Second hormone therapy drug- decision needed-any views?

[Brysonal]

I am due to start the third part of my 'triple' plan on Monday and am signed up for abiraterone (zytiga) with prednisolone. My 'triple' initial plan for my PCa which spread to the spine and rib last year has already changed from:

Degarelix

LU-177 (personal choice to replace chemo though i am hormone sensitive

Abitraterone

to

Degarelix

Lu-177 x 3 plus Chemo x 3 ( Onco recommendation)

Second hormone therapy drug

I have been on Degarelix since 25th November, completed 3 x LU-177 (PSA drop from 17.6- 0.55 after second LU-177, so fingers crossed third one has dropped it further). 1st Chemo on 7th March.

My Lu-177 onco would prefer me to start Enzalutamide (Xanti) instead to avoid prednisolone.

My understanding is my private healthcare cover will pay for either- any advice here as my London onco prefers Abi!

With the Arasens clinical trial publishing yesterday should I push for Darolutamide if I can access it or just go with Abi or Enza?

Then there is Apalutamide (Erleada) , approved last Sept in UK for HSMPC if docetaxel is not suitable ( I'm not having it in the UK but overseas and out of pocket) or 'according to the commercial arrangement'.

Ideally I would like to use my insurance or the NHS for the cost of my second hormone therapy drug.

Any thoughts on what's worth asking about?

If i stick with Abi v Enza - which one?

[Chrisbaird]

Been on zytiga and prednisone for 14 months with H T injections every 3 months. Was on 1000gm zytiga at start but suffered liver toxicity after 3 months so reduced to 500gm PSA reduced from 25 to 11 in 2 months last 6 months has been 0.01 readings. Only problem I found lack of energy /get tired easily and in summer months hot sweets were bad. Good luck on this treatment

[Chrisbaird]

The hormone drug I’m on is pro strap

[Magnus1964]

I would go with abiratorone. If it fails them move on to xtandi.

[Tall_Allen]

Abi->Enza lasted longer than Enza->Abi. Arasens is only for newly diagnosed.

[elkmt]

PROpel trail has shown zytiga + lynparza to give 24mt of rPFS. inhibts DNA repair of pc resulting in cell death.keep in touch if you hear more on this

[Seasid]

Abi first then Enza. That is a usual way. If you start Enza and it fails then Abi will most likely fail also. That is the reasoning.

[Seasid]

Abi is harsh on the liver. One member said that he had to stop Abi after 6 years of treatment because of problems with the liver caused by Abi. Enza is crossing the blood brain barrier and because of that can cause "Sturzgefahr" so you are in danger of falling. Not very desirable of you have a lot of bone mets.