Should I Pay for Enzalutamide

[Hazard]

I started ADT in May (my PSA had risen to 7.5 after IMRT in 2016). Unfortunately I am in the small group of me who have 'primary ADT resistance' and my PSA is now 21 after 6 months of ADT. Not a good look!

I am seeing MO next week, chemo is likely. In the meantime, urologist has added Casodex to my Zolodex. He did say that Enzalutamide is much better, but in Australia it is not covered by PBS until you have had chemo (and PSA is rising). He did say that some men self-fund Enza, it costs $4k per month.

I can pay this for a month or 2 but not indefinitely, is it worthwhile taking enza while I get chemo sorted out?

[Hidden]

Sorry to hear you didn't get a good response to primary ADT. You are right that Enzalutamide is better than Bilcalutamide (Casodex), but many people get a good result with Bicalutamide so I would suggest waiting to see if it works and how well before deciding. If you are doing 6 cycles of chemo, you will only be waiting 18 weeks to see what your response to that is.

I'm not a doctor, but from what I know a poor response to primary ADT makes it likely that chemo will be more effective than another androgen-based treatment. I have to say I agree with your health care system in this case. If I was in your situation, I wouldn't take Enzalutamide until after chemo and after rising PSA.

[Hazard in reply to Hidden]

Thanks Gregg, good advice.