1. Drugs like casodex and similar have value but also have some side effects that are nasty a bit. Seldom mentioned is the cancer fighting drug for prostate cancer namely DES (man made estrogen) drug. It is very cheap in price, does cause direct apoptosis of PCa cells and actually retains or builds bone density (while other drugs rob it from you and thin your bones). Cost is almost free too. Compare DES 1-mg (100) count at $25 to Casodex 50 mg of 100 for probably $1000 retail (insurance will pay). Might I add that I have used both the mainstream drugs of Lupron-Zoladex-Casodex-Proscar and DES outperformed them all with test results too, and little or no side effects. Countrary to some discussion 1-mg of DES or even using 1/2 mg. is still effective and does not cause blood clots, used with 81 mg aspirin (1-tablet normal size). I had great results with this and no problems. Lupron billings was around $8400 per year, Zoladex was less some. DES per year was $100, cheaper than vitamins too. Truth shall set you free.

Posted at 2:27PM on Sep 12th 2006 by Robert Parsons

2. Robert, thanks for recounting your experience with DES. I'm wondering if you were lucky using the aspirin to prevent clots or are on to something. In "A Primer on Prostate Cancer -- The Empowered Patient's Guide," pp. 154-155, it says: "Although many physicians are using aspirin in place of Coumadin ["to prevent thrombotic events associated with antithrombin-III deficiency"], aspirin has no effect against antithrombin-III deficiency. Therefore, aspirin will not abolish the abnormal coagulation findings in patients treate wih PC SPES and other oral estrogenic compunds including DES and Emcyt." I've taken that at face value and not checked it at PubMed. Have you looked into this issue?

I have a rooting interest as DES or some other estrogenic approach could be a fallback for me if intermittent triple androgen deprivation fails. So far, I'm doing very well with a PSA of 0.02 and falling on my second round of triple blockade in my seventh year of diagnosis with a very challenging case.

Jim (website: http://www.mycancerplace.com/profile.php?id=147)

Posted at 3:27PM on Sep 12th 2006 by Jim Waldenfels

3. Thank you Kristina for calling our attention to this hot-off-the-press news!

I just checked for the study in PubMed after reading the linked article. I found it, as well as interesting related articles.

Basically, the solidifying conclusion based on large trials is that bicalutamide (Casodex) at 150 mg helps delay or prevent progression in a very significant way for men who have had radiation for locally advanced cancer, but does not help those who have had radiation but do not have locally advanced cancer (those whose cancer is confined to the prostate), and it may even do slight harm. This is extremely useful information in tailoring therapy to the patient.

Robert alluded to side effects of bicalutamide (and other anti-androgen drugs like flutamide). The set of studies indicates clearly that many patients experience breast issues such as enlargement, tenderness and pain, though generally not to a great degree. There are known ways of dealing with those side effects, but they need to be considered. An earlier report about the same series (Tyrrell CG, Payne H, See WA and others 2005) stated: "The most common adverse events were breast pain (74.8%) and gynecomastia [breast enlargement] (66.6%), which were mild to moderate in >90% of cases."

My impression is that intermittent triple blockade does a better job of reducing cancer impact, but it is expensive, as Robert noted, and it has a different set of side effects. Also, it is not at all as well documented, with no randomized, double-blind placebo controlled clinical trials. (That said, I'm a firm believer that it will prove highly effective when trials finally are run.) I've read that intermittent triple blockade has a much better profile of breast side effects than blockade with just anti-androgens alone.

Jim (web site: http://www.mycancerplace.com/profile.php?id=147)

Posted at 4:49PM on Sep 12th 2006 by Jim Waldenfels