Enzalutamide/Xtandi monotherapy as ADT with fewer side effects than Lupron

[GP24]

Enzalutamide monotherapy can improve the quality of live for advanced prostate cancer patients. Thank you, Prof. Tombal, for promoting this arm in the Embark trial!

Enzalutamide does not lower testosterone and estrogen, it even increases the level of these. This avoids the following side effects of Lupron significantly:

- hot flushes

- muscle loss

- weight gain

- reduced libido, patients can stay sexually active

- bone loss, no bisphosphonates or Xgeva and Prolia needed

- brain fog

- shrinked testes

On the other hand Enzalutamide monotherapy will cause gynecomastia and breast enlargement. You can take tamoxifen 10-20 mg to avoid that. Radiation of the breast will also help when done before starting with Enzalutamide monotherapy. Another side effect is fatigue. The Embark study will report on further side effects of this therapy.

In these studies side effects of Enzalutamide monotherapy are reported:

sciencedirect.com/science/a...

jamanetwork.com/journals/ja...

It is likely that Apalutamide and Darolutamide can be used as monotherapy as well, but there is no phase III trial to prove it. Enzalutamide monotherapy could probably be used instead of Lupron after radiation too.

[Brysonal]

That’s interesting as I am due to make a decision about coming off Hormone therapy if my PSA stays undetectable until July and scans at that time are clear.

My MO says he will support my decision ( on Apalutamide as well as ADT) but would rather I stayed on for another 12 months or tried patches. He hasn’t mentioned dropping ADT and staying on Apalutamide as a mono therapy

Will discuss!

Thanks for posting

[j-o-h-n]

Enzalutamide monotherapy will cause gynecomastia and breast enlargement. Another side effect is fatigue.

How true.... I'm really getting tired of carrying these big tits around.

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 03/18/2023 9:33 PM DST

[BrianF505 in reply to j-o-h-n]

I understand! Been on Xtandi, Avodart, Finesteride since 2014. Had a really good run. But it’s failing and I’m looking to the next step. That being said, the fatigue was/is killer. Tho, I’ve just adapted and can manage myself fairly well with rest and naps.

As far as my “huge tracks of land”, please see me in this coming May’s Playboy. I’m the centerfold. 🤣😂

[j-o-h-n in reply to BrianF505]

Now that's funny.......................Tell me, since you're going to be in the centerfold does the belly staple hurt?

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 03/19/2023 2:46 PM DST

[Linebacker75 in reply to j-o-h-n]

my wife tells me a sports bra comes in handy. I can remember the day when a nice set of cones was eye candy but now they just remind me of my “Limpy” No more rising to the occasion!!

[j-o-h-n in reply to Linebacker75]

Mr. Limpy. Another funny one........ Guys stop it, I can't take the competition.....

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 03/19/2023 2:51 PM DST

[BrianF505 in reply to j-o-h-n]

You have taught us well! 🤣😂

[Linebacker75 in reply to j-o-h-n]

Limpy served me well for many years but sadly he was forced into retirement. Gotta laugh or I’d cry.🥲

“Stay in the fight”

[j-o-h-n in reply to Linebacker75]

Retirement LOL

My WILLIAM fell asleep long time ago, so I've been trying to wake Willy up with long tender strokes but to no avail. Mind of his own.....

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 03/20/2023 1:00 PM DST

[SpencerBoy11 in reply to j-o-h-n]

I am sure I am a C cup or better, but when I look down on them, I imagine that they are muscles.

[j-o-h-n in reply to SpencerBoy11]

C cup? I wish mine were that small...........Muscles.....with tuning knobs?

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 03/19/2023 6:59 PM DST

[Brysonal in reply to j-o-h-n]

radiotherapy shots to my breast buds pre hormone therapy worked for me!

[EdBar]

This study was done with men who were low risk/intermediate risk PCa who were not previously treated. There was no control arm. Most of the men in this group have advanced stage cancer.

Ed

[GP24 in reply to EdBar]

This phase III study was done with patients recurring after RP or RT. It also included high risk patients: "... in men with high-risk nmCSPC and rising PSA concentrations after radical prostatectomy (RP), RT or both". It had three arms, the ADT+Placebo arm was the control arm.

bmjopen.bmj.com/content/11/...

[EdBar in reply to GP24]

That is not how it was described in one of the links that you shared.

Ed

[GP24 in reply to EdBar]

Because the Embark trial has not reported side effects of Xtandi monotherapy, I had added links to two different studies which reported side effects of Xtandi monotherapy. I wrote: "In these studies side effects of Enzalutamide monotherapy are reported:"

[Seasid in reply to EdBar]

We high volume patients should be more careful than GP24 type of patient. I will rather stick to my ADT and if I wish big breasts I would just add bicalutamide. I am in Australia and we have a very strict PBS rules to follow. That is my nightmare.

[dhccpa]

Nothing on the horizon about using generic Zytiga as monotherapy?

[GP24 in reply to dhccpa]

The SPARE trial tested this. But it will not help you with side effects because Zytiga lowers testosterone even better than Lupron.

pubmed.ncbi.nlm.nih.gov/354...

[dhccpa in reply to GP24]

Thanks I'll take a look.

[PSAed in reply to GP24]

Thank you for informative posts.

[Brysonal]

Thanks for flagging this I am now following this prof on Twitter and love his reply tweet

‘ If we don’t think out of the box, we will still be imposing castration to patients in two decades…’

Does he consult do you know?