Flutamide, bicalutamide, nilutamide, apalutamide or enzalutamide?

[RICH22]

According to the cancer.gov fact sheet for Hormone Therapy for Prostate Cancer, there are 5 types of CAB, Complete Androgen Blockade. I've been on bical. for about 20 months. However, against advice, I have not had radiation nor surgery. The combo I'm using is finasteride, tamsulosin and bicalutamide, which has kept my PSA <0.1 -- I've been told this cannot last but have seen enough evidence against that to give me pause. Should bical. fail anyway, which -utamide would you choose?

[MJCA]

First off, what’s your Gleason score?

What did your biopsy show? Is it encapsulated or has it spread?

I was Gleason 7. Had this disease close to 15 years. In 2018 my PSA rose very fast. First line androgen therapy (Lupron, bicalutamide) ceased to keep my PSA low. Started apalutamide and my PSA dropped fast. I was really depressed and nauseous not eating. I tried darolutamide, OMG. I was so depressed I wanted to eat a gun plus I urinated in bed at night. I had to weigh the side effects and went back to apalutamide. In 3 months my PSA went from 1.0 to 1.5. So, I am freaking out again. Hope this helps. Your treatment is more like BPH not cancer (except for Casodex).

[RICH22 in reply to MJCA]

thnx for reply, VERY helpful! would've posted my history but can't find where to do that. Biopsy 9/2018 - GL 4+3, PSA at 14.8, down from 16.3 using ayurvedic herbs, supplements, etc.

Uro-onc (who last week would NOT answer any PCa questions, only spoke about BPH, wanted to strangle him) put me on the three pills mentioned above. No ECEs, so i'm hoping that is still the situation. Hormones kill libido and erections but not orgasms, but lucky me, I got other interests in life at age 73.

dutasteride is supposedly selective for PCa cells than finasteride but it sucked at lessening urination urgency. I'm guessing the darolutamide is one more bad news with good advertising promo.

15 years... wow. my PSA started climbing in 2012 or so but my attention was diverted by discovery of 7+ comorbidities, including bone marrow cancer. by 2018, PSA was over 17. Your story gives me hope - thank you, my friend.

[MJCA]

Rich22,

If your doctor won’t answer your questions, I would find another doctor!

Just sayin’.

Cheers

Mark

[RICH22 in reply to MJCA]

already done! seeing a dr. that all 18 guys in the real-world support group trust and like. altho only a urologic surgeon, his knowledge of oncology is respected. good enuff for me!

[Tall_Allen]

ADT is not a cure. It will not last. You can delay progression for longer and increase survival by using a stronger anti-androgen. But if you are not metastatic and hormone sensitive, you will have a hard time getting any of them.

[Magnus1964]

I would recommend radiation at this point

Then move on to other ADT drugs.

[RICH22 in reply to Magnus1964]

yeah, seems everyone and his aunt mary is pushin me toward "actually treating" the cancer instead of pushing it around with various hormones. However... been researching the work of the late celebrated Dr. Labrie, thnx to tango65, who referred me to Labrie's work in 2008. He made these statements: "...androgen blockade is

now recognized as a potential cure for localized prostate cancer and is no more considered as only palliative, a characteristic essentially based upon observations made in metastatic disease."

and : "The simple addition of a pure antiandrogen to castration in order to block the action of the androgens made locally in the prostate increases the potential of cure from 33% with monotherapy to more than 90% with combined therapy."

I hate rolling the dice, Mag. Radiation could let me stop using hormones, which could vastly improve erections and let my bod go "back to normal" -- or it could ruin everything I enjoy now: no pain and no incontinence. Most men suffer little to zero SEs from RT but my instincts tell me the less damage I do to my body, whether by treatment, accident or self-inflicted insanity (eating garbage food, since I haven't done street drugs in over 30 yrs), the more chance I give my body's natural (or God-given, depending on your orientation) healing abilities to do their thing.

Again, thanks for attention, buddy. Two words for ya: Rock on!!

[Magnus1964 in reply to RICH22]

Yea, I think the race is on to create an ADT drug that would put Pca in a permanent remission state. That would then get us all on a single expensive drug for the rest of our lives.

[RICH22 in reply to Magnus1964]

sounds good to me! Nalakrats says the genetic engineering boys and girls will eventually figure it out. My urno-onc agreed today. Had a great talk with him - he's not even a qualified onc but knew more than the uro-once who referred me to him. From now on, he's my go-to guy.

Oh, gotta ask you - did you ever make a video with a urologist, to be used as an infomercial for various medical groups? saw one today, the patient looks exactly like you!!

[Magnus1964 in reply to RICH22]

Nope, not me. Maybe I should sue .

[RICH22 in reply to Magnus1964]

go for it! for the record, you're better looking than the guy in the video... but then, that guy was a chimpanzee, so i dunno. lol

[Boywonder56]

Mide,mide,mide,mide,.....what a lovely mess youve got us in ollie.....couldnt help myself....must be the earleda.....orj.o.h.n.....starting to rub off on me...

[RICH22 in reply to Boywonder56]

gotta keep laughing, BW! lose yer sense of humor and yer toast, no butter, dead carbs, etc. thnx for the reply.

[j-o-h-n in reply to Boywonder56]

Yessiree Ollie..... this Desert is a Son of bitch.....if you ask me....

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 02/14/2020 2:52 PM EST

[j-o-h-n]

Beware of the "IDEs" of ADT......

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 02/14/2020 2:47 PM EST

[RICH22 in reply to j-o-h-n]

oh you kid! good one!

[pinejogave]

I’m