What is clinical flare vs biochemical flare?
When this increase in tumor burden causes signs of bone pain, or compression of a nerve root or spinal cord compression, or blockage of ureter(s) this is called clinical flare. If the increase in tumor burden does not result in symptoms but does result in an increase in PSA alone, this is caused biochemical flare. We would like to avoid any stimulation of tumor cell growth whether or not it is associated with clinical symptoms. The purpose of Flutamide, Casodex, Nilutamide or any anti-androgen prior to Lupron or Zoladex should be to block all flare reactions. Other agents like Nizoral that turn off testosterone production from the testes or DES or Cyproterone acetate that decrease LH also have been used to prevent flare. Can we prevent flare? If we saturate the androgen receptors with Casodex or Flutamide we can prevent both clinical and biochemical flare. What we propose is to study not only LH and testosterone levels after starting Lupron but also to measure PSA levels. We propose th
