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Prostate Cancer, Stage 4, spine & pelvis, Eligard, now abiraterone

Prostate Cancer | Last Active: Oct 5 9:35am | Replies (34)
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@wooldridgec

I recommend talking to your doctor about switching to Darolutamide. The efficacy of Daralutamide is outstanding and the clinical trials have consistently shown this drug out performs the other Androgen receptor signaling inhibitors (ARSI) (i.e., Abiraterone, Apalutamide, and Enzalutamide). For me personally, I would not want to be on prednisone for long periods of time. I understand I had to take prednisone daily while on chemo, but beyond that, I prefer not to be on prednisone for long periods of time. When I have asked why my fellow brother's that are stage 4 are not taking Darolutamide, the answer consistently is that their insurance will not pay for it. If your insurance pays for Darolutamide then consider talking to your provider. Darolutamide also does not break the blood brain barrier, so you will not have the brain fog that comes with the other ARSI's. I am a hard core software developer and since taking Eligard along with Darolutamide I have had no issues other than hot flashes and some fatigue.

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Replies to "I recommend talking to your doctor about switching to Darolutamide. The efficacy of Daralutamide is outstanding..."
jeffmarc | @jeffmarc | Oct 2 11:21am

After 2.5 years on Zytiga I switched to Darolutamide, due to Zytiga giving me afib 3 times, the third time put me in the hospital for 4 days, doctors couldn’t stop it. My Oncologist did stop further issues by switching me to Darolutamide.

While on Zytiga my PSA stayed low but was only undetectable one month for all that time.

Now on Darolutamide I have been undetectable for 10 months.

While Darolutamide costs about $12,000 a month, on Medicare I paid $2300 the first month and then nothing for all my drugs for the rest of the year. In 2025 the maximum will be $2000. There are also a lot of ways to get discounts on this drug, Bayer also has a program providing huge discounts.

The thing is, studies have shown that starting on Zytiga gives the longest time without problems. Here is a link to an article that discusses the best sequence.
https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(19)30688-6/abstract?mc_cid=c2dca8aa74&mc_eid=99575fc699

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northoftheborder | @northoftheborder | Oct 2 3:30pm

"The efficacy of Daralutamide is outstanding and the clinical trials have consistently shown this drug out performs the other Androgen receptor signaling inhibitors (ARSI) (i.e., Abiraterone, Apalutamide, and Enzalutamide)."

That's helpful information, but I think it needs a bit more detail. As far as I know, there are no head-to-head studies between Daralutamide and Apalutamide for my metastatic castrate-sensitive prostate cancer, for example. A secondary study (always tricky because of methodological differences) found no survival benefit of one over the other for mCSPC, but there was a slight reduction in secondary injuries from things like falls under Daralutamide.

For non-metastatic castrate-resistant prostate cancer, the DEAR study did show a statistically-significant survival advantage for Daralutamide over Apalutamide (median age of participants was 79–80), so if you fit that profile — you're older and your PSA is rising despite ADT, but there are no detectable metastases yet — it might be worth talking to your oncologist about Daralutamide.

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