Darolutamide and Desunomab Questions

[vintage42]

Prostate was radiated in 2021 and pelvic node and pelvis in 2023. Cancer is growing prostate, shrinking in pelvic node, and spread to an abdominal node. Opinions are welcome on two subjects.

I have started on ADT Orgovyx with no side effects in a month. The urologist plans to add an ARI (reception inhibitor)) and I prefer Nubeqa (darolutamide) which has less risk of seizure because it does not cross the blood brain barrier. However, I now read that darolutamide “inhibits the BCRP transporter so its concomitant use with BCRP substrates such as rosuvastatin, should be avoided where possible.” And of all the statins, I have been taking rosuvastatin, specifically because like darolutamide, it does not cross that barrier. So is darolutamide with rosuvastatin good because they both don’t cross the barrier, or bad because one inhibits the other? Should I change my statin to simvastatin, or choose the ARI to be Erleada (apalutamide)?

He also proposes adding Prolia (desunamab) to head off bone loss. He does not want to do a DEXA bone density test first because it would show no bone loss yet, which might prevent approval of Prolia. But I am a little afraid of Prolia’s side effects and wonder if calcium pills and weight bearing exercise will make it unnecessary. Should I take Prolia now, or wait to see what a DEXA scan shows in 6 months?

[Tall_Allen]

See my response here:

healthunlocked.com/advanced...

[tango65]

In the darolutamide trial a patient died because of taking daro and crestor. You could change to lipitor or pitavaststim at low doses.Bone agents are not indicated in mCSPC unless the dexa scan shows osteoporosis.

[vintage42 in reply to tango65]

Thanks to the pointers from you and T_A, I have researched and found some good info to discuss with my MO and Uro in the next two days of appointments: The dangerous interaction of certain statins and receptor inhibitors, the connection between the BBB and seizure risk, and whether I need a bone agent at this point.

[pe43 in reply to vintage42]

I'd be interested to hear what your MO and Uro have to say. I have metastatic PCa with bone mets, and I'm getting Xgeva even though I don't have osteopenia. Xgeva and Prolia are the same, only the doses are different, as far as I know. The idea is to prevent possible osteoporosis, although I'm not sure that effect has been shown. Why does your urologist say you don't have osteopenia?

[vintage42 in reply to pe43]

The MO said he thought a bone agent was premature without a scan showing osteoporosis. The Uro does not know if I have osteopenia or not, just said it was possible at age 81, but if a test showed I did not have it, that might prevent insurance paying for Prolia.

The Uro backed off Prolia after I said I had read it was for castration-resistant men with osteopenia and mets to bones. But I said I did want a baseline bone scan since I was starting ADT which can cause osteopenia.

[Seasid in reply to pe43]

Why did not you asked your MO for reference or alternatively to dig it up yourself like am doing it and learning with it?

[pe43 in reply to Seasid]

I'm trying to learn by reading, but the nice thing about this forum is that others have already done it and can be very helpful.

[Seasid in reply to pe43]

Everybodies cancer is different. Some people have a best oncologist, a best cancer centre a triplet therapy and still having lots of problems. I can recommend that you get a PSMA pet scan. If you don't get it it is a big mistake. (I didn't look into your profile if you have one.) You should create your profile and start a new post if you want to know more.

Most importantly get a PSMA pet scan.

[CAMPSOUPS in reply to pe43]

Xgeva (denosumab) is a prescription medicine that can help prevent serious bone problems in people with bone metastases from solid tumors and multiple myeloma. These problems include broken bones, spinal cord compression, and the need for surgery or radiation to the bone. Xgeva is a bone-targeting antibody that works by blocking proteins that destroy bone tissue. This helps keep bones stronger and prevents them from hurting, breaking, or causing high calcium levels in the blood.

If you have numerous bone mets Xgeva might have nothing to do with osteopenia etc.

It can help "strengthen" for lack of a better word bone met damage.

[pe43 in reply to CAMPSOUPS]

Thanks for posting this information.

[gsun]

if a scan won’t show at least osteopenia then no need for prolia

[vintage42]

The urologist knows there is no need, which is why he does not want to order a scan, because it would show no present osteopenia, which might cause insurance to deny the Prolia. He wants to start me on Prolia proactively, because assumes it will be necessary after I have been on Orgovyx and Erleada awhile. He wants to prevent osteopenia.

I just wonder if I can prevent osteopenia if I take calcium pills and do weight-bearing exercises.

[Grandpa4]

I don’t think it makes sense to take Prolia unless you are osteoporotic or have bone Mets that are castration resistant.

[vintage42 in reply to Grandpa4]

My urologist has newly moved to the cancer department of his medical corporation. He may think it's OK to be proactive against osteoporosis, and not know about the mets or CR part. I really don't plan to go with Prolia.