Robert,

I haven't got the book in front of me, but if I remember
correctly, Dr. Stephen Strum, in his book, says that
patients who get to a PSA below .05 on hormone
therapy are unusually responsive to it, i.e., their
cancer is more than usually hormone dependent.

Again, IIRC, he recommends a combination HT
therapy for such patients whom, he says, may live
many more years than average patients on HT.

You might want to have a look at his book. See:
http://prostate-cancer.org/resource/primer.html

I'll make another posting about Strum's approach
to hormone therapy.

  Alan

As someone who is taking 150mg of Casodex a day as an adjuvant to external
beam radiation therapy, I too am concerned about the withdrawal of the
approval of Casodex for early stage prostate cancer treatment in both the UK
and England. The basis for the concern seems to be the results reported in
the 8000 patient trial that was reported in the Journal of Urology vol.168,
pges 429-435, August 2002. The results of this trial were broken down into
three groups broken. Trial 23 consisted of 3293 patient with an initial
avaerage psa of 7.1. Trial 24 consisted of 3603 pateinets with an average
starting psa of 11.7 and trail 25 had 1218 patients with an average starting
psa f 16.2. Thus, the groups correspond to low, medium and high risk cases
of prostate cancer. In each group, roughly half were given 150mg of Casodex
per day and the other half were given  a placebo. The background treatments
were either radical prostatectomy, external beam radiation or watchful
waiting. To illustrate the problem, I will give the results only for the
intermediate risk group (trial 24). At the end of about three years, 181
patients in the Casodex group showed evidence of clinical progression.
However, clinical progression includes deaths although not necessarily from
prostate cancer. In this group of 181 progressions, there were 85
progressions and 96 deaths. By contrast, the placebo group had a
significantly higher rate of progression of 293 patients. Of these, there
were 201 with clinical progressions and 92 were deaths. The other groups had
roughly similar outcomes. The odd thing is that the Casodex group have
certainly an improved rate of clinical progression but that there seems to
be a slightly higher death rate in the Casodex group. Without having more
data, it is difficult to know if the difference is of high statistical
significant but my instinct is that it is not. Nevertheless, my impression
is that it is these figures that have made the medical authorities uneasy
about the approval of Casodex for early stage cancers. However, so far as I
know, there is no obvious cause for the increase in deaths although the
paper seems to suggest that there is a small increase in abnormal liver
function in the Casodex group.

I have been tasking Casodex for a year following radiation therapy and, as I
reported in an earlier posting to this group, things seem to be progressing
well with not too serious side effects. My inclination is to continue taking
the Casodex for another year or maybe two because there is quite a lot of
evidence (although not indisputable) that the long term disease free
survival rates are significantly improved by the adjuvant use of drug
therapies with radiotherapy. In the case of your father with Casodex being
prescribed as the only treatment, it is a difficult decision but you should
certainly put it in the context of his psa history and Gleason scores. I
think deciding what to do when you are diagnosed with prostate cancer at a
reasonably early stage but when you are of reasonably advanced years (i.e.
65 plus) is a very tricky decision and is influenced by what your general
health is like and whether or not you are still having an active sex life
and so on. One of the advantages of Casodex compared to other hormone
therapies like Zoladex and Lupron is that its side effects are not generally
as severe but they are not negligible either.

I should stress that I am not a medical practitioner but you might like to
quizz your father's consultant a bit more on his reasons for suggesting the
150mg Casodex treatment as the primary treatment. Best wishes.
Les Bradbury