I've recently received a diagnosis of Stage 4 prostate cancer, which is high volume and hormone-sensitive. I've consulted with 3 oncologist and all recommend triple therapy: Lupron alongside 6 rounds of Docetaxel, plus an ARPI. While two oncologists recommend Nubeqa, one strongly advocates for Zytiga instead. He mentioned that if resistance develops on Zytiga, transitioning to Nubeqa later is an option, but switching from Nubeqa to Zytiga might not be as effective.
I'm seeking any insights or thoughts on this matter, as I'm struggling to find any literature or research discussing the efficacy of these treatments..
Thanks in advance
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littleCar
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little Car, praying for you. I have found this group of warriors to be invaluable in my own journey against this terrible beast of a disease.
It's very helpful to those of us following you if you can "flesh" out the details in your bio a little, age, Gleason score, biopsy, care givers, any details you feel comfortable sharing.
This group will embrace you and support you, to the degree you need, and your own contributions will also help those such as I, in our path fighting this.
I am NOT a Doctor. Here are my opinions, and I request that you discuss
with the doctor.
I made a mistake in taking Zytiga and then moving to Xtandi. I learned from other groups, comments, and Google searches. Starting Xtandi or Nubeqa. Starting Nubeqa is a good suggestion
I think starting from Zytiga and moving to Nubeqa, May be Nubeqa will not give you a 100% fight
There was a trial done to see if Zytiga->Xtandi or Xtandi->Zytiga gave the longer therapy. Xtandi and Nubeqa are the same class of drugs (anti-androgens), while Zytiga has a different mechanism, so I would guess that Nubeqa would be similar to Xtandi.
Khalaf et al reported the results of a randomized Phase 2 trial in British Columbia. 202 newly diagnosed mCRPC men were randomized to either Zytiga or Xtandi first. After progressing on the first therapy, they were given the second therapy (cross-over).
• The Zytiga-first men progressed after 19 months vs 15 months in the Xtandi-first group
• After cross-over, PSA was reduced by more than 30% (PSA30) in 36% of those who had Xtandi-second vs only in 4% of those who had Zytiga-second.
They conclude: "Our data suggest that using a sequencing strategy of abiraterone acetate followed by enzalutamide provides the greatest clinical benefit."
Hi TA...I'm high volume metastatic G8. I'm on zytiga with dexa & Lupron. I see that 36% who went from zytiga to xtandi had success,, that's better than I expected. My Onco suggested 4 to 6 taxotere treatments and then going to Xtandi or erleada when I become resistant to zytiga. Would doing chemo first then adding Xtandi, for example increase my odds ( how much) better outcome, if any....Thanks
1. Chronic low testosterone is known to be associated with developing PCa.
2. Casodex is a weak anti-androgen. It is started along with GnRH agonists (like Lupron) only to prevent the initial surge in testosterone they cause from activating androgen receptors. It doesn't mean anything that the PSA decrease was only moderate - it was not given for that purpose.
That is up to your oncology team: I am not a Dr. I had RT + duplex therapy, doing well now about 2 years on. I had RT fairly early on. I have no idea if it is less effective if done later.
My husband also did IMRT radiation early on while on Zytiga and Eligard injections. (Every 3 months). He’s still on the hormones and his PSA is undetectable after radiation around a month ago. Of course, it’s early in his treatment plan. Diagnosed in November. His MO prefers not to start him on Triplet therapy because he said his mets aren’t in his organs. Just small spots on two ribs and scapula, plus lymph nodes and seminal vesicles. Gleason 9, Stage 4. The MO considers that low volume at this point. He mentioned quality of life on chemo, as well. I know he’s up to date with the latest, so I’m sure he’s well aware of Triplet therapy. Well, I hope he’s choosing the right plan for my husband. I’m reassured that you’re doing well around 2 years on!
I was G8 with a high PSA and mets to my pelvic lymph nodes. I started with 6 chemo treatments with darolutimide and lupron. I followed up with EBRT six months later. My PSA dropped from 52 to undetectable. I’ve been undetectable for over a year now.
My partner has been diagnosed in 2017 with Stage 4 prostate cancer, high volume, hormone-sensitive, with a few lymph nodes in the lower abdomen and a few bone mets. He qualified for the ARASENS trial which was going on at the time, and got started on degarelix (Firmagon), along with 6 cycles of taxotere (Docetaxel) and darolutamide (Nubeqa). The lymph nodes went away, his PSA dropped dramatically from 1600 to something under 0 (can't remember the exact figure right now) and the bone mets regressed. He was lucky to tolerate the chemo rather well, and there were few if any side effects with Nubeqa.
One major problem was when they added bisphosphonates (Zometa) for the bone mets; 2 days after the treatment, he had a spectacular hypocalcemia requiring hospitalization, so that was abandoned back then. However, he was given Zometa again 4 years later, at half-dose (2 mg instead of 4 mg) for the first two treatments, then at the full 4 mg dose, every 3 months.
The good results lasted for about 4 years, then the PSA began increasing and the bone mets began to progress again. He got 2 sessions of SRBT targeting mets on a thoracal vertebra, Nubeqa was stopped and he was started on Zytiga + 10 mg prednisolone/day.
That lasted about 2 years, then his PSA began to increase (up to above 7) and the oncologist decided the Zytiga was no longer adequate and stopped it. He got started on Ra-223 (Xofigo) due to the bone mets and the apparent absence of viscerallmets, and so far has had 4 treatments out of the 6 planned in total. He seems to tolerate the Xofigo rather well globally (some gut issues, though). The PSA is still rising, but it is no longer a useful marker because of the Xofigo.
The oncologist had decided to stop the Zometa when the Xofigo was started; my partner and I checked that issue in depth, and Zometa was continued, with a gap of 5 months instead of 3, not a major problem, apparently.
I cannot attest to the difference between the efficacy of the medications in question. I can tell you that the oncologists you have spoken to are spot on recommending triplet therapy.
I entered treatment after a chemical resurgence of cancer post RP surgery.
PSMA scan indicated lower lymph node involvement. My diagnosis at that point was Prostate Cancer Ductal Variant Stage IV. Gleason score 8.
Two Taxotere treatments and one Lupron shot later my PSA returned to <0.1 and has remained there throughout the remainder of my Taxotere treatments (6 in total) and one additional Lupron shot.
I have had a third Lupron shot and am currently on generic xytiga and prednisone.
I will have a follow-up PSA test end of April.
I firmly believe they were correct that Chemotherapy is the key in getting things under control... It affords the greatest chance for longevity and gives the ancillary medications a fighting chance to keep things at bay...
As sick as this sounds Taxotere is like Roundup for the body... It kills the cancer...the trick is withstanding the side effects, if any, while the shit circulates and goes on its cancer killing spree 😜🤣... I called it getting "JUICED"
Hey, littleCar - I recently started my journey with similar status as you - Stage 4, Gleason 4+5, metastatic, 59 YOA. My doctors started me on abiraterone and has the same approach - abiraterone first, Nubeqa later if needed. Hope that helps.
I too am not a doctor......However I still would like to be a gynecologist but my wife won't let me....
Anyway for what it's worth, My M.O. replaced my Casodex with Nubeqa (as of April 2023 at MSK) and it has lowered my PSA (still on Lupron however)........
Thanks for the LOL. I have to remember that you don't misspell anything on purpose. And then I get another LOL. I understand there is a vacant jar next to Einstein's brain. Make 'em laugh, make 'em laugh, make 'em laugh.
Welcome to the Whack-a-Mole game. Whatever you decide on will be wrong. ADT plus Lupron, 8 cycles chemo, then added Xtandi. (Also asked for Celebrex for back pain. Has this made a difference????????????? ) Extensive bone mets. 7 years last month. After 0.2 psa for years, in last 6 mo. psa now 0.4 I have a feeling Xtandi is starting to fail. I'll ask for a bone and cat scan in a couple of months. Maybe chemo plus Xtandi is next move if dr. agrees. Maybe ask for Predisone for just a while to gain weight. I would go with the proven. The new medication's promises seemed to always be broken. You can probably get better advice from j-o-h-n. (p.s. Celebrex may cause heart attack. What? Me worry?)
Hi, I got a 3/4 metastatic diagnosis, castration sensitive, 3 years ago, and was given 3-5 years by a Urologist. However my new Oncologist gave me option of a trial on Enzalutimide (where I could take no other medications or supplements), or Abiraterone (Zytiga) with Prednisone and with food. I also have hormone treatment (Gosrelin), and I had Radiotherapy for my lower spine. Since then I've been on that program as well as following Jane McClelland's protocol (not as an alternative, but as a backup). It is working well for me. My PSA is still unmeasurable, and I feel good. Energy is lower because of lower testosterone, and my skin is a bit thinner from the Prednisone, but otherwise life is good. My Oncologist would agree that bringing out the bigger guns later is a better option. He said "let's try and keep you alive for another 7-8 years, and we'll almost certainly have better option to help you then". I hope this helpsBest of luck
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