treatment post surgical castration

[Pops78]

79 yr old with stage 4 pc with mets to bones, dx May 21. Chose surgical castration instead of Lupron. PSA went from 68 in July to 1.1 in Sept (10 days later), 0.6 in Oct. to 0.4 Nov. 2nd. Oncologist wants to start Nubega which is for non-metastatic castration-resistant pc, and has some pretty nasty side effects. Should I wait until PSA stops going down to start treatment? Different treatment? Anyone with similar dx? Anyone taking this drug? Have medicare with no prescription coverage. Any recommendations on prescription coverage?

[pjoshea13]

Why is your oncologist so eager for you tp start on Darolutamide [Nubeqa]?

"Darolutamide is specifically approved to treat non-metastatic castration-resistant prostate cancer (nmCRPC) in conjunction with surgical or medical castration", whereas you have metastatic castrate-sensitive PCa. [1]

The cost for a single Nubeqa 300 mg tablet is over $100!!! [2] If you needed an antiandrogen, there are cheaper alternatives.

-Patrick

[1] en.wikipedia.org/wiki/Darol...

[2] drugs.com/price-guide/nubeqa

[Pops78 in reply to pjoshea13]

Wow, that is expensive! Thanks

[Tall_Allen]

If you don't have prescription coverage, Nubeqa is expensive.. Nubeqa is unique in that it contributes less to fatigue than other 2nd line hormonal drugs. The 2nd line drugs provide longer life, even when men are castration sensitive, so it is not a good idea to wait. You may want to discuss financial toxicity with your oncologist. Abiraterone is available as a much lower cost generic (about $250/mo.)

[Pops78 in reply to Tall_Allen]

Quite a difference! Thanks

[Pops78 in reply to Pops78]

So you think watching PSA as long as it's going down might be a mistake?

[Tall_Allen in reply to Pops78]

I said don't wait. I didn't say not to monitor

[Pops78 in reply to Tall_Allen]

Guess I didn't say it right, I meant waiting to take med if PSA continues to go down?

[Tall_Allen in reply to Pops78]

For the third time, I said don't wait.

[Hailwood in reply to Pops78]

Please don't wait

[Concerned-wife in reply to Pops78]

Even if you decide not to get Medicare drug coverage, you can use programs like GoodRx to buy abi at approximately $250/ month and the accompanying prednisone is very,very inexpensive

[Magnus1964]

Why not wait to see where your PSA is headed before starting a new drug. Plus, there are other drugs that cost less and have fewer side effects.

[Pops78 in reply to Magnus1964]

Thank you. Cost and side effects are a concern, esp. side effects.

[Pops78 in reply to Pops78]

What I was thinking, watching PSA for a little while longer?

[Pops78]

Thank you! We have original Medicare, parts A and B right now, no D coverage. Carried it for years and it didn't cover our branded drugs so dropped it. We've been so healthy until now. Not up on all this, is the Humana you have a Medicare Advantage Plan or a PDP Humana drug plan with original Medicare?

[Sheba215 in reply to Pops78]

Hello, Pops: Bayer (nubeqa povider) has a financial assistance program. Your MO can get an application for you. I filled one out even though I thought my income was too high to qualify. Bingo, they sent me three free bottles and have call to ask if I'm ready for more. BTW I have castrate resistant PC with bone mets and still holding on to my nuts. I'm on one Zytiga and four Nubeqa daily. Also on Lupron for at least 10 years now.

[Pops78 in reply to Sheba215]

Do you have prescription coverage like Plan D, or Advantage Plan with D? Can that affect receiving help from Bayer?

[Seasid in reply to Sheba215]

my mother had chronic pielonephritis for 12 years (one of her kidneys dropped down after pregnancy) and was cured from the infection with 8 months of MANDELAMINE.

This was very long time ago. Maybe they have now better medications but mandelamine was the only drug which one helped her to get rid of her kidney infection afte 8 months of use.

[Concerned-wife]

Medicare Part D plans vary by state..even by county. You will pay a penalty each month if you have been on Medicare but not chosen a drug plan yet, but this might be well worth with it.

You can input all your drugs, or drugs you are considering at Medicare.gov to see what the overall cost ( premium plus drugs ) will be for various Part D plans.

You can look there at Medicare Advantage plans, too

An easier route is to find an insurance broker in your area that sells both types of plans to have them research this for you. It is Open Enrollment right now so don’t hesitate

Caveat. I believe if you switch to a MA plan, you have one chance, in the first year, to switch back if you are unhappy. . Otherwise the supplement is medically underwritten and with cancer you could be denied.

[Grumpyswife]

My husband has experienced fewer side effects with Nubeqa. Xtandi was the worst for side effects.

[Pops78 in reply to Grumpyswife]

Do you have ins. that covers it? Really expensive.

[Grumpyswife in reply to Pops78]

Absolutely have insurance that covers a good portion. There is also an assistance plan.

[Pops78 in reply to Grumpyswife]

If you don't mind saying, what ins. do you have? Original with plan D (which company plan D) or a MA plan? Do you have a supplement and does it cover meds? Sorry, we have just been so healthy til now so never needed much coverage so clueless about all this. Thanks

[Grumpyswife in reply to Pops78]

My primary is Medicare A & B and secondary Blue Cross Blue Shield from a former employer. Friends have had good luck with AARP but no one I know is having to cover such expensive drugs as the ones Grumpy is on.

[CSHobie]

Pops, I just wanted to say, Great response to get the PSA to drop so fast after Orchiectomy. Well done