Advice needed please.

[16starsky]

Hi Guys

My husband G9, MCRPC previous Doxycycline chemo, on Lupron since dx Aug 2019, PSA 320 down to 1.5, Dec 2019 PSA started to rise OC added 50mgs day Caxodex(Bicalutamide) saw OC yesterday and PSA gone up slightly (4.7, 3.9 NOW BACK UP TO 4.5) So looks like Cax has failed after 3 months, OC upped the doze to 150mgs day to see if that does anything.

Our OC (we are on the NHS in UK) said he will change to Abi or Enza when PSA reaches 15. (he seems to favour Enza) Having another body and bone scan in may, last one in Dec, no new mets,just the original 3 (2 spine , 1 pelvic bone)

My question which is the best option ? , we need to get this right.Our OC says there is not one better than the other? Is this true or is he spinning us a line ? He said he favours Enza because you don't need the steroids with that and wouldn't compromise the immune system as much.

All I want for my Husband is the best possible outcome, and we need help to choose what to do in the near future,

Thanks in anticipation of your replies,

Kim

[LearnAll]

Both Abiraterone and Enzalutamide are effective meds. They diifer in their mechanism of action and side effects.

Enza works by strongly blocking the action of Testosterone and thus stopping cancer cells whereas Abiraterone works on ALL THREE possible sources of testosterone in human body .i.e Testicles, Adrenals and cancer cells themselves. So, in this way, Abi is more potent med.

But, Abi can cause Heart related side effects such as increase in high blood pressure and in some cases even heart failure.

On the other hand, Enza can cause seizures. So we have to pick our poison...and that decision depends on individual's health condition..and his vulnerabilities in tolerating cardiac vs neurological side effects.

[16starsky in reply to LearnAll]

Thankyou for your reply Learnall. I have looked at studies ect in the past and I thought Abi was superior.

To be honest don't like the sound of eithers SE but a choice will have to be made'

Thanks for explaining in a 'simple' way that I can understand

[LearnAll in reply to 16starsky]

If you choose Abi, please monitor his blood pressure closely and get atleast a baseline EKG for future comparison. Make him eat heart healthy diet mostly plant based with veggies and fruits to keep BMI as close to 22 as possible.. Keep his potassium level above 4.0. Reduce sodium intake. Walk and physical movements are essential. Keep record of BP and show it to his primary doctor so he/she can adjust dose of BP meds, if he is on any. Yes, I agree that Abi is very effective med for a lot of people with PCa.

[Tall_Allen]

There seems to be no survival difference among castration-resistant men who have already had chemo. I would prefer abi based on this:

europeanurology.com/article...

[16starsky in reply to Tall_Allen]

Thanks TA hoping that you would reply. Read the link that you have just supplied, convinced that Abi is the way to go , less fatigue and cognitive issues .

Kim

[Hidden in reply to 16starsky]

Dear Kimx , you will make the right choice.. glad you two made it back home safely . Peace & Hi! To Mr Clint

[Grumpyswife]

My husband was started on Xtandi and had so many side effects he could not tolerate full dose. He is elderly (76).

He did have PSA reduction with half dose for about 18 months but it was a struggle for him. He switched to Zytiga with prednisone and it worked for awhile. He changed to dexamethasone instead of prednisone and that worked for awhile, too.

When he wakes up I will ask him about taking full dose with food to make sure he is getting enough into his blood based on an article just share on this website.

[16starsky in reply to Grumpyswife]

Thanks for your reply mjbach, appreciate the time you have taken to respond to my question.

Kim x

[16starsky]

Thanks Nal !