Now on ADT, what to add?

[x-rays1]

I found out in October last year that I had several tumours in my spine, one in my rib and some in the lymph nodes that run up the middle/left side of my back.

As the bone and CT scans in March showed them getting larger and my PSA around 18.5, I went on ADT (Lucrin-depot). My medical oncologist is now suggesting adding either 6 cycles of chemotherapy (Doxetaxel) or Abiraterone. I have also been looking at adding either Enzalutamide (Xtandi), Darolutamide or even Apalutamide.

Can anyone suggest what may be the best one to add to my current ADT that may improve life expectancy without too many additional side effects.

Thank you in advance.

[Tall_Allen]

The best drugs to take for a man in your situation is a combination of Lucrin+ docetaxel+darolutamide (or abiraterone). This is called "triplet therapy." You can read about it here:

prostatecancer.news/2021/05...

[rsgdmd in reply to Tall_Allen]

That was the plan for me, but (presumably) abiraterone caused my bilirubin to go up to 2.5 (had been 0.9) and told to stop for now. Just had my 1st Docetaxel chemo. Hoping to get back on abiraterone at lower dose.

[Tall_Allen in reply to rsgdmd]

Sometimes, once the liver gets used to a lower dose, it can be gradually increased.

[rsgdmd in reply to Tall_Allen]

Yeah, they talked about trying that after chemo is over, but wondering if worth trying during. Don't want to kill my liver while beating down my cancer.

[Tall_Allen in reply to rsgdmd]

I agree - Chemo can be hard on the liver.

[x-rays1 in reply to Tall_Allen]

Thank you Tall Allen. A very interesting read. I guess the thought of going on chemo treatment such as Docetaxel is worrying me a bit.

[Tall_Allen in reply to x-rays1]

There will never be a better time for it. When you do it early, it has its greatest effect and the side effects are lowest.

[x-rays1 in reply to Tall_Allen]

Thank you

[tango65]

If this is a de novo diagnosis or you already had primary therapy and these findings are a recurrence of the cancer?

If it is a de novo diagnosis triple therapy with ADT, docetaxel and abiraterone it is the best choice of treatment. If you have problems with abiraterone perhaps they could do the triple therapy using darolutamide if they could get it approved by insurance.

If this a recurrence of the cancer, the ADT plus docetaxel, or ADT plus enza or abi are therapies shown to prolong life.

Try to get a biopsy (liquid or direct) to do IHC studies, histological and genetic studies. The cancer may be susceptible to treatment with drugs such as Olaparib, rucaparib, Keytruda, Ipatasertib, or other experimental drugs in clinical trials.

[x-rays1 in reply to tango65]

Hi Tango65. Yes I guess I didn't give quite enough information in my post. It is not de novo. This is a recurrence. I had prostatectomy in 2012 and Salvage radiation plus 6 months ADT (Zoladex) in 2015. I thought that drugs such as Darolutamide and Apalutamide were only used when metastasis were not seen. I have had a genetic test which showed no muttions were shown. I haven't yet done IHC studies. Thank you for your response to my post. Really appreciated.

[TEBozo]

Tall_Allen has it down. He is always on top of the newest and best drugs to take. Thanks to Tall_Allen for continually participating in this forum.

[j-o-h-n]

Greetings x-rays1,

Would you please be kind enough to tell us your bio. Age? Location? When Treatment(s)? Treatment center(s)? Scores Psa/Gleason? Medications? Doctor's name(s)?

ALL INFO IS VOLUNTARY, but it helps us help you and helps us too. When you respond, you should post your response in the bio section on your home page for your use and for other members’ reference.

Note: Answers are for your benefit, not mine.

THANK YOU AND KEEP POSTING!!!

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 07/04/2022 7:28 PM DST - God Bless America

[x-rays1 in reply to j-o-h-n]

Thank you. Will do.

[KocoPr]

I would definitely push for darolutamide.

Evaluation of Darolutamide (ODM201) Efficiency on Androgen Receptor Mutants Reported to Date in Prostate Cancer Patients

Out of 68 known Variants only one escapes darolutamide.

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

[x-rays1 in reply to KocoPr]

Thank you KocoPr. Very interesting read. I will speak to my Oncologist here in the UK to see about cost, availability etc.

[Benkaymel in reply to KocoPr]

Darolutamide is only available for non-metastatic castration-resistant cases according to the drug description which would rule it out for x-rays1 (and me) wouldn't it?