Switch to enzalutamide after SbRT

[Bronzee]

i have been on Abiraterone and prednisone for 4 years until it failed last Oct 2024. My rad Onco and mO as well as Uro onco agreed it was the next step I need to take after I am done with SBRT. I had my SBRT today and will do 3 more since my PSA rose to 6. Petscan showed a new spot in the sacral area. And the L1 lesion which was not resolved totally by the first SBRT and VMAT done In December 2024. All other lesions were resolved and remain resolved up to now.

My Question is, should I go back to taking Abiraterone with Prednisone or switch to enzalutamide?

any thoughts pls ? thank you

[GP24]

When Abiraterone failed you usually try Enzalutamide instead. It may be that the SBRT radiation has killed quite a number of resistant tumorcells and this causes Enzalutamide to work well.

[Bronzee in reply to GP24]

thank you for your reply

[God_Loves_Me]

Here is my personal opinion,

You can try Abiraterone + dexamethasone when Abiraterone + prednisone failed. Also you can start Xtandi/Enzalutamide during SBRT as well.

[Tall_Allen]

Switch. Your cancer has learned how to resist abiraterone. You treated PSA, not your cancer:

prostatecancer.news/2020/07...

[MateoBeach]

If all of your PSMA expressing mets have been treated with SBRT, then the treatment I chose to try to "mop up" remaining micro-mets (that are certainly present, even though unseen), is Lu177-TLX591 (formerly Lu-J591). Stronger and more persistent binding to PSMA molecules, they can hold on until much more of the Lu177 can decay and kill the cells. Worth considering if you can. Search for a clinical trial.

A few cycles of BAT monthly high dose testosterone, is simple to try and monitor via PSA to see if you respond favorably or not. It has been shown that it can re-sensitize to ARPIs and letting them be effective again, at least for some more time. I would favor switching to enzalutamide now anyway. MB

[Bronzee in reply to MateoBeach]

Thank you. I was thinking the same.

[gsun]

I just switched because of a rising PSA. Won’t know if it works for a couple months.

[NRH_Beach]

I am at a very similar checkoint. Aberaterone failing after five years. My BRCA2 gene mutation has contributed to making my disease very aggressive. My next move will be to start Oliparib; evaluate PSA and look at switching Enzu or other option.

[Bronzee in reply to NRH_Beach]

How are your stats now? Did you switch yet?

[MNGopher]

Looks like your Dr has you covered. My understanding Abiraterone & Prednisone was first partner’s Dr’s first choice for stage 4 aggressive. He withdrew from the combo-stating he would rather have a shorter lifespan. Taking inly 3 months of a very strong combo. PSA levels are very low…🙏We learned from Urologist that cancer changes (resistant) and a new drug of attack is needed periodically. Prostate Cancer is a war. Go to battle!!!

. Stay vigilant. Listen to Dr. Educate yourself. Eat healthy. Exercise. May God Bless You on your journey.

[Bronzee in reply to MNGopher]

Thank you for your thoughts. I exercise , still ride my motorcycles and horses. I am quite active and in no pain. I am trying all possible means to fight this beast

[MNGopher in reply to MNGopher]

😇