Nubeqa monotherapy experiment coming to end

[joeguy]

Sadly it looks like after roughly 9 months of Nubeqa as a monotherapy, the Nubeqa alone is not going to keep PSA at bay. PSA has steadily crept up from a low of .9 to 2.6 today. Ct scan showed that the size of the largest lymph node tumors had been greatly reduced, but there are more of them (not sure if thats good or bad). I am going to try adding Relugilix to the Nubeqa to see if taking testosterone back to castrate levels has any effect. My Uro thinks it will lower it some, but no telling for how long since I am castrate resistant. Hoping that the Relugilix does not cause the nasty heart and cognitive SEs I experienced previously while on Firmagon and Xtandi, but if it does, it sounds like things return to normal fairly quickly upon stopping. Depending on how well ADT + Nubeqa works, my next choice is going to be LU177 treatment.

[Tall_Allen]

Good decision!

[joeguy in reply to Tall_Allen]

Yes, I think its the best way to go for now. I am still very impressed with the very low side effect profile of the Nubeqa, compared to Xtandi and the other next gen anti-androgens, but it just wasnt enough to hold down grade 5 PC by itself.

[GP24]

I thought these next gen anti-androgens would be so effective that you would not need to add Lupron. However, I read a few small studies now, which indicated that this is not the case.

[joeguy in reply to GP24]

I can confirm its not the case with Nubeqa. I think some have had success with Xtandi as a monotherapy, but Im leary of Xtandi after all the SE issues it brought on the first time I used it

[Grumpyswife]

My husband has been using Nubeqa with abiraterone and at first dropped his PSA by 100+ points. It has since stabilized.

[MateoBeach]

ARSI monotherapy means using it without an ADT to block testicular testosterone production. Simce the hypothalamus ARs are blocked by the ARSI (bicalutamide, enzalutamide or darolutamide) it perceives a lack of androgens and Calls For More via the pituitary. So high levels of testosterone and DHT occur in spite of the blockade. The problem here is the DHT which can be mitigated by adding dutasteride.

Eventually the ARs can mutate to be stimulated (agonists) rather than blocked (antagonist) by the ARSI. Darolutamide is less susceptible to antagonist to agonist switching mutations than enzalutamide or parallelize. Still it must be watched for. Using an ADT Regimen or a dutasteride along With the darolutamide can help protect the regimen.