what are the best time to apply darolutamide?

[leechi]

HiHi, really glad to know this forum and this is my first post here and we are very frustrated as short of information in our medical system and we have a very lag behind medical protocol to allow for more aggressive treatment.

We are from Hong Kong where there are not much information with referring to medication of PC. My dad aged 75 got metastatic with 2 bone mets and a lot of small lung nodes found by body check in June. PSA 54 by the time and Gleason Score 8 for all 12 biospy. We immediately arranged Zoladex and started the first Docetaxel in July. PSA drop back to 4 and we processed to second Chemo. However, with some slight fever at 38.5 treatment with antibiotic we postponed the third Chemo for 3 weeks. I try to study and noted adding Abiraterone or Darolutamide will increase the OS. Even we did enquire our oncologist he recommended to start the above on the third Chemo. May i ask for the following questions which i believe there are already some hints in the forum but i still want to reconfirm correctly:

1) Which one is better to add at the moment, Abiraterone or Darolutamide? Should we apply it immeidately? Both of them are not free here so we will need to pay out of pocket. But seems both of them have quite a significant price difference (Darolutamide 5x of Abiraterone). Are there any big OS differences?

2) Will there be any shortfall if we apply it after the Chemo? Since seems my Dad is suffering a lot from the Chemo and he has 10kg weight loss since July.

3) I recently requested to add Atorvastatin to pill lists and may i know any of you have any bad impact on applying statin at the beginning?

4) It's not easy to get rid of rice (high glucose) at our place, so, we are not sure adding metformin will be a good thought. His fasting blood glucose is 5.7mmol/L.

The problem is suddenly adding a lot of medicine makes him feel worried. And changing diet seems not a good time when he is suffering such a weight loss.

Again, very glad to be able to ask questions here and i really want to try all possible ways to make sure my Dad has good quality of life while can cure and delay the drug resistance as far as it could be.

thx

Lee

[Tall_Allen]

1) They've never been comparatively tested. Abiraterone is a lot cheaper, if you can get the generic.

2) Don't wait. Start it now. Chemo drives cancer cells into dormancy, so you have to attack before they are dormant.

3) statin doesn't interact

4) His blood sugar is fine - why is he taking metformin?

[cesces]

Metformin can't hurt and may help. I take 4 grams a day.

My medical oncologist preferred rouvastatin for his prostate cancer patients. He thought it superior in its mechanism of action.

I am certain the hard data supports Tall_Allen.

But still, why not.

[cesces]

All good resources and goof closing advice.

[cesces]

By the way you did come to the right place. Lol

"Abiraterone or Darolutamide" there probably is a difference, but no way to know what it is.

Start with the cheaper one. If you run into side effects, try switching.

[cesces]

"And changing diet seems not a good time when he is suffering such a weight loss."

That's a good point. Maybe leave that as is for the moment. The metformin will help.

Just start the metformin at a low dose. It can give some people GI upset at first. And some people not.

[Benkaymel in reply to cesces]

Be sure to start Metformin dose low as cesces says. My Mum who had type 2 diabetes suffered 10 years of GI upset that Doctors could not fix until they finally lowered her Metformin dose! She died a few years later of ovarian cancer, btw.

[cesces]

"Are there any big OS differences?"

What's OS?

[Benkaymel in reply to cesces]

Overall Survival

[Seasid]

You can start Nubeqa (Darolutamide) as soon as possible.

With the combination of ADT, early Chemotherapy (6 cycles of Docetaxel) plus Darolutamide. The survival rate was 63% at 4 years after starting ADT.

With Darolutamide nobody who stayed alive developed castrate resistance.

All of this is very impressive. The problem is the price. Try to contact Bayer, the producer of Nubeqa maybe they can work out for you something so you get the drug cheaper. It is worth asking.

Don't use metformin (my vitamin B12 levels dropped therefore I stopped taking metformin). There is no cancer benefit in using metformin, only harm. Test your vitamin B12 levels.

Your Dad sugar is fine.

[leechi in reply to Seasid]

Hi all,

Really appreciate for your kind information and we started the Chemo again with abriaterone since this is one of the medicine which may can offer free in some stage.

Hi Seasid,

“With Darolutamide nobody who stayed alive developed castrate resistance.” I am strongly impressed in this and do you mean Daroluyamide has some very good capability of maintaining hormone sensitive? Currently Abriaterone and Daroluyamide are same price at around usd6000 here per month. So it’s no difference in terms of cost on our selection. Should I turn to Daroluyamide now?

Really appreciate all of your thoughts.

Thx

[Seasid in reply to leechi]

I myself would probably switch to Darolutamide if I could. I believe it has the least toxic side effects and it is the most effective.

Ask your oncologist to prescribe it.

I asked my here in Australia but I can currently only choose between Abiraterone or Enzalutamide (Xtandi).

In Australia even Apalutamide is not yet approved. We believe that Apalutamide will be available hopefully very soon.

I wish you all the best.