zytiga or xtandi ? Which to choose

[Tinkudi]

how does one decide if to go with zytiga or xtandi ?

I read xtandi can cause falls and that sounds scary !

Are both equally effective ?

Are there any comparitive studies

[RyderLake2]

Hello,

Pepsi or Coke? Each one has its adherents and detractors. With Xtandi (enzalutamide) you don’t have to take Prednisone.

[lcfcpolo]

I'm 2 weeks away from 4 years on Xtandi (Enzalutamide). No falls yet.

There is some research that doing Zytiga (Abiraterone) first, you can then switch to Xtandi later.

Everyone responds differently. You can Google for comparisons. There is very little difference. If I was starting now I would ask for Darolutamide (Erleada) the newest 2nd generation hormone treatment.

[Tinkudi in reply to lcfcpolo]

Did you take the full 160 mg xtandi dose from the start

[lcfcpolo in reply to Tinkudi]

Yes 4 X 40mg tablets per day.

[Tinkudi in reply to lcfcpolo]

What side effects did you feel

[lcfcpolo in reply to Tinkudi]

Some fatigue, muscle loss and belly fat but these are all as likely from Lupron than Xtandi. There is no way to know.

[Tall_Allen]

There are no comparative studies. But abiraterone->enzalutamide works (in terms of preventing PSA progression) longer than enzalutamide->abiraterone.

thelancet.com/journals/lano...

[Tinkudi in reply to Tall_Allen]

Thanks a lot Allen 😊

[Tinkudi in reply to Tall_Allen]

Allen , this article says for castrate resistant men ?

[Tinkudi in reply to Tall_Allen]

Allen. , Would this study apply to castrate sensitive men too ??

[DrawingSnowmen]

Here are some articles that might be of interest:

urotoday.com/conference-hig...

jamanetwork.com/journals/ja...

onclive.com/view/real-world...

ascopubs.org/doi/abs/10.120...

[Tinkudi in reply to DrawingSnowmen]

Thanks a lot

[lgutman]

I read the same thing that TA posted which is why I was pissed when my dad was put on Xtandi first due to Zytiga requiring a steroid. My dad has glaucoma and is blind in one eye and steroids are not good for it, but it beats dying from cancer. I was furious with my dad as his MO ordered Zytiga first and the oncologist pharmacist switched it.

[Tinkudi in reply to lgutman]

Sorry to hear this. What’s a oncologist pharmacist ? How did he change what the doctor wrote

[lgutman in reply to Tinkudi]

She talks to him monthly by phone..she is a pharmacist that specializes in oncology. She orders blood work and other tests too. I have never met her.

[JJFR60]

I was on Xtandi for 6 years u til it stopped being effective. No falls.. but fatigue ( really noticed it after I stopped) and pain in lower back. But it was worth the ride.

[Tinkudi in reply to JJFR60]

thanks. Did you have any other side effects. Have you been on zytiga too ?

[JJFR60 in reply to Tinkudi]

No other SE's . And no Zytiga either. I started with the recommended dosage of 160 mgr. But after a few months it was determined by study that 120 mgr is just as effective , so that's what I used till the end. Costwise it made no difference to me as all was covered by our healthcare insurance here in the Netherlands. Actually for teh past 9 years besides my premium of about 1400 euro per year, no extras ! Scans, chemo's , radiation etc : all covered. It sucks having cancer but it’s great not having to worry about the cost of all the treatments .

[Tinkudi in reply to JJFR60]

Thanks. Do you have a link to study saying 120 was as effective ?

[larry_dammit]

Xtandi has a lot of down side stuff that goes with it, that being said. I’ve been on it now since Dec. of 2016. Worst part of Xtandi is it doesn’t play well with a LOT of drugs. But in all I give it credit for me still being alive today. My dad was on Ztiga and I didn’t see anything that was positive about it especially when you add the prednisone to the mix.

Just a layman’s observation. Keep up the war there warriors 🙏🙏🙏

[Tinkudi in reply to larry_dammit]

Thanks Larry. What downside did you experience with it

[larry_dammit in reply to Tinkudi]

Well 2 trips to the ER due to wrong opiods ! Some neuropathy due to wrong pain meds. I had to switch to morphine based pain meds for the bone pain. Missed the fentanyl but that’s just one. My doctor is overjoyed every time I see him ( every 28 days ). Cost is the major down side but both meds are way overpriced in America compared to any other nation

[Tinkudi in reply to larry_dammit]

Thanks. No falls etc right. I Read xtandi can cause falls and that’s scary.

I am in India and all these medicines here are way way cheaper

[larry_dammit in reply to Tinkudi]

Falls are just part of both drugs as I see it, great care is needed with both, my dad was on the zytiga and fell broke a hip. I’ve had a few tip overs myself on the Xtandi, you just have to know your limits, use a cane or walker especially until you get used to either med. just saying. Keep up the fight Warrior 🙏🙏👍👍

[Ian99]

I was on Zytiga for 2+ years, main SE was fatigue but I think ADT also contributed. As it began to fail I asked about Xtandi but MO said cross resistance was an issue, so that did not happen.

[Tinkudi in reply to Ian99]

Hi Ian. Thanks. Did you start adt and zytiga together or added zytiga later ?

[Seasid in reply to Ian99]

Did your zytiga faile?

[Ian99]

Started ADT (ZOLADEX) Aug 2021, Zytiga Jan 2022. PSA hovered around 10 then gradually began to rise a few points every 3 months. Stopped Zytiga May 2024, was meant to start Docetaxel, meanwhile tested positive brca2 so now on Lynparza instead.