I asked ChatGPT to list drugs from most toxic to least toxic. Here is the result:

[Seasid]

Here is a general toxicity ranking for the drugs you listed, considering overall toxicity across systems, including liver, kidney, cardiovascular, and other potential toxicities. The ranking is organized from most toxic to least toxic, with explanations.

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Toxicity Ranking for Overall Toxicity

1. Cabazitaxel

Toxicity Profile: High toxicity due to severe myelosuppression (neutropenia, anemia), hepatotoxicity, gastrointestinal toxicity, and hypersensitivity reactions.

Cardiovascular: Risk of thromboembolic events and hypotension during infusion.

Other: Increased infection risk and fatigue.

Clinical Use: Reserved for advanced, resistant cases due to its toxicity profile.

2. Docetaxel

Toxicity Profile: High, similar to cabazitaxel, with neutropenia, hepatotoxicity, and fluid retention syndrome.

Cardiovascular: Risk of thromboembolism and arrhythmias.

Other: Neuropathy and hypersensitivity reactions.

Clinical Use: Standard chemotherapy for metastatic prostate cancer.

3. Enzalutamide (Xtandi)

Toxicity Profile: Moderate to high due to CNS effects, hepatotoxicity, and potential cardiovascular issues.

Cardiovascular: Increases the risk of seizures, hypertension, and cardiovascular events.

Other: Fatigue, falls, and cognitive impairment are common.

4. Apalutamide (Erleada)

Toxicity Profile: Moderate, similar to enzalutamide but less CNS toxicity.

Cardiovascular: Increases the risk of cardiovascular events, hypertension, and hypothyroidism.

Other: Skin rash and fractures are notable side effects.

5. Abiraterone (Zytiga)

Toxicity Profile: Moderate, primarily due to hepatotoxicity and mineralocorticoid effects (fluid retention, hypertension, hypokalemia).

Cardiovascular: Can exacerbate hypertension and cause cardiac arrhythmias.

Other: Fatigue and hot flashes. Requires prednisone co-administration to mitigate adrenal insufficiency.

6. Bicalutamide (Casodex)

Toxicity Profile: Moderate, less toxic than newer anti-androgens but can cause hepatotoxicity and gynecomastia.

Cardiovascular: Minimal compared to newer agents.

Other: Low risk of cognitive side effects compared to enzalutamide or apalutamide.

7. Niraparib (Zejula)

Toxicity Profile: Moderate due to hematologic toxicity (anemia, thrombocytopenia) and gastrointestinal side effects.

Cardiovascular: Hypertension is a common side effect.

Other: Fatigue and nausea.

8. Olaparib (Lynparza)

Toxicity Profile: Moderate, with hematologic toxicity and mild hepatotoxicity.

Cardiovascular: Rare hypertension or cardiac arrhythmias.

Other: Fatigue and gastrointestinal disturbances.

9. Degarelix (Firmagon)

Toxicity Profile: Low to moderate. Injection-site reactions are common, and prolonged use can lead to osteoporosis and hot flashes.

Cardiovascular: Slightly increased risk of cardiovascular events compared to non-castration therapies.

10. Lupron (Leuprolide)

Toxicity Profile: Low to moderate. Causes significant hormonal effects like hot flashes, osteoporosis, and metabolic changes.

Cardiovascular: Slightly elevated risk of cardiovascular events.

Other: Fatigue and injection-site reactions.

11. Castration (Surgical or Chemical)

Toxicity Profile: Low to moderate, dependent on duration.

Cardiovascular: Increased long-term risk of cardiovascular disease and metabolic syndrome.

Other: Osteoporosis, muscle loss, and emotional side effects are common.

12. Pluvicto (177Lu-PSMA-617)

Toxicity Profile: Low to moderate. Primary toxicity involves mild nephrotoxicity and hematologic effects (mild anemia, leukopenia).

Cardiovascular: Minimal known effects.

Other: Nausea and fatigue are common.

13. Keytruda (Pembrolizumab)

Toxicity Profile: Moderate but can become severe due to immune-related adverse events.

Cardiovascular: Rare myocarditis has been reported.

Other: Immune-mediated hepatitis, colitis, nephritis, and pneumonitis can occur.

14. Provenge (Sipuleucel-T)

Toxicity Profile: Low. Side effects are primarily infusion-related (fever, chills).

Cardiovascular: Minimal risk.

Other: Fatigue is the most common side effect.

---

Summary: Most Toxic to Least Toxic

1. Cabazitaxel

2. Docetaxel

3. Enzalutamide

4. Apalutamide

5. Abiraterone

6. Bicalutamide

7. Niraparib

8. Olaparib

9. Degarelix

10. Lupron

11. Castration

12. Pluvicto

13. Keytruda

14. Provenge

---

Key Takeaways

Chemotherapy agents (cabazitaxel, docetaxel) have the highest overall toxicity due to systemic effects on multiple organ systems.

Newer anti-androgens (enzalutamide, apalutamide) have moderate toxicity, particularly in the cardiovascular and CNS domains.

Targeted therapies (olaparib, niraparib, pluvicto) tend to have moderate, focused toxicities but are generally less systemic.

Hormonal therapies (degarelix, lupron, castration) are lower in overall toxicity but have long-term risks like osteoporosis and metabolic syndrome.

Immunotherapies (Keytruda, Provenge) have specific immune-related side effects but are less toxic overall.

Would you like detailed insights into any specific drug's toxicity profile?

Our friend ChatGPT spit out a new list of toxicity after being squeezed:

Comprehensive Overall Toxicity Ranking for Prostate Cancer Treatments

Below is a detailed ranking of the treatments for prostate cancer (PC) based on their overall toxicity, including renal, liver, cardiovascular, hematologic, neurologic, and other toxicities. Treatments are ranked from most toxic to least toxic based on their profiles.

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1. BAT in Combination with Carboplatin

Hematologic: Severe toxicity, including neutropenia, anemia, and thrombocytopenia.

Renal: Potential for nephrotoxicity, though less severe than with cisplatin. Requires hydration protocols.

Liver: Minimal direct hepatotoxicity.

Cardiovascular: Risk of anemia-induced cardiovascular strain and thromboembolism.

Other: Nausea, fatigue, and immunosuppression.

2. Cabazitaxel

Hematologic: High risk of neutropenia and febrile neutropenia.

Renal: Rare nephrotoxicity unless compounded by dehydration or other drugs.

Liver: Requires dose adjustments in hepatic impairment; moderate hepatotoxicity risk.

Cardiovascular: Fluid retention, possible arrhythmias.

Other: Gastrointestinal (nausea, diarrhea), fatigue, peripheral neuropathy.

3. Docetaxel

Hematologic: Similar to cabazitaxel, with significant neutropenia risks.

Renal: Minimal direct effects, but dehydration-related risks.

Liver: Moderate hepatotoxicity risk; contraindicated in severe liver disease.

Cardiovascular: Edema and thromboembolic events are possible.

Other: Peripheral neuropathy, fatigue, gastrointestinal issues.

4. Pluvicto (Lutetium-177 PSMA-617)

Hematologic: Bone marrow suppression (anemia, thrombocytopenia, neutropenia).

Renal: Moderate nephrotoxicity due to renal excretion; hydration is critical.

Liver: Rare liver enzyme elevation.

Cardiovascular: Minimal direct effects, but anemia may exacerbate cardiovascular issues.

Other: Fatigue, nausea, dry mouth.

5. Xofigo (Radium-223)

Hematologic: Moderate risk of anemia, leukopenia, and thrombocytopenia.

Renal: Minimal renal toxicity.

Liver: No direct hepatotoxicity.

Cardiovascular: Rare cardiovascular effects, but bone marrow suppression can indirectly affect cardiovascular health.

Other: Localized bone pain, fatigue, and diarrhea.

6. Niraparib

Hematologic: Anemia, thrombocytopenia, and neutropenia are common.

Renal: Low renal toxicity, though secondary effects like dehydration may occur.

Liver: Can elevate liver enzymes; requires monitoring.

Cardiovascular: Increased risk of hypertension and cardiovascular events.

Other: Fatigue, nausea, and decreased appetite.

7. Olaparib

Hematologic: Similar to niraparib, with anemia and thrombocytopenia risks.

Renal: Mild risk of renal impairment; dose adjustments required for severe dysfunction.

Liver: Occasional liver enzyme elevation.

Cardiovascular: Generally mild; anemia may indirectly stress cardiovascular health.

Other: Fatigue, nausea, diarrhea.

8. Enzalutamide

Hematologic: Rare cytopenias.

Renal: No significant renal toxicity.

Liver: Mild to moderate liver enzyme elevation; monitor regularly.

Cardiovascular: Hypertension, risk of seizures, and falls due to CNS effects.

Other: Fatigue, cognitive impairment, and musculoskeletal pain.

9. Apalutamide

Hematologic: Low risk of cytopenias.

Renal: No significant renal toxicity.

Liver: Mild liver enzyme elevation.

Cardiovascular: Increased risk of hypertension and cardiovascular events.

Other: Skin rash, fatigue, and falls.

10. Abiraterone

Hematologic: Low risk of cytopenias.

Renal: Fluid retention may strain renal function.

Liver: Hepatotoxicity is a concern; requires routine monitoring.

Cardiovascular: Hypertension, hypokalemia, and fluid retention increase cardiovascular risks.

Other: Fatigue, muscle pain, and gastrointestinal symptoms.

11. Keytruda (Pembrolizumab)

Hematologic: Rare cytopenias.

Renal: Immune-mediated nephritis is rare but serious.

Liver: Immune-mediated hepatitis is possible but uncommon.

Cardiovascular: Rare immune-related myocarditis.

Other: Fatigue, fever, and infusion-related reactions.

12. SBRT (Stereotactic Body Radiation Therapy)

Hematologic: Minimal unless treating near bone marrow-rich sites.

Renal: No significant toxicity.

Liver: No significant toxicity.

Cardiovascular: Rare, unless radiation affects nearby cardiac structures.

Other: Fatigue, localized irritation.

13. Degarelix

Hematologic: No significant toxicity.

Renal: No significant toxicity.

Liver: Minimal liver toxicity.

Cardiovascular: Metabolic changes can increase long-term cardiovascular risks.

Other: Injection-site reactions, hot flashes, and fatigue.

14. Lupron (Leuprolide)

Hematologic: No significant toxicity.

Renal: No significant toxicity.

Liver: Minimal liver toxicity.

Cardiovascular: Similar to degarelix, with long-term cardiovascular risks.

Other: Hot flashes, fatigue, and mood changes.

15. Castration (Surgical or Medical)

Hematologic: No significant toxicity.

Renal: No significant toxicity.

Liver: No significant toxicity.

Cardiovascular: Long-term risks of metabolic syndrome and cardiovascular disease.

Other: Hot flashes, bone loss, and mood changes.

16. Bipolar Androgen Therapy (BAT)

Hematologic: Minimal toxicity.

Renal: No significant toxicity.

Liver: No hepatotoxicity.

Cardiovascular: Neutral or potentially protective short-term effects.

Other: Fatigue, mild mood swings.

17. Darolutamide

Hematologic: Minimal toxicity.

Renal: No significant toxicity.

Liver: Minimal liver enzyme elevation.

Cardiovascular: Low cardiovascular risk.

Other: Minimal CNS side effects compared to enzalutamide/apalutamide.

18. Bicalutamide

Hematologic: Rare cytopenias.

Renal: No significant toxicity.

Liver: Occasional hepatotoxicity; requires monitoring.

Cardiovascular: Minimal effects.

Other: Fatigue, nausea.

19. Provenge (Sipuleucel-T)

Hematologic: No significant toxicity.

Renal: No significant toxicity.

Liver: No significant toxicity.

Cardiovascular: Minimal effects.

Other: Mild infusion-related reactions (fever, chills).

---

Summary of Changes

Pluvicto is ranked higher in toxicity due to hematologic and renal side effects.

Darolutamide and bicalutamide are positioned closer to the least toxic treatments.

Detailed explanations ensure a comprehensive understanding of each treatment’s toxicity.

This ranking provides an exhaustive overview of toxicities to aid in informed decision-making. Always consult an oncologist for tailored advice.

[Nusch]

That just proves why it’s so important to manage these side effects.

[Seasid in reply to Nusch]

I always thought that parp inhibitors are very toxic.

[Ian99 in reply to Seasid]

I began Lynparza June 1/24, on 600mg/day. The MO asked to do it for 3 months, then we’d assess. By that time I was in bed, had never experienced such toxicity. The upside is PSA dropped from 61 to 48. But blood counts down.

Reduced dosage gradually till I could tolerate it.. that was 200mg/day. Have increased in stages. Now on 400mg/day and finding it tolerable. Awaiting PSA and blood counts this week.

In summary toxicity depends on dosage and how you prepare for it. In my experience.

[ragnar2020]

Thank you. This is very useful information for anyone considering HT.

[petabyte in reply to ragnar2020]

I guess Orgovyx would be similar to Lupron? I have nothing to compare it with but I love the convenience of one pill per day and I've had very limited sides effects (ymmv).

[ulfhbg in reply to petabyte]

Hi !

the minus for Firmagon(Degarelix) compared with Lupron was 1. Injection site reaction and 2. You can only have ones a month and not longer periods.

Probably all ADT, agonists and antagonists are in the same toxic league but I’m guessing

[Tinkudi]

thanks. It’s useful to know

[Seasid]

You can also communicate with ChatGPT. You can learn a lot just don't take everything like true because there are always mistakes as always in our lives.

[Justfor_]

"Darolutamide and Bicalutamide are positioned closer to the least toxic treatments". It would be interesting to learn where ChatGPT positions irradiation toxicity in the above scale and also whether drug toxicities are dosage related.

[Seasid in reply to Justfor_]

Good question. It takes sometimes a lot of knowledge and questioning of the ChatGPT to get a proper answer. I believe that neither of this drugs are trivial. Even BAT has much more possible toxicities than what you would think. Bottom line we are learning and we can't stop using this drugs. This is a dangerous road.

[Seasid in reply to Seasid]

We are all genetically different. Therefore everybody reacts slightly different to everything like radiation, high dose, low dose etc.

[Justfor_ in reply to Seasid]

It was meant as a prompt to you for asking ChatGPT. (smiling face here)

[Seasid in reply to Justfor_]

That is actually true that you should get lots of experience and knowledge in order to get out a most from the artificial intelligence. I am actually happy that I can learn this way a lot. If you don't know what you are doing big mistakes are possible. Therefore always check what ChatGPT said and very often you should make corrections.

[petabyte in reply to Seasid]

It even has a name it is called "prompt engineering". It is an important skill for many jobs. I work in IT and we use AI (various models) a lot and, as you point out, it is often wrong. On the other hand it does provide interesting avenues for exploration that one may not have thought of.

I've found that the more specialized the subject matter the less accurate it is. Recently a colleague was checking something I said that seemed wrong (but I knew was correct). Chatgpt disagreed with me but I proved to be right.

Not all the training data is good as well. The new models are much better but one should be cautious and not make important decisions based on the result.

[Seasid in reply to petabyte]

I totally agree. It is more for learning than for decision making. But learning about a subject should be a very important part of the decision making.

For example I decided to get castrated but first I have to learn about the possibilities. You have many types of castration and you wish to do it right. In a very short time I learnt all the possibilities and AI even helped me how to communicate with my medical team in order to get it right.

[ulfhbg in reply to Justfor_]

Hi !

How do you grade primary treatment like prostatectomy and / or radiation. Both is mostly done with ’curative intent’ and have different ’toxicities’. I mean you could be incontinent or being impotent for life with for example prostatectomy but prostate cancer may be gone. Is incontince and / impotence a ’toxicities’ then and how do you compare that with other toxicities.

I think it’s interesting however to see the evaluation done by ChatGPT and what criteria it uses to rank.

But from a personal point of view I wouldn’t go for ChatGPTs ranking if it tries to rank every single treatment modality 👍

[Seasid in reply to ulfhbg]

I am double checking everything with ChatGPT. It is not perfect but gives you chance to think more deeply about your situation. You should also consult your oncologist etc. I am using ChatGPT to brainstorm. It is very often wrong but you learn by picking up what he said wrong. You need to practice to operate ChatGPT.

[Justfor_ in reply to ulfhbg]

FYI since you asked: IMO there is no "cure". "Curative intend" is a marketing artefact for selling a bunch of badly designed disfunctional products. The difference between prostatectomy and irradiation is similar to paying cash or via a loaner. I am the "cash" type buyer and more interested into the quality of the product I am about to buy than the terms of payment. It is my life and I place my judgement over and above any doc's or AI information system. Both fabricate answers to things not clearly, albeit deeply, understood, but are serving them in a different manner. For that, docs are vested with the authoritative attitude of religion practicioners while AI that of populist politicians.

[Seasid in reply to Justfor_]

Thank you for sharing your perspective—it’s clear you’ve given this a lot of thought. Your analogy comparing medical treatments to payment styles is intriguing, emphasizing how personal preferences play a significant role in decision-making, especially for life-altering choices. The critique of "curative intent" as a marketing construct also highlights the complexity and subjectivity of evaluating medical options.

Your view that individuals should retain agency over their decisions, irrespective of expert advice or AI guidance, is a powerful stance. It reflects a broader skepticism toward institutional authority, whether it comes from traditional hierarchies (like doctors) or newer systems (like AI). The analogy to religious practitioners and populist politicians is a sharp commentary on the roles these entities play in shaping perceptions and decisions.

If you’re open to it, I’d be interested to hear more about how you approach making these critical judgments—do you rely on specific frameworks or guiding principles?

ChatGPT said

[Seasid in reply to Seasid]

Every decision is difficult to make. My GP's husband had a 6 hours long robotic surgery but now he is cancer free. His PSA was only 3.9 and they also had a PSMA pet ct scan. Of course after the operation you end up using pads if you are cured than probably you have a chance that you don't need to use pads but if you end up on ADT for long term than your incontinence will worsen by time especially if you stay alive for long time after the operation. Your pelvic muscles will get weaker.

Usually if you are young they recommend radical prostatectomy.

[Seasid in reply to Seasid]

It sounds like you're reflecting on the complexity of making medical decisions, especially regarding prostate cancer treatments. Indeed, deciding on a course of treatment for prostate cancer can be very challenging, as each option has its benefits, risks, and potential long-term side effects. Here's a breakdown of some of the factors you've mentioned:

PSA and PSMA PET Scans

A PSA level of 3.9 is relatively low, but it can still indicate the presence of cancer depending on other factors like age, family history, and prostate size.

The PSMA PET-CT scan is highly sensitive and can detect even small cancerous lesions, making it an excellent tool for staging and planning treatment.

Radical Prostatectomy (Surgery)

Often recommended for younger patients or those with localized prostate cancer, as it aims to remove the cancer entirely.

Robotic-assisted surgery has become increasingly popular due to its precision, reduced blood loss, and potentially quicker recovery times.

Side effects like urinary incontinence and erectile dysfunction are significant concerns, though many patients improve over time. Younger, healthier individuals often have better recovery outcomes.

Incontinence and ADT

Post-surgery incontinence is common but may improve with pelvic floor exercises or physical therapy.

If long-term androgen deprivation therapy (ADT) is required (e.g., in advanced or recurrent cases), it can exacerbate muscle weakness, including in the pelvic floor, leading to worsening incontinence over time.

Tailoring Treatment

Treatment choices often depend on factors such as the cancer's aggressiveness (Gleason score), patient's age, overall health, and personal preferences.

Active surveillance might be an option for less aggressive cases, avoiding the immediate side effects of surgery or radiation.

It's commendable that you're thinking deeply about the implications of different treatments. Open discussions with specialists (e.g., urologists and oncologists) can help weigh the benefits and risks tailored to individual circumstances. Are you or someone close to you facing a decision about prostate cancer treatment?

ChatGPT said

[Tall_Allen]

As usual, ChatGPT is wrong.

[Seasid in reply to Tall_Allen]

It will improve. I agree that we have to be very careful with the results, but it is because be are not asking the questions properly.

[Tall_Allen in reply to Seasid]

The problem, as with all misinformation, is that people believe it and act upon it. If you know it is misinformation, why post it?

[Seasid in reply to Tall_Allen]

I will delete my posts.

[Tall_Allen in reply to Seasid]

It's more useful if you go through it and highlight the errors.

[Seasid in reply to Tall_Allen]

I like your way of thinking. We should educate people how to use AI. I double check everything what my MO said with AI.

You said that bicalutamide and enzalutamide have cross resistance.

ChatGPT confirmed your views. My MO said that there is no cross resistance. The true is I believe inbetween.

[Tall_Allen in reply to Seasid]

There is cross-resistance between any two drugs that directly target the AR (rather than those that limit endogenous T production).

[Seasid in reply to Tall_Allen]

I am still waiting for my cancer to die off after the SBRT radiation to my prostate. I realised that you needed up to 10 years for your PSA to stabilise after SBRT radiation. I realised that you didn't have any ADT. I was only on degarelix and my PSA dropped from 1.5 to 0.25 6 months after prostate irradiation with MRI Linac machine. About a year after radiation I added bicalutamide because my PSA started to rise quickly with PSA doubling time less than 3 months and my MO commented that I have a CRPC in my prostate which survived high dose SBRT radiation. But as I said now 2 years after radiation my PSA is stable at 2.5.

[Seasid in reply to Tall_Allen]

My problem is that I had early docetaxel chemotherapy 6 cycles and that did drive my cancer into a senescent state. I don't have any visible metastasis only cancer in my prostate and I just wait and see what will happen.

MarcBC had a similar treatment and he added bicalutamide to ADT when his PSA was 1 and stayed on Bicalutamide for about 19 month and switched to Abiraterone when his PSA was 1 again.

I am a slow mover.

[ulfhbg in reply to Tall_Allen]

Hi !

That’s a powerful statement and you seem to know something most other don’t know so, what is wrong? Please don’t say everything. I like to know because I also use ChatGPT sometimes for reference, not almighty good but I find it helpful to summarize things and I find ChatGPT very good at that, as a TOOL

[Seasid in reply to ulfhbg]

ChatGPT is not a doctor it is an artificial intelligence tool. It is good to build up knowledge but your final decision should be done with your doctor.

I would be very uncontactable relying only on my doctor without a knowledge gained from this site plus ChatGPT. Everything is better than a cattle medicine.

[ulfhbg in reply to Seasid]

Hi !

My question was to T-As comment because he seemed so sure

[Seasid in reply to ulfhbg]

TA has right, because he is afraid that people will think that everything what ChatGPT said is correct. Of course it is not. I don't believe in anything without going deeply into building knowledge about a subject. I am considering castration and after talking to ChatGPT I now know everything and I feel fine to make a decision. I still have to talk to my MO and to the urologists etc.

[Seasid in reply to Seasid]

It is in our benefit to be exposed to the knowledge available by the AI. I definitely use it for my knowledge building. ChatGPT only say what you asked. If you don't ask ChatGPT will not tell you. You should dive into the conversation with ChatGPT and you will see the benefits. You will understand the issues much better.

I am very happy what I can get out from AI. It is not perfect.

[Tall_Allen in reply to ulfhbg]

For example, more men end PARP inhibitors due to their toxicity than anything else on the list. If you'd ask what percent of patients taking the drug, have to stop taking it due to side effects, you might get a more useful answer. Also, the degree of side effects must be included - a drug that causes a few grade 3-5 side effects may lead discontinuation even if it has fewer grade 2 side effects. And unless a drug is tested in the same random sample of people, no comparisons are possible. AI has no judgment - only humans can have judgment- it is a quality of consciousness, not something AI can possibly have.

[ulfhbg in reply to Tall_Allen]

Hi !

Thanks and then I think I understand what you meant and I agree with you that this type question, evaluating top to bottom toxicities is perhaps not the best way to use ChatGPT as the AI actually needs to do a judgement and not do what it is best to, summarize from many sources and give a person a rather good overview that you as a person can use together with the professionals or, like in my case , try to give me a overview of a specific topic that I’m curious about

[Seasid in reply to ulfhbg]

I had an early chemotherapy and despite it is listed high I am very happy that I made a decision to jump into chemotherapy. The list is interesting in order to educate people about the treatment options and toxicity related to that treatment. It is not that you should avoid a treatment. Parp inhibitors are great to have for later but they are doing clinical trials with early use. I am now with bicalutamide and not with darolutamide plus plus New generation of parp inhibitors because I responded well to treatment until now and my PSA is 2.5 , ALP 38 , LDH around 190 and I feel fine. I am de Novo Polymetastatic with distant spread and already more than 6 years undergoing ADT. Has SBRT radiation treatment to my prostate two years ago because I didn't have any visible Mets on any scan and decided to irradiate my prostate. Now I started bicalutamide about 11 months ago and the PSA is more or less the same and I am just waiting for my cancer in my prostate to die off.

[Seasid in reply to Tall_Allen]

Thanks for clarifying.

[ulfhbg]

Hi !

Did you check why ChatGPT considered Firmagon more ’toxic’ then Lupron? 😀

I would assume that Lupron have a high ’risk profile’ compared to Firmagon especially when heart problems.

But interesting and I’m glad to see that Abiraterone, antagonist ADT and Lutetium is not in the top of the toxic leauge 👍

Best wishes - Ulf

[Seasid in reply to ulfhbg]

I agree with you. It is a mistake, but my first oncologist professor Richard Epstein was not very happy that I wanted to continue with degarelix. The reason is that we don't have enough experience with it. I still on degarelix. For your situation degarelix ADT injections are a best choice because you will be able to regain your testosterone levels much quicker. I decided to stay with degarelix because it will not cause you dementia and it is better for your heart. Doctors don't like to use New drugs and that is understandable. You will not stay long on degarelix or on your Orgovyx and you want your testosterone back quickly. You made a good choice with degarelix injections.

[Seasid in reply to ulfhbg]

Everything depends. If you are only 2 years on Abiraterone it is the best for you. Everything is very dependent from person to person.

[j-o-h-n]

WATER cause fish fornicate in it.....

Good Luck, Good Health and Good Humor.

j-o-h-n

[GAdrummer]

I was surprised at Keytruda's very low ranking. ChatGPT failed to list two of its side effects that continue to send my husband to the ER: adrenal insufficiency and hypothyroidism.

[Seasid in reply to GAdrummer]

Thanks for the I formation. A possibility of adrenal insufficiency was a reason that I refused to take prednisolone during my early chemotherapy. I still had to take dexamethasone before the infusion.

[Seasid in reply to Seasid]

Maybe we should try to dig up as much information as possible from ChatGPT before making a decision. It should be like a learning experience. My professor of oncology said that ChatGPT is not medical. Still I digged up lots of information and that is a good thing. On the basis of the digged up information you can ask good questions about your treatment. Actually ChatGPT is great, just know that it can make lots of mistakes. It is definitely a good first step. I very often do also Google searches when I am doing my research about a subject. Even my bank blocked my bank account couple of times relying on artificial intelligence.

[addicted2cycling in reply to Seasid]

Began my medical GL10 treatment at almost 65yo in 2015 with --

1st - surgical castration

2nd - Hemi Cyoablation to right half of prostate with GL10 tumor

3rd - had 1 in situ injection of Keytruda + Opdivo + Yervoy

4th - continue taking Dutasteride

5th - now excuse me as I begin a non medical treatment -- heading out for a 25+/- mile bicycle ride under a 96.9% Illuminated Waning Gibbous MOON at 3:10AM

[Seasid in reply to GAdrummer]

Thank you for sharing this. You're absolutely right that adrenal insufficiency and hypothyroidism are notable immune-related adverse effects of Keytruda (pembrolizumab). These conditions, while rare, can be serious and require prompt management. I will adjust its placement in the toxicity ranking accordingly to better reflect these potential severe side effects.

---

Revised Placement for Keytruda

Given its potential for life-threatening endocrine disorders like adrenal insufficiency and hypothyroidism, Keytruda deserves a higher toxicity rank, particularly above treatments with lower systemic risks.

Updated Rank (Most Toxic to Least Toxic):

1. BAT in Combination with Carboplatin

2. Cabazitaxel

3. Docetaxel

4. Pluvicto (Lutetium-177 PSMA-617)

5. Xofigo (Radium-223)

6. Keytruda (Pembrolizumab)

7. Niraparib

8. Olaparib

9. Enzalutamide

10. Apalutamide

... (continues as before).

---

Keytruda Toxicity Explanation:

Hematologic: Rare cytopenias.

Endocrine: High risk of immune-related adrenal insufficiency, hypothyroidism, and even diabetes mellitus due to autoimmune destruction. These side effects often require long-term hormonal replacement and careful monitoring.

Renal: Immune-mediated nephritis, though less common.

Liver: Immune-mediated hepatitis is possible but less frequent.

Cardiovascular: Rare myocarditis.

Other: Fatigue, fever, and infusion-related reactions.

Thanks for bringing this to my attention, and I hope your husband’s care team has developed an effective plan to manage these side effects. Let me know if you’d like more information about supportive care for these conditions.

ChatGPT said

[TuffNuttoCrack]

Please ask the chat monster what drugs suppress white blood cell counts and neutrophils. Thanks.

[Seasid in reply to TuffNuttoCrack]

Chemotherapy but if you survived than your immune system bounce back. My sister had 3+3 Taxol plus Carboplatin infusions and now she is much better. You are considered immunocompromised during chemotherapy. I believe 2 % of people die during chemotherapy but I am not sure in that. I will copy and paste into ChatGPT what you just said.

[TuffNuttoCrack in reply to Seasid]

I almost died as well with the one that I got.

[Seasid in reply to TuffNuttoCrack]

Drugs that suppress white blood cell (WBC) counts and neutrophils (a specific type of WBC) are typically those that impact the bone marrow, where these cells are produced. These include:

1. Chemotherapy Agents

Chemotherapy is a major cause of WBC and neutrophil suppression due to its effect on rapidly dividing cells, including those in the bone marrow:

Taxanes: Docetaxel, Cabazitaxel

Platinums: Carboplatin, Cisplatin

Anthracyclines: Doxorubicin

Alkylating Agents: Cyclophosphamide, Ifosfamide

Antimetabolites: Methotrexate, 5-Fluorouracil, Gemcitabine

2. Radiopharmaceuticals

Pluvicto (Lutetium-177 PSMA-617)

Xofigo (Radium-223)

Both suppress bone marrow and can lead to neutropenia.

3. Targeted Therapies

PARP Inhibitors: Niraparib, Olaparib (can cause anemia and neutropenia).

VEGF Inhibitors: Bevacizumab (can occasionally suppress bone marrow).

4. Immunotherapies

Checkpoint Inhibitors: Keytruda (pembrolizumab), Nivolumab. While less common, immune-mediated bone marrow suppression can occur.

5. Corticosteroids (Indirect Effect)

While high doses of steroids (e.g., prednisone, dexamethasone) don’t directly suppress neutrophils, they can reduce the appearance of infection-fighting cells due to redistribution and inhibition of WBC activity.

6. Immunosuppressants

Used for autoimmune diseases or transplant rejection:

Methotrexate (low-dose for autoimmune disease).

Azathioprine

Mycophenolate mofetil

Cyclosporine

7. Others

Antibiotics: Some, like chloramphenicol or trimethoprim-sulfamethoxazole, can rarely suppress bone marrow.

Antivirals: Ganciclovir, valganciclovir.

Anti-seizure Medications: Carbamazepine.

Clozapine (used for schizophrenia): Can cause agranulocytosis.

If you’re concerned about specific drugs or side effects, feel free to ask!

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