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Welcome to Dr. Hamid Sanatinia's Virtual Headquarters
Prostate (Hormonal)

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Dose Modifications (hepatic)
MDR

Goserelin
Leuprolide
Bicalutamide
Flutamide
Nilutamide
Prednisone
Ketoconazole + Hydrocortisone
Aminoglutethimide

Goserelin (Zoladex)
3.6 mg SQ day 1 & repeat q28 days
10.8 mg SQ dat 1 & repeat q12 weeks
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Leuprolide (Lupron, Leuprolide)
7.5 mg IM on day 1 & repeat q28 days
22.5 mg IM on day 1 & repeat q12 weeks
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Bicalutamide (Casodex)
50 mg po QD - monitor LFTs if long term use.
note: in patients refractory to other antiandrogen agents, may start with a higher dose of 150 mg po qd.
Urology 1997; 50:330.
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Flutamide (Eulexin)
250 mg po q8
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Nilutamide (Nilandron)
150 mg po qd
note: start 300 mg po qd on day of castration, decrease to 150 mg on day 30.
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Prednisone
5 mg po bid
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Ketoconazole 1200 mg po qd (start 600 mg qd X 1 week then increase to 1200 qd)
Hydrocortisone C 20 mg with breakfast & 20 mg with dinner.

note:
Hydrocortisone is administered with ketoconazole to prevent Addisonian crisis.
Patients may experience increased liver enzymes, peripheral edema, hypertension, congestive heart failure, hyperglycemia, rash, or nausea.
Patients must avoid drugs that have dangerous interactions with ketoconazole, which inhibits their metabolism. These drugs include cisapride, astemizole, terfenidine, phenytoin, cyclosporine, and coumadin.
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Aminoglutethimide
250 mg po QID. If tolerated may increase to 500 mg po QID
Cancer Treat Res 1988; 39:83.
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Some Abstracts:

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Publication Year: 2001 #705
 
Bicalutamide (Casodex) 150 MG as Immediate or Adjuvant Therapy in 8113 Men with Localized or Locally Advanced Prostate Cancer.

Manfred Wirth et al.

INTRODUCTION: The efficacy and tolerability of bicalutamide (a non-steroidal antiandrogen) as immediate therapy or as adjuvant to therapy of curative intent in localized or locally advanced prostate cancer has been evaluated in an international program of 3 prospective, double-blind, placebo-controlled clinical trials. MATERIAL AND METHODS: A total of 8113 men with prostate cancer and negative bone scans were enrolled in the program which was carried out in N. America (3292 patients), Scandinavia (1218 patients), and Europe, S. Africa, Australia and Mexico (3603 patients). Patients were randomized to receive bicalutamide 150 mg/day (n=4052) or placebo (n=4061), in addition to standard therapy of radical prostatectomy, radiotherapy or watchful waiting. Objective disease progression was determined by bone scan, CT scan, ultrasound or MRI. Deaths from all causes were counted as objective progressions. PSA progression was not a criterion for objective progression. A planned, pooled analysis of all 3 trials was performed on an intent-to-treat basis using a Cox proportional hazards regression model for progression-free survival. RESULTS: At a median follow-up of 3 years, bicalutamide significantly reduced the risk of disease progression by 42% compared with placebo (HR 0.58; 95% CI 0.51, 0.66; p<<0.0001). Of 922 patients with objective progression, 363 progressed in the bicalutamide group compared with 559 in the placebo group. Reductions in risk were seen across the entire patient population, regardless of underlying therapy (radical prostatectomy, radiation therapy or watchful waiting) or disease stage. The most frequently reported side effects of bicalutamide were gynecomastia and breast pain. Survival data were immature with 6% overall mortality and less than 2% of patients dying due to prostate cancer. CONCLUSIONS: Immediate treatment with bicalutamide 150 mg, either alone or in addition to standard therapy, in men with localized or locally advanced prostate cancer significantly reduces the risk of diease progression. Casodex is a trade mark of the AstraZeneca group of companies