Bicalutamide with Prostap SR DCS 3.75 + solvent for injection

The Biclutamide is for a lot longer than most people get it, But it may be effective. I know someone that was on it for years without ADT.

Prostap SR DCS 3.75 is Lupron, Something that most of us probably started with. I was on it for six years.

The timing for radiation is just about right. The 20 sessions can be a little hard on some people, Usually, they have some urinary burning issues and diarrhea. 40 sessions makes it a lot easier, but insurance companies don’t like that. I had it in 40 sessions and I noticed no side effects at all went right to work after, But that was 12 years ago.

Somebody with a 3+4 doesn’t really need ADT usually, unless there are other aggressive issues. Of course that depends on the doctor, Some want it anyway. If you only need it for four months, then it’s not a big deal.

This treatment is not far from the norm.

Perhaps ask if they will substitute Orgovyx instead of the Lupron. It has several advantages over the injectable drug.

Thank you very much for your response. It is much appreciated.@jeffmarc you mentioned “ unless there are other aggressive issues”. My score was downgraded from a 3+5 to 3+4. Does that account for your comment?

As was mentioned, use of hormone therapy for a 3+4 is atypical, but doesn’t hurt (as long as you’re ok dealing with the quality-of-life side-effects).

> with your Gleason 3+4=7, what % of that was the “4” cell type?

> did your MRI or biopsy reports mention anything about extracapsular extension, seminal vesicle invasion, perineural invasion, cribriform pattern or intraductal carcinoma?

> did you have an ArteraAI prostate test? (That will let you know if ADT would even benefit your treatment.)

> if you use a rectal spacer and practice consistent full bladder/empty bowel protocol, your risk of GU, GI, rectal, and bowel issues will be minimized.

> if they avoid radiating your penile bulb, your risk of late ED issues will be minimized.

Take it a step at a time and you’ll be fine.
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At 65y (in 2021), I was initially diagnosed w/Gleason 7(3+4) w/PSA of 7.976:

> we planned for 28 sessions of proton radiation (over 5-1/2 weeks); but, a 2nd opinion upgraded the 3+4 to a 4+3. So, we first…..

> started Bicalutamide (Casodex) for 30 days (to minimize the risk of testosterone flare).

> had 1st injection of Eligard 6 days after starting Bicalutamide; had 2nd (and final) injection 3 months later.

> started the 28 sessions of proton radiation (over 5-1/2 weeks) just 5 days after that 1st Eligard injection.

Treatments were relatively uneventful.

@thefonz Regarding your downgraded Gleason score.

A Gleason score is a pathologist’s educated, experienced, and expert “opinion” of what he (or she) believes they see under a microscope); it’s often as much an art as it is a science.

What one pathologist sees as a Gleason 7(3+4), another might see as a 7(4+3), and another as a 7(3+5). There’s no sure way to know which one is “right.”

When I was diagnosed with a 7(3+4) and waiting for the results of a 2nd opinion, (and understanding the ambiguity about the situation), I made a personal commitment:
> if the 2nd opinion came back a lower 6(3+3), I would still get treated to the original higher 7(3+4);
> if the 2nd opinion came back the same 7(3+4), I would (of course) get treated to that 7(3+4);
> if the 2nd opinion came back a 7(4+3), I would then get treated to the higher 7(4+3).

As it turned out the 2nd opinion came back a higher 7(4+3), so we added 30 days of Bicalutamide (Casodex) and 6 months (two 3-month injections) of Eligard. (My doctor even asked if I wanted another biopsy as a tie-breaker; I said “no, let’s go with the 4+3.”)

What I didn’t want to do was to inadvertently under-treat the disease and then have to address it again later. (Nor did I want to turn my prostate into a pincushion with another biopsy.) Time will tell if that was the right call, but so far, so good (5+ years later).

These are all personal calls that one has to make as part of self-advocacy and shared decision-making. (And it might be why they chose to go with hormone therapy for your 3+4=7.)

Thank you for your comprehensive and educated response.
I will certainly take your comments on board !

@thefonz
The other aggressive issues are

any of these things found in the biopsy intraductal, ductal, large cribriform, Seminal vesicle invasion, EPE or ECE. (Extraprostatic extensions extra capsular extensions). They can make the cancer much more aggressive.

The Gleason score does not take into account these issues.

I read these and just amazed at all the different ADT drugs, how can anyone ever decide which is best for them. That would put a lot of stress/anxiety on a person.