Why Erleada after Lupron doesn't work and PSA is 24 with no signs of cancer? anywhere after all scans negative.

[dadsdrdawn]

Please tell me your experiences with Erleada. My dad is resistant to Lupron shots after 5 years. Had radical prostatectomy 11 years ago. PSA is 24...and now on Erlaeda Chemo pills for 2 1/2 months and feeling fatigue he has never felt. All other scans show no cancer anywhere so does anyone have any thoughts on what to do instead of Erleada and WHY the dr. wants him on Chemo? He's 84 SUPER active and travels and collects art and LOVES life and works out in the gym I own with my husband 2 X weekly doing strength training! Also, he gets what he calls "the heebie jeebies" that run through his body after 5 pm nightly (not really restless legs, more like restless body) and are wondering what to do about that.

[Tall_Allen]

Are you sure that he has never had metastases show up on a scan? It would be hard to get Erleada or chemo if has no metastases. If not, he can get an Axumin PET scan to show that he has had metastases.

Chemo is the best next step. It does a great job at halting progression and improves quality of life. The tragedy is when men wait too long for it. It is less effective and harder to take later.

[tallguy2 in reply to Tall_Allen]

TA,

Erleada is only FDA approved for men who are not metastatic and have failed first-line ADT, such as Eligard or Lupron.

I know this because I am on a Phase II trial now to see if it helps extend time to progression for men with MCRPCa.

[Tall_Allen in reply to tallguy2]

Erleada is also FDA-approved for men with metastatic hormone-sensitive PC.

fda.gov/drugs/resources-inf...

[tallguy2 in reply to Tall_Allen]

Thanks for the update. I apologize, as I forgot about last summer's announcement.

I'm quoting from the flyer included with my latest bottle of Erleada: "ERLEADA is a prescription medicine used to treat prostate cancer that has not spread to other parts of the body and no longer responds to a medical or surgical treatment that lowers testosterone."

(They hadn't updated the flyer, obviously.)

[ctarleton]

Technically, Erleada (apalutamide) is not a traditional "chemo" like Taxotere (docetaxel). Instead of killing many types of cells the way docetaxel can, Erleada "does its thing" by being an Androgen Receptor Inhibitor, which interferes with the life cycle of prostate cancer cells which depend on Testosterone to survive and multiply.

The Full Prescribing Information for Erleada shows that is is approved for two Indications:

1. Metastatic Castration-Sensitive Prostate Cancer

2. Non-Metastatic Castration-Resistant Prostate Cancer.

More details are here:

janssenlabels.com/package-i...

If there is doubt about his status, keep asking his doctor to clarify.

If regular CT scans or NM Bone Scans or MRI scans have not been enough to help confirm his status, as TA mentioned, his doctor might get more information using an Axumin (Fluciclovine F 18) scan.

More patient-oriented information about that is here:

axumin.com/patient/patient-...

An Axumin Imaging Center Directory is here:

axumin.com/imaging-center-l...

Hope all goes well. It is great that your Dad has been able to lead such a full and active life up to age 84. Keeping him "moving" will probably continue to help. Keep us posted.

Charles

P.S. Sometimes people who are beginning to develop early age-related neurological conditions begin to show what is called "sundowner syndrome". Restlessness and agitations as daylight fades is sometimes a symptom. You might discuss with him the possibility of screening for such things, just in case, and perhaps get a referral to a gerontologist or family doctor with lots of elderly experience.

[dadsdrdawn]

Thanks for replying...my dad is such an active person with SO many things going on...traveling, golfing, huge new condo with my mom...that he does forget some stuff...Not sure it's related to the meds though LOL.

[j-o-h-n]

Your Dad is a badasss... from the 30ths. Give him a fist bump for me............Forgetting stuff is par for the course......... as long as he doesn't forget his wedding anniversary (write it down for him in and store in a safe place)....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 03/10/2020 7:48 PM EDT

[dadsdrdawn]

YOU rock! Thank you for this reply. Yes he is, and I am BLESSED to have him inspiring me and our family. TODAY was a great day...he found out that his PSA is ZERO after only 2 months of Erleada. So...1/2 the dose for the next 2 months and a Lupron shot with fingers crossed, prayers and my dads smile in our gym today with teary eye's as he told me the news! Wishing stellar news and health to you all!