Does ADT actually kill cancer cells?

Posted by ddl @ddl, Jul 2 8:02pm

It seems like a simple question, but finding a definitive answer is not so easy. My MO says yes - the combination of Orgovyx and Abiraterone does kill cancer and he wants me on it for two years (3 months leading up to radiation, 2 months during radiation, and 19 months post radiation) but almost everything I read says the ADT weakens cancer and causes it to in essence hibernate, but doesn’t kill it. I’m wondering if any of you guys know the answer to this?

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robertmizek | @robertmizek | Aug 8 10:41pm

In reply to @gbvetracer "don’t you think it’s strange that the only way my PSA lowers is when my testosterone..." + (show)

Fellow cancer patient here just weighing in with what I’ve been able to find. My doctor was originally going to put me on Casodex and Lupron. I opted for ORGOVYX instead.

Casodex does not reduce testosterone but affects your body’s ability to utilize it. It is normally prescribed with a second drug like a Lupron that does reduce testosterone.
https://www.drugs.com/tips/casodex-patient-tips

gbvetracer | @gbvetracer | Aug 8 10:58pm

Casodex for 30 days and psa drops in half with no side effects. T rises from 300 to over 1000.. which i dont notice other then seeing it on blood test results.. So this is completely opposite of all the posts here saying they lower testosterone to lower psa.

gently | @gently | Aug 9 12:17am

Casodex is an antiandrogen that works by binding to receptors in the tumor. You have more unattached or free
or unused testosterone. It is seldom given alone because it's more effective given with an LHRH which stop the testicles from producing testosterone.

northoftheborder | @northoftheborder | Aug 9 4:50am

In reply to @gbvetracer "don’t you think it’s strange that the only way my PSA lowers is when my testosterone..." + (show)

I strongly suggest that you have a conversation with your oncologist. Here in the forum, we're not experts, and we don't have access to your medical records in any case, so we have to way to reply to or verify anecdotal evidence. Your oncologist can explain what you think you're seeing.

web265 | @web265 | Aug 9 7:13am

Hey @gbvetracer, your situation may be somewhat unique, we all respond a little differently to things, but, keep in mind that makes you a study of one.

Disclaimer, I'm no doc, pharmacist or chemist, just a member of the "club" for a few years.

I might suggest (a more accurate word might be "guess") that your T goes up because it's still being produced but being blocked from use by the Casodex. It seems to be described as a receptor inhibitor as opposed to Orgovyx (Relugolix) which works by decreasing the amount of testosterone produced by the body.

From the WebMD website..
Bicalutamide (Casodex) - Uses, Side Effects, and More
Drug Classes: antiandrogen; antineoplastic; nonsteroidal androgen receptor inhibitor

From medlineplus.gov
Bicalutamide is in a class of medications called nonsteroidal antiandrogens. It works by blocking the effect of androgen (a male hormone), to stop the growth and spread of cancer cells.

From Wikipedia
Antiandrogens, also known as androgen antagonists or testosterone blockers, are a class of drugs that prevent androgens like testosterone and dihydrotestosterone from mediating their biological effects in the body.

From the National Cancer Institute
antiandrogen
A substance that keeps androgens (male sex hormones) from binding to proteins called androgen receptors, which are found in normal prostate cells, some prostate cancer cells, and in cells of some other tissues. Preventing this binding blocks the effects of these hormones in the body. Treatment with antiandrogens may keep prostate cancer cells from growing. Examples of antiandrogens used to treat prostate cancer are apalutamide, bicalutamide, darolutamide, enzalutamide, flutamide, and nilutamide. Also called androgen receptor antagonist and androgen receptor blocker.

So if I'm reading this correctly, Casodex is more of a blocker, keeping the cancer cells from feeding on the testosterone as opposed to something like orgovyx which is used to stop production of testosterone in the body.

"That's just my opinion, I could be wrong" - Dennis Miller

Best of Luck to you!

josgen | @josgen | Aug 9 8:14am

I had the same thing happen with my T (over 1000) when I was on bicalutimide for 30 days before planning to start Lupron. It also lowered my PSA pretty dramatically (50 to 8). Ended up using Firmagon instead of Lupron so the bicalutimide wasn't necessary to prevent a T flare but I'm glad I found this out about it causes rising T. Might want to use it on an ADT holiday to help restore T. I'm continuing to use bicalutimide as part of doublet therapy now alongside Orgovyx. Here is a snippet about bicalutimide causing rising T (and estradiol) under the article "Osteoporosis Associated with Cancer Therapy". https://www.sciencedirect.com/topics/neuroscience/bicalutamide#:~:text=Bicalutamide%20(Casodex)%20is%20a%20nonsteroidal,levels%20of%20a%20premenopausal%20woman.