When would you give a patient with spinal cord compression and PSA of 2000 ketoconazole?
patient with multiple bony mets, heme/onc already started on casodex and lupron (simultaneously) family refuses orchiectomy
Answers:
Orchiectomy is the fastest way to obtain a castrate level of testosterone. Ketoconazole is the next fastest. If a patient has symptomatic spinal cord compression from prostate cancer mets, immediate orchiectomy or ketoconazole AND steroid bolus is indicated. Lupron will eventually result in chemical castration, but first causes a "flare" of testosterone that can initially worsen cord compression, but this affect is minimized by blocking the testosterone receptor with bicalutamide (casodex) Also, external beam radiation to the affected vertebrae can slow progress of mets and should be considered in a patient like this. Hope this helps.
Ketoconazole is antifungal but I also remember that it may have some anti-testosterone effects, so it may be for the purpose of a "chemical" orchiectomy.
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Answers:
Orchiectomy is the fastest way to obtain a castrate level of testosterone. Ketoconazole is the next fastest. If a patient has symptomatic spinal cord compression from prostate cancer mets, immediate orchiectomy or ketoconazole AND steroid bolus is indicated. Lupron will eventually result in chemical castration, but first causes a "flare" of testosterone that can initially worsen cord compression, but this affect is minimized by blocking the testosterone receptor with bicalutamide (casodex) Also, external beam radiation to the affected vertebrae can slow progress of mets and should be considered in a patient like this. Hope this helps.
Ketoconazole is antifungal but I also remember that it may have some anti-testosterone effects, so it may be for the purpose of a "chemical" orchiectomy.
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