For ADT, double blockage, Lupron and Casodex, should the Casodex dose be 50 mg. or 150 mg. daily? When on ADT, what laboratory test level of DHT in my blood serum has to be achieved, so not to have to use Advodart?
The answers to your questions have not been proven in clinical trials. I can only tell you how we currently handle these issues. We generally use 50 mg of Casodex. I reserve 150 mg of Casodex for patients who are either at high risk for the development of hormone-resistant disease or who have stopped responding to 50 mg of Casodex. We monitor DHT monthly and add finasteride or Avodart if the DHT is above 10. With this approach, approximately 90% of the patients we treat reach a PSA of less than 0.01 ng/ml and usually do so within 90-120 days. However, it is important to point out that no randomized controlled trial has been done to show a survival benefit to this approach.