ADT now failing, what is next for us. ? - Advanced Prostate...

Advanced Prostate Cancer

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ADT now failing, what is next for us. ?

tasmanien13 profile image
13 Replies

After 2 years of Trelstar my husbands PSA is now 2. He had RP in 2011, with PSA 32,followed by IRT. No symptoms at all now, no sideeffects from ADT which took PSA to 0. Small rise in blood pressureHas anybody survived for a lenghty time adding a new ADT drug? Should he have chemo? He is 75 years old, exercising daily. Sorry for all my questions, but this forum hosts so much experience and knowledge!

I should add that scans has been clear.

Best wishes from Sweden

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tasmanien13
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13 Replies
Tall_Allen profile image
Tall_Allen

He should have a PET scan to confirm metastatic spread. Lots of choices- Zytiga, Xtandi, docetaxel, Xofigo (if in bones), Pluvicto (if available). And if BRCA+ on a biopsy, a PARP inhibitor. Also, wise to check for MSI-hi/dMMR, even though it's rare.

tasmanien13 profile image
tasmanien13 in reply toTall_Allen

Thanks TA! So there is a possibility of adding more adt. Could he have some more years out of that? Here in Sweden they do not test genetics, so we cannot hope for precision medicine. What about Lu177?

Tall_Allen profile image
Tall_Allen in reply totasmanien13

You may have to go to Germany to get Pluvicto.

Grandpa4 profile image
Grandpa4 in reply totasmanien13

you could add abiraterone or related drugs but not more ADT.

tasmanien13 profile image
tasmanien13 in reply toGrandpa4

No more ADT? Should you not combine treatments now? Or do you mean BAT?What would be most favourable? Sorry, I am so worried, he so much wants to follow our sons a longer time ahead.

CAMPSOUPS profile image
CAMPSOUPS in reply totasmanien13

I think Grandpa4 misspoke. Your husband will continue ADT (Trelstar) and you will add something to it.

Grandpa4 profile image
Grandpa4 in reply totasmanien13

sorry yes . I meant you can’t increase ADT but you add abiraterone to it.

GP24 profile image
GP24

If the scans are clear, he castration-resistant without mets. In this case I would add Darolutamide to Trelstar because this works well, has the lowest side effects and is approved for this situation.

tasmanien13 profile image
tasmanien13 in reply toGP24

Thanks GP! Have your heard about success of Darolutamide aďded to Trelstar? Or does it only work for a short time?

GP24 profile image
GP24 in reply totasmanien13

Here are reports about Darolutamide with ADT (e.g. Trelstar) in non-metastatic CRPC:

urotoday.com/transformative...

urotoday.com/conference-hig...

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

tasmanien13 profile image
tasmanien13 in reply toGP24

So it seems favorable to now combine Trelstar with Darolutamide. Has anybody experience with this? Can it last a lengthy time, ie years? I read about a member who got 17 years out of Erleada, is this to prefer? Thinking of Magnus, who thankfully is back here, and his long, long time living with PCA. So comforting to know that it is possible for some! Thank you GP24 and all of you out there!

All the best

GP24 profile image
GP24 in reply totasmanien13

In the third link I provided the autors mention: "the median time to PSA progression was 33.2 months". So this is close to three years.

tasmanien13 profile image
tasmanien13 in reply toGP24

🙏 Thanks GP

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