Update to: "Newly detectable PSA after prostatectomy: RT + ADT planned; add Erleada?"

[Brokedown_Palace]

Thanks for all the input to my original post.

First, here is an administrative posting/question: am I correct to add this as a new post, or should I have posted this as a reply to my original post?

Here are some additional details regarding medication side effects and treatment decision-making for anyone interested:

I started Erleada 2 weeks ago (after having started Lupron 3 weeks earlier) . For the first 10 days after starting Erleada, the vasomotor/thermoregulation/skin symptoms (hot flashes alternating with feeling cold, skin tingling, night sweats) and insomnia were pretty strong, but have been improving over the past few days. I have taken Cymbalta and trazodone for many years for a history of recurrent major depressive disorder, and increasing the trazodone dose has helped with the insomnia. I assume the vasomotor symptoms are improving because I am adjusting to the Erleada, although I guess it is possible that the increased dose of trazodone is helping the vasomotor symptoms as well, even though trazodone is not known to do this so far as I know.

My local MO (UW/Fred Hutch Cancer Center) was not supportive of or comfortable with adding Erleada, as his approach is to only use medications that are supported by published evidence for a specific clinical circumstance and that are consistent with NCCA guidelines. My UCLA second opinion MO, who prescribed the Erleada, is comfortable with off-label use when suggestive data for it's use exists and potential side effects are taken into consideration. In my case, Erleada has known efficacy for hormone sensitive metastatic PCa, and it is reasonably likely that I have micro metastatic disease due to Gleason 4+5, complex pathology (intraductal, cribriform pattern), and a positive lymph node discovered at radical prostatectomy/lymph node dissection. I am in the process of switching to a new local MO (same institution) who may be more comfortable with this approach. My initial appointment with the new MO is in 4 weeks.

[j-o-h-n]

this as a reply to my original post?

Keep it that way, otherwise you'll be found guilty of drowning us......

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 09/20/2023 10:08 PM DST