Start on Abiraterone two years after Docetaxel?

[Jlcwonderboy]

Hello, am writing on behalf of my Dad who was diagnosed in July 2017 with a PSA in the mid twenties.

I’m glad to say he has responded very well to treatment and his PSA is currently below 0.2 (getting to the nadir about 12 months after starting ADT). He also had 6 rounds of Docetaxel in late 2017 and is on the PATCH arm of the STAMPEDE trial here in the UK.

I am writing because recently the NHS in Scotland have ruled that they will now recommend giving abiraterone as a first line treatment to patients before they become castrate resistant and there are rumours circulating that NHS England will be announcing similar soon.

My question is, do we think it is a good idea for my Dad to start Abiraterone as soon as possible (if indeed it is made available to him) before he becomes castrate resistant? Or should we just wait? I appreciate it is an unusual situation, and taking it now could hardly be considered ‘early’ two years after chemo, but I suppose it depends on whether ‘early’ simply means before castrate resistance.

Any thoughts?

Thanks

JLC

[Tall_Allen]

Abiraterone extended survival by about 18 months in men who are hormone sensitive and newly diagnosed, and by about 3 months if they waited for castration resistance. There is no data on the incremental benefit if used after docetaxel. There is also no data on the survival advantage afforded by estrogen -- It may be that estrogen is all he needs. .