I'm new here....been on Firmagon since my diagnosis July 2015 (with Gleason 9 right side with Advanced Prostate Cancer with possibly 3 to 4 bone mets) and then changed to Lupron Injections every 3 months starting July 2018 (with gradual rising PSA from 0.05 on 9-29-16 to now 4.75 on 3-27-19. My options at his time according to the Oncologist would be Xtandi or zapping the one left illium Met with 10 Radiation treatments.
Now my Onco says to first try the Xtandi. (I have one bone met 2.1 x 1.6 x 2.3 in left ilium adjacent to S1 joint according to 2-21-19 MRI Pelvis which confirms the same original met found on August 2015 MRI) Recently started watching some of the Dr. Meyers Videos on Prostate Cancer Treatments he has used for years including his patients and his own complete durable remission of Castration Resistant PC.
Appreciate if anyone out there would happen to know if Dr. Charles "Snuffy" Meyers has any info videos or blogs or books) available on how to begin dosage levels for Xtandi 40mg capsules? The recommended dosage says "Take 4 capsules (160mg) once daily as directed by the physician" Would it be possible to start with 1 capsule (40mg) daily and work up to the daily 160 mg on a gradual basis? The side effects/precautions listed on the Xtandi Enclosed Info Sheet are numerous and run the full spectrum of everything you can imagine.
( With the Metformin Dosage Dr. Meyers has videos that mention working up to 2000mg daily by starting week 1 starting with one tablet daily (500 mg) and reaching the full dosage by adding another tablet daily and successively for weeks 2 -3-4 until the full dosage of 4 per day is reached.)
Thanks for any thoughts on this.......tgrec
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tgrec
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I have been on Xtandi (enzalutamide) for nearly 20 months. The biggest side effects that I have experienced over that time are fatigue and some "brain fog". I started out with four pills a day and maintained that dosage to the present day. My one suggestion is to take Xtandi at night because the pills do make you drowsy. Good luck!
I've been on Xtandi 28 months. Fatigue is my main symptom. It comes and goes. It's not like it suddenly just hits right after I take the 4 capsules each day. I happen to take mine just before bedtime. (I had about 10 Ga-68 PSMA PET "hot spots" in bones and lymph nodes when I started Xtandi with a PSA of 95.0. It quickly took my PSA down to 1.2 over a year ago. Most recent PSA was 2.9.)
The package insert mentions that it typically will already take almost a month for a peak serum level of Xtandi to be achieved using the standard 4 capsules per day dosage.
"With the daily dosing regimen, enzalutamide steady state is achieved by Day 28, and enzalutamide accumulates approximately 8.3-fold relative to a single dose. Daily fluctuations in enzalutamide plasma concentrations are low (mean peak-to-trough ratio of 1.25)."
Most men tolerate it well, considering the alternatives. Of course, report all your actual symptoms to your doctor. Good Luck!
My father has same.just daignosed last mknth... Gleasone score 9...right side.... Bone metastates.... Spinal and 4th rib..... Till now.... Zytiga and firmagon is going on.... Could you please tell..... What year of survival I can expect now.... Is it in month or year...?
On page 341 under the heading "Overall survival" they report that 83% of the included patients in the trial were alive after 3 years from the beginning of the therapy.
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Xtandi after Zytega and then chemo
Starting Zytiga after Xtandi failed
Xtandi, Xgeva, and Dental
Looks great, but think Xtandi is coming to an end. 
Xtandi for PSMA expression
