Examining Prostate Cancer Survival Outcomes by Patient Age and Treatment Type in Patients with mHSPC

[Maxone73]

“the research suggests a differential impact between androgen receptor antagonists (like enzalutamide, apalutamide, and darolutamide) and androgen synthesis inhibitors (such as abiraterone), with antagonists showing a more pronounced benefit”

urotoday.com/video-lectures...

[vintage42]

Interesting video, because at age 81 I have just started the synthesis inhibitor Abiraterone instead of one of the newer receptor inhibitors -- enzalutamide, apalutamide, and darolutamide. I was afraid of the receptor inhibitors because of their ability to cross the blood-brain barrier vs. my history of seizures, and hoped Abiraterone would be as effective.

But the study behind the video says that those receptor inhibitors are more effective: "... treatment intensification in older men with non-abiraterone androgen receptor-signaling inhibitors derived significant survival benefits."

urotoday.com/conference-hig...

[Maxone73 in reply to vintage42]

Darolutamide dose not cross the barrier….

[vintage42 in reply to Maxone73]

That's what I had thought, but...

My urologist wanted me to take Erleada (apalutamide), amd I did not want either it or Xtandi (enzalutamide) because I read they crossed the BBB at a brain:plasma ratio of 62% and 27%. I wanted Nubeqa (darolutamide) but he countered that it actually did cross, with a ratio of 17%, plus I was not eligible to combine Nubeqa with my Orgovyx for doublet therapy. I am radiated, castrate-sensitive with cancer persisting in prostate and mets to two nodes in pelvis and abdomen. I have read of others getting that doublet, but he seems adamant that I do not qualify for Nubeqa.

So I was the one who suggested Abiraterone, to which he agreed. Meanwhile I have asked for an appointment with my neurologist to hear if they think seizures can be caused by meds that cross the barrier, and if I could take Erleada. Neurology had no theory about what caused my 3 seizures, and it was my Primary thought it might be Zocor (simvastatin) crossing the barrier, so she changed me to Crestor (rosuvastatin).

[PELHA in reply to vintage42]

Hubs has been on Erleada for a month and doing well. PSA dropped 9.6 to 1.8 in that time. Does not seem to have side effects. Those have mainly come from the Lupron he started two months before that which has caused hot flashes and mild fatigue. I also thought Nubeqa would be better due to blood-brain barrier issue but I believe there was a study that showed Erleada helpful for meta cancer which he has (some bone Mets).

[Jazzman2023]

Thanks. I'm pitching my M.O. the idea of switching me from Abiretarone (Zytiga) to Nubeqa (Darolutamide) for these and other reasons. This article is a good one, that might lend more justification in my case...Thank you !!.

[wolverine11]

I'm 3 years in with Abiraterone with 0.5 dexamethasone DX high volume metastatic. Uptick in PSA from 0.21 to 0.41 in 3 months. Just turned 80 yrs. Question probably nobody can answer. Can switching to Xtandi, Erleada, or Nubeque be more effective at my stage.

[vintage42 in reply to wolverine11]

I wonder if the PSA uptick means you are now castrate-resistant with abiraterone. And if so, will changing from that androgen synthesis inhibitor to an androgen receptor inhibitor restore castrate-sensitivity. Would Xtandi, Erleada or Nubeqa be prescribed if castrate-resistant? And if not, whether it is time to move on to chemo docetaxel.

[wolverine11 in reply to vintage42]

Thanks.....I will ask my oncologist next week she has already suggested possibly going to Xtandi or Erleada.....

[Maxone73 in reply to wolverine11]

I am not a MD, but I suppose it's worth trying. You would see if it works or not in a very short time.

[wolverine11 in reply to Maxone73]

Thanks for sharing, interesting. Past trials have shown ADT plus Taxotere, Abiraterone, Xtandi and Erleada demonstrate roughly the same results for overall survival for High volume metastatic stage 4 prostate cancer.However, I do not recall seeing age breakdown.But this is worth exploring thanks. I understand switching from one second generation pill to another, in most men, cross resistance is a problem.