I just had a scan (it seems they located some tracer dye!) and I'll be meeting with my oncologist of 13 years, to review the pictures and decide on what to do next. I still want to raise the possibility of BAT, but I'm aware that it's not common in the UK. And I'm not even sure that I'm metastatic beyond seminal vesicle involvement.
It appears though both enzalutamide and apalutamide are approve in the UK. Some a couple of questions to you all:
1. Is any singificant difference between the two?
2. Does BAT favour a particular 'amide', or will any of that class work?
Will let you know his recommendations
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CrocodileShoes
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Two word answer: No and No. BAT is not safe for everyone...Only in carefully selected men on basis of various parameter and of course closer monitoring is required in BAT.
Because, as of today, I am castrate resistant and metastatic. My scan today showed lymph nodes in groin. So, I'm pretty devastated even though I knew it was likely inevitable.
I'm sorry. I know that isn't the news you wanted. That makes you eligible for any of several therapies. I think in the UK you can get docetaxel, Zytiga, or Xtandi. If that was on a PET scan, with nothing on a bone scan, you can also get Nubeqa or Erleada.
Are any of the groin LN metastases big enough to biopsy?
Well, my onco is putting me on enzalutamide. Would welcome thoughts on effective alternatives. Don't think the groin Mets are big enough to biopsy and I don't know what FDG is.
I'm glad that this forum is so knowledgeable and empathetic. I can't really vent to my wife until I get a sense of equilibrium.
Apalutamide is an advanced / amplified version of Bicalutamide. I have taken both at one time or another over a period of 6+ years of treatment. Bicalutamide is an OPTION in the UK - if you are one of a 'smaller' group of men that it actually works for.
There is another major difference between the two.
Bicalutamide CAN be used as a form of monotherapy (the weakest version of ADT).
Apalutamide hasn't been used / tried as a monotherapy - I don't know if it ever will.
Today, I'm undetectable and have been for about one year using the monotherapy, BUT it is not something that works for everybody.
It's a circumstantial thing (Bical monotherapy) and may be a 'TEST' to see if it's adequate to do the job. There's not much to lose because you'll know soon enough if it is working (trending in the right direction). Simple blood tests every month will be the proof you need to continue 'trying'.
At Dx, I was node positive in the pelvic area (regional spread) with a G9 result, from a biopsy.
I understand your fear and sense of urgency but I would respectfully suggest you don't panic!
There is enough time to manage/treat this disease - you have much to learn with further testing / ongoing monitoring. You SHOULD learn to realize that this (your life) is far from over.
There are new advances in treatment(s) and PCa is no longer the death sentence that so many assume as the end.
Ron,So kind of you. I should update my profile, as it's out of date. I was on Bicalutamide 150mg monotherapy, once my PSA began to rise (2017) and we assumed recurrence. Bicalutamide alone seemed to keep PSA low. Had PSMA scan at Peter Mac centre in Melbourne (I live in UK but happened to be working in Melbourne) which showed seminal vesicle involvement. BY end of 2019 PSA began to rise again, so started Prostap (Leuprorelin) injections and Bicalutamide 50mg. All was good initially and my nadir was 0.7 (I still have a prostate). So I've been on injections AND Bicalutamide since beginning of 2020. Now that I appear to be castrate resistant, my onco wants to put me on Enzalutamide AND continue with the Leuprorelin,
My interest is now in looking at Eostradiol transdermal gel as a monotherapy. I have not had significant side effects from the Prostap, but the fatigue this is likely from enzalutamide doesn't thrill me either.
But the biggest reason for looking at more novel treatments is that there's an inevitability about enzalutamide failing after a while and then we're on a path that only seems to end in one destination.
Maintaining your Estrogen levels (thru the add-on therapy) should be beneficial, as you probably know WHEN Bicalutamide was first working. With Bical, you can maintain some muscle mass and have greatly reduced side effects. As well, the 1/2 life is in days vs. months or years.
Stronger ADT 'offerings' will suppress the 'E' as well as the 'T' - so the side effects are more evident. It appears that you progressed to the point where it won't work anymore.
Thanks for the response - I hope you find some light on the horizon ......
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