Xtandi or Zytiga or Yonsa? Pros, Cons, Side Effects? What about Erleada?

[cesanon]

What are the pros and cons of Xtandi (enzalutamide) and Zytiga (abiraterone acetate) and Yonsa another formulation of abiraterone acetate?

Particularly regarding side effects. It seems the docs never do a good job of explaining side effects, until they are upon you. LOL

My understanding is that Zytiga blocks the production of androgens and Xtandi blocks the androgens being produced from interacting with the cancer cells. Have there been any attempts to administer both together at lower doses to moderate the side effects of each?

What about Erleada (apalutamide) for metastatic prostate cancer.

[Magnus1964]

Everyone responds differently to these drugs. I did well on all of them (never took yonsa). If you are looking for an ADT drug with little or no side effects I would recommend casodex.

[LearnAll in reply to Magnus1964]

I had very little side effects with Casodex and PSA was dropping down like a rock. But once on Lupron and Zytiga, my Uro and Onco ,both told me to stop casodex saying once you are on Zytiga,you don't need casodex.

Now, I am confused...doctors and big pharma are aggressively promoting newer AR blockers like Enzulutamide etc ($7000 a month cost) and badmouthing good, old Casodex which is very inexpensive. It does not make any sense to me

Magnus, were you on casodex monotherapy for 8 years OR casodex plus Lupron ?

[cesanon in reply to LearnAll]

I understand that casodex works, but that these other drugs really shut the testosterone down far more completely.

[Magnus1964 in reply to LearnAll]

I was on casodex for 5 years before it started to fail. For 5 years nothing but casodex. But I think you are right. Now big pharma pushes the newer more expensive drugs. They want to make their money while the patent is still good. Each of these ADT drugs approaches Pca in a different way. That is why when one fails you can go to another. I have been on casodex, zytiga and xtandi. I have gotten a lot of years from each.

When a doctor tells you to stop one drug that is still working for another, that is big pharma talking.

[GeorgeGlass in reply to Magnus1964]

Have you taken ADT/Lupron or any of those at all? Can you get castration resistant in casodex like men do on Lupron etc?

Another man on this site said that he asked to take Xtandi without ADT and it has worked well for him.

[Magnus1964 in reply to GeorgeGlass]

I did not take Lupron, I had the orchiectomy. I started with Casodex (5years), then zytiga (3 1/2 years, then xtandi, (4 years).

[JuanVV in reply to LearnAll]

I just wonder if it's possible to use casodex monotherapy -my husband has never had it- if/when Enzulutamide stops working? He was never offered Casodex.

[cesanon in reply to JuanVV]

I would ask Tall Allen.

But casodex is an older and weaker drug with a similar mechanism to the newer drugs.

If the newer drugs stop working, I don't see casodex being of any utility.

[JuanVV in reply to cesanon]

Thanks for your reply. Hi Tall_Allen would it make any sense to consider Casodex after Enzulutamida? I guess as he has mets in bones it might not be for him?

[cesanon in reply to JuanVV]

Bayer has actinium 225 for bone metastasies. You need to look into that.

[JuanVV in reply to cesanon]

Thanks so much!

[cesanon in reply to JuanVV]

And also lu177 psma treatment. There is an actinium psma treatment as well. You need to check out tall Allen's blog on these treatments.

[JuanVV in reply to cesanon]

Thanks have to get ready in case, will read Tall_Allen's blog.

[Tall_Allen]

Yes, they have been tried together, but there was no extra benefit.

urotoday.com/conference-hig...

Erleada so far is only approved for non-metastatic CRPC. I expect it will get approved soon for metastatic HSPC.

[cesanon in reply to Tall_Allen]

Hmmm the worst of both worlds:

"The combination of abiraterone and enzalutamide for patients with mCRPC does not prolong survival compared with enzalutamide alone but does increase the toxicity of therapy. This combination approach should not be used for patients with mCRPC."