My husband started Xtandi 2/3/18 and his cognitive decline may be coincidental to It. MO thought it best to hold off use of it to see if there is improvement.
This MO who we highly respect prefers to use Zytiga anyway and may start hubby on that when we see him in 30 days. The MO feels the disease load isn’t high and he is in no pain. Xtandi hasn’t produced great PSA decline anyway but did seem to level PSA at 8. Also hubby has recent orchiectomy and Provenge last year so he does have that going for him.
At age 75 with cognitive decline we are re-examining treatment plan as his quality of life has been great except for side effects of treatments.
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Grumpyswife
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We moved and started a new to us MO who wanted Xtandi.
We are traveling now and saw our original MO and he prefers to use Zytiga first. I just read in a recent study on here that the order doesn’t seem to matter. If I recall they both listed cognitive side effects at 5.9.
After having been on Xtandi for 6 weeks myself I can understand the concern but I have had no dementia yet. Just takes me longer to remember some things but no significant issues. Ugh aging too fast.
I was on xtandi last spring for about six weeks,along with cemo,lupron,xgeva,an nulasta after chemo, when the nulasta kicked in the next day I found myself on the floor with two rescue tec. ,an was taken to the hospital,the next am my mo took me off xtandi ,started zitaga the next month, on it since, mo told me only 2% have this happen. All the drugs take have side effects.
Xtandi can cross the blood brain barrier (whatever that means) where Zytiga doesn’t. However, you need to take prednisone with Zytiga and monitor liver which adds more complications and side effects.
We are in a holding pattern at the moment relying on Provenge and orchiectomy. His PSA actually went down after stopping Xtandi 30 days earlier. This disease is full of surprises.
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Zytiga failed, starting Xtandi. What to expect for my dad. 
Update on restaging cancer
Need guidance: maybe stopping treatment Due to treatment failure
