still have your anxieties.

best wishes and good luck!

Hello Brizzy1 . I have no experience of switching from Prostap to Bicalutamide but as you probably know they work in different ways and it is generally recognised that the Prostap offers greater suppression. My question would be what dose is being suggested 50mg or the 150mg monotherapy. There is also a tablet which has just been approved by NICE, although I don't know how available it is yet, which can be used instead of Prostap which gives you more control so it might be an idea to ask about Relugolix.

It is a difficult decision and I wish you well no matter what you decide.

Hello Brizzy1 

An interesting post with many questions, so for what it's worth here's my take on it. I am a T3aN0M0 but with an initial PSA of 182. RT to the pelvic lymph nodes and 3 years HT.

I have managed 3 years HT - it's not been easy, I think I have had every side effect going and some not even listed, but the thing that kept me going (apart from the folk here) were the 2 words "Curative Pathway". The side effects have been an inconvenience and I am 3 years older, would I do it again for the same result - yes I would.

Volunteering on the Community I am aware of how the different HT treatments have different effects on folk. Prostrap looks to be the one that upsets more folk than any. I have done 3 years on 6 monthly Decapeptyl jabs and apart from the side effects I am great. It's done the job for me.

Bicalutamide looks to be a "milder" HT but it affects us all differently - I know you don't want to but I would stick with the last 10 months on HT whatever you are on. Your PSA results are great - it looks like the treatment is working.

I hope my "ramblings" help.

Best wishes - Brian.

Hi !

Having high risk locally advanced cancer, even with a fantastic respons like your husbands, it would be much wiser asking to go on to other real ADTs (e.g. Suppresing the production of Testosterone to castrate levels)

Your husband is having a agonist hormone therapy and there are several kinds. There is also never ones; antagonists like Firmagon and Orgovyx

Bicalutamide is not really ADT in the sence that the testicles will still produce Testosterone but Bicalutamide will block (its a inhibitor) the possibility for any prostate cancer left to have access to androgens or ’starve the cancer by blocking the food’

So I really understand your doctors concern. I would check for alternatives with other versions of ADT first at least 

So, like somebody said, Bicalutamide is a ’light’ version and with that fantastic respons I would never go the light way and really risk anything until I had tested other equal options.

I would say that the most use of Bicalutamide is before a couple of weeks before starting hormone therapy because Bicalutamide minimizes the risk of a Testosterone flare at beggining when you go on hormone therapy. This is however not necessary when Firmagon or Orgovyx because they don’t create flare, they just lower Testosterone rapidly

There are even more never and more powerful versions of Inhibitors like Bicalutamide today. but listen to your because the concern is very real

Best wishes - Ulf