Starting enzalutamide

[33947]

MO recommends adding enzalutamide to current ADT regimen since PSA has gradually risen to 4.4 from 2,9 in 3 months. Original idea was for darolutamide but insurance disallowed. Passed on Zytinga with the prednisone due to afib and mild heart failure. Can anyone provide insight comparing these three drugs? Should I appeal the darolutamide decision?

[Tall_Allen]

Is there any reason you can't have docetaxel?

[33947 in reply to Tall_Allen]

No, the MO hasn't suggested it. I'll bring it up when I see her next week after another bone scan.

[RyderLake2]

Hello,

I can't compare them because I have only been on Xtandi (enzalutamide). What I can say is that I have been on enzalutamide for a little over three years. Between enzalutamide and Zoladex (goserelin acetate) they have kept my PSA consistently low. It is currently 0.044 which is not bad considering that at diagnosis (seven years and four months ago) my PSA was a little less than 1700, Gleason 8 and widespread bone metastases. Do I have side effects? You bet, but given the alternative nothing my wife and I can't live with. I would go along with your medical oncologist. Darolutamide might be slightly better than Xtandi but, in my opinion, not worth paying the additional cost. Hope that helps!

[tango65]

Darolutamide is approved for nonmetastatic castration resistant prostate cancer. If he had or have metastases he does not qualify for darolutamide. The metastases diagnosis has to be made with CT scan and/or bone scan.

accessdata.fda.gov/drugsatf...

You could request zytiga without prednisone. They could use zytiga plus Inspra (eplerenone) a drug which blocks aldosterone receptors and avoids the complications produced by the increase in aldosterone caused by zytiga.

ncbi.nlm.nih.gov/pmc/articl...

[2dee]

Very excited that Xtandi added to Lupron over 5mos ago has dropped my PSA down to .5 after ramping up to 9.1 from my nadir of 1.2. Started at 1303 Jun 2018.

Expected more side effects but only more fatigued now.

Only problem is cost of these drugs. Research YOUR cost and alternatives carefully.

2Dee

[EdBar]

I’ve been on Xtandi for over 5 years now, side effects are significant but tolerable, my PSA has been undetectable during that entire time. I was able to scale back to a half dose about two years ago and it is still effective and it’s helped with some of the side effects. I’ve also had early chemo per CHAARTED, chemo was no walk in the park, and I still have side effects from it but the aggressive approach seems to have worked thus far.

Ed

[33947 in reply to EdBar]

What are the significant side effects you experience?

[EdBar in reply to 33947]

With Xtandi, mainly fatigue and cognitive issues, but also headaches. Sartor prescribed Celebrex, that I cleared with my cardiologist which has helped quite e a bit with those. When I was on a full dose these side effects became very pronounced after talking it for a couple of years. Side effects seemed to be cumulative.

Ed

[33947 in reply to EdBar]

What was the nature of the cognitive issues, if I may ask?

[EdBar in reply to 33947]

Memory issues, brain fog, etc. I continue to take it however, because it sure beats the alternative. Just learned to live with it and laugh at myself, thank goodness for all the reminder and notes features on my iPhone, Alexa etc, lol.

Ed

[Shooter1 in reply to EdBar]

Definitely cumulative with me. Full dose made me an invalid after about 9 mo.

[Shooter1 in reply to EdBar]

Same with me. 1/2 dose Xtandi to cut intolerable side effects. PSA stable to slightly declining for most of time (0.12-0.00) in no particular order). Still have hand and foot neuropathy from 9 cycles of chemo. Cut Xtandi over 2 yrs ago.

[33947 in reply to Shooter1]

What were the "intolerable" side effects you experienced?

[Shooter1 in reply to 33947]

Oh, shedding skin on entire body, losing toenails, inability to get up out of chair, numb ( hands, face. butt ,feet) loss of balance, blurred vision, inability to feed myself or bath myself. Probably others I didn't mention but this list will give you an idea of what 160 mg daily did to me. 80 mg I can handle and PSA staying very low and I am still here years after drs said I would be gone..