Stage 4 Prostate Cancer and Hormone Therapy quit working

No, definitely go with what you and your cancer team decide on after careful evaluation. Overall survival alone is a tricky stat, because we all start from different places: is your cancer localised or metastatic? castrate-sensitive or castrate-resistant? oligo or high-load metastatic? bones, lymph nodes, and/or organs? how old are you? how's your heart? how well do you tolerate hormone therapy? how active are you? do you have diabetes or other comorbidities? what have you already tried? etc etc.

If the median OS is slightly higher for one treatment than for another, that doesn't mean that the same will apply to your specific situation.

Darolutamide is the newest. Has the least side effects. You’ve already been on Enzalutamide so apalutamide is almost definitely not going to help. It works the same as Enzalutamide as does Darolutamide. You need to go another direction.

If you have not been on Zytiga then it may be the best bet for the next drug, but you have to speak to your oncologist to find that out. Zytiga is hard on the heart. Can raise your blood pressure. Causes hot flashes to become more intense. Makes the brain fog worse. But it can give more years of low PSA.

Another option is BAT where you have testosterone injections to try and reset the ability of Enzalutamide to work again. Doesn’t always work.

What about the side effects Looks like their the same yet Apalutimide seem more serious

Any experience BTW I am 8 years with this sine radiated out in 2017 Now 80

Lungs improving See Resporoligist tomorrow Get Zolodex shot too

I'm so happy to hear that your lungs are improving!

As far as side effects go, it's very personal again. I've tolerated Apalutamide well for the past few years; others here in the forum have found its impact on their lives almost catastrophic.

In the end, the right medication is the whatever keeps YOUR cancer in check and doesn't prevent YOU from living a fulfilling life. I was lucky to hit that on the first try with the Apalutamide (and ADT to some extent, but Firmagon really did knock me out for 2-3 days every month, so switching to Orgovyx gave me a nice quality-of-life boost).

When you find a treatment works for you, stick with it until it stops working, whatever the stats say (they're just aggregates, and don't apply to every single person).

I don’t see you mentioning having Pluvicto treatments. That is usually the next step. It doesn’t work at all for 1/3 of people, but it is very successful for 1/3.

Not sure what you mean by big prednisone. Not sure if you have been on Zytiga which requires you take 5 mg of prednisone. That might work for you, it might not, you need to ask your oncologist if it makes sense.

Think Oncologist is going Zytiga. He did not know of BAT Raising testosterones and faking it to trick C cells

Would BAT be next option after Zytiga?
Plan travel to Sandals Moe Bay in Jan Have great health insurance Hope side effects would not put issues on me? Thoughts?

Bat would be after Zytiga fails.

Does it always fail How long does it work I see some with OS in years

Like all the -lutamides, Apalutamide can be very effective — so much so that they had to unblind the TITAN trial because it was unethical to keep half the participants on placebo. That study didn't reach median overall in its 4½ years, even (IIRC) counting those who had started on placebo and then switched and those who had become castrate-resistant during the trial, because the participants just kept living so darned long. 🙂

Erleada (Apalutamide's brand name) is in the Ontario formulary, so your ODB should cover it without having to mess with the extra paperwork around joining a patient-access programme or getting authorisation from private insurance (which is important, since it would cost nearly CA $5,000/month otherwise).