Stage 4 Prostate Cancer and Hormone Therapy quit working

Yes, that makes sense, with the caveat that if you're already on one of the -lutamides and it's been working for a while with tolerable side effects, it doesn't make sense to "roll the dice" and switch to a different one, even if the dice are loaded a bit in Daralutamide's favour as @jeffmarc reports: after all, in that case you now know with 100% certainty ex-post that your current -lutamide is working (whatever the probabilities were ex-ante, before you started taking it).

OTOH, if your current -lutamide isn't keeping your PSA low/undetectable, or if you're finding the side-effects so difficult to tolerate that you've considered stopping, then it makes sense to talk to your oncology team about trying a different med. Everyone's reaction will be different, and we're fortunate that we have so many good options these days.

@9036george, how is treatment with Pluvicto going?

Xtandi stopped working after a year Did Xofigio or Radium 223 6 injections which worked PSA back up now so 2 sets of chemo of 6 gave me reaction, fluid on lungs Has to stop Now aweing direction

Should I try Daralutimide PSA 190 Feel great at 80 8 years since radiated out prostate

Am taking Xofigo ( infusion ) every four weeks for six doses—had first treatment couple of weeks ago. Tolerated well—-continue with Nupron—no numbers yet on effectiveness—will be happy to share if you wish

I appreciate it when you and others share their stories about the next steps with stage-4 PCa treatment. I'm still holding at castrate-sensitive for now, and I know from my oncology team that there are many options waiting for me if/when my PCa becomes castrate resistant, but hearing personal experiences is worth far more than sterile knowledge or articles.

It's great news that you're tolerating your Xofigo well so far!

It is unlikely that Darolutamide will work if Enzalutamide (xtandi) stopped working. You could try it, ask your oncologist

If you have not been on Zytiga that may be a better choice. It is usually used before one of the lutamides but it probably would work after. Ask your Oncologist.

Another option would be to try BAT? This is where you Get testosterone injections for a few months and it hopefully resets your ability to have a drug like Xtandi work again. Doesn’t work with everyone.

Appreciate I am on Zolodex injections 3 months for now 5 years ISs BAT better Can one do both
I will ask about Zytiga Other ideas welcome I did Radium 223 Maybe LU 177?? if allowed Its free here

I also get EGEVA and take 600 MG calc with D K daily

If zolodex is working, there is no reason to do BAT. You do it when no other drug keep your PSA down.

You definitely should consider Lutetium. It’s very successful in about 1/3 of the patients somewhat successful in 1/3 and does nothing at all and 1/3. of course if your PSA is under control, you don’t want to do that yet.

You should get a somatic genetic test before doing lutetium. It does not work well if you have RB1 or PTEN genetic anomalies. a somatic test can tell whether or not you have those. There are many genetic anomalies that can pop up after having prostate cancer.

Xgeva is only to prevent bone loss, which happens with the cancer drugs you take for prostate cancer.

After second chemo my lungs go fluid on them and a small embolism Had to stop On BIG prednisone Difficult breathing
Chemo gave me PGA flair up 30% get that Google it
PSA jumped from 10 last Jan after Xtandi then Radium 223 failed to 40 before chemo and today is 191 Help??
Blood work Monday 1 PM CVH then doc sees me What's next is issue
80 feel great Fighting since radiated 2017 C in T 5 L2 and some small in hip L 1 radiated 3cm out in 2020

I'm sorry to hear about your new challenges. You've been carrying on the fight for 7 years already, and the fact that you're feeling great at 80 gives me hope that you have many, many more years of joyful life in you.

I can't remember for sure, but I think you're the one who mentioned that Princess Margaret Hospital in Toronto is the world's 10th highest ranked cancer centre, behind Mayo Rochester (4th place) but ahead of the Cleveland Clinic (17th place) and the other Mayo satellite clinics. Are you getting treatment there? If so, then you can be pretty confident that the options they give you for "what's next?" will be the best and latest. But really, any major Canadian cancer centre associated with a university medical school will be great, because practitioners/researchers move back and forth among the top cancer treatment clinics (my new oncologist just came back home to Canada from Harvard med school), and they carry their knowledge around with them.

Best of luck!