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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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@northoftheborder

"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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Replies to ""The efficacy of Daralutamide is outstanding and the clinical trials have consistently shown this drug out..."
northoftheborder | @northoftheborder | Oct 2 3:34pm

But also, if what you're on has been working for a few years and the side-effects are tolerable, you might want to think hard about switching to something new for a small hypothetical statistical benefit. After all, you already know that the current treatment works for you, just like you already know the result of a coin toss after you've done it, so you're not starting ab-initio like the studies. You could end up in the cadre that the new treatment *doesn't* work for. 🙁

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jeffmarc | @jeffmarc | Oct 2 4:34pm

This article in JAMA shows a comparison of the Lutamides

Search this title and you will find the article

Androgen Receptor Inhibitors in Patients With Nonmetastatic
Castration-Resistant Prostate Cancer

The studies purpose is to find

‘What are the clinical use and outcomes of the androgen receptor inhibitors (ARIs) darolutamide, enzalutamide, and apalutamide in US patients with nonmetastatic castration-resistant prostate cancer (nmCRPC)?”

This may not be as complete as we’d like to see, but it is a start of a comparison of the three products and favors Darolutamide.

And then the question comes up “if someone has their metastasis zapped with SBRT are they actually non-metastatic now”!!!??

While it refers to nmCRPC many doctors are suspecting that some people that are listed as non-metastatic actually are metastatic, just that the metastasis are too small to detect yet.

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