I am on Abiraterone (Zytiga) and Leuprorelin (Eligard) for 18 months and my understanding is that Eligard and Lupron are the same drug, but the Eligard is an injection into the fat in your body whereas Lupron is an injection into the muscle in your body.

At face value of reading journal articles and other available articles, it sounds like Apalutamide (Erleada) has a bit of a better efficacy when compared to Abiraterone (Zytiga), however I don't get a sense that one is remarkable better than the other. It is like purchasing a Honda or a Toyota, they are both good cars, yet the final determination might not be made solely on one set of similar metrics.

My health team (we actually reviewed this last week) is of the feeling that the drop in my PSA to less than 0.1 is largely a result of the Eligard and that the Zytiga is just doing a supportive role. I started just on Eligard with a PSA of 19 and three months later my PSA was 0.4, so we opted to add in the Zytiga for traditional couplet therapy. One can wonder if I just stayed on the Eligard if my PSA would have dropped more, or would it have it leveled out at 0.4, fortunately I'll never know and more importantly it is less than 0.1 as of April 2024.

Side effects are not a walk in the park, but the option to complain or do something about it is a big factor in how you work through these challenges. I chuckle that 12 months ago I complained about hot flashes, today I have the same hot flashes, but I have a coping mechanism, and also have other side effects to deal with like brain fog and overall fatigue.

Just to add on that topic, for a while I found that getting 8-9 hour of sleep was working well, even though I wanted 10, but even with 10 hours of sleep I would wake up tired. Recently I have switched to 7 hours of sleep with an alarm clock and surprisingly I have the same energy levels if I slept more, I get to sleep quicker and spend more time in REM sleep. I think the moral of this short story is that you have to try things out.

Hopefully this helps and please do reach out and keep the faith

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