Chemotherapy ...Scared

@melcanada Apalutamide is much newer than Zytega, and the "-lutamides" in general are a bit like miracle drugs for some cancer situations (that may or may not apply to yours).

Apalutamide is also, unfortunately, very expensive. In Canada, it costs nearly CA $5,000 (US $3,500)/month; in the U.S., it can cost 4 or 5 times that much. Ontario did add Apalutamide to the formulary in early 2022, so it's covered by the Ontario Drug Plan, the Trillium Drug Benefit, and most private insurers. There's also a patient-access programme that your oncology team might be able to enroll you in, if there's some issue with coverage.

First diagnosis I started with stage 4 metastasized to the bone. Started with 10 rounds of chemo and firmagon. Yes the chemo is rough to go through but for me the sides are all the same. You can do this. As for my hair, started falling out with treatment, I shaved it off,,year later its all back, small price to pay. I like to laugh so during treatment I wore shirts, Chemo, breakfast of Champions, My Oncologist does my hair, to make me smile. When I finished last treatment, Dr said I was done,,, for now. If down the road I have to do again, so be it. Much better then the alternative. For me with so much focus on fighting the side effects, I don't really focus on the fact I have cancer. Hope this makes sense. I wish you the best on this journey. Best to all.

Darolutamide is even Newer than Apalutamide And has fewer side effects. In the US it cost about $12,000 a month but insurance pays almost all of that. I’m on Medicare And this year the maximum you can pay is $2000 for all your drugs. This year I paid $2300 in January and then never paid anymore for any drugs for the rest of the year. That’s how Medicare works.

There is a reason you go on Zytiga before lutamides. If you go on Zytiga first You can then go on one of the lutamides and have a good chance that it will work for another few years. It doesn’t work in the reverse, Going from a lutamide to Zytiga Almost always fails.

I went from 2.5 Years of Zytiga To Darolutamide And now after a little over a year I’ve been undetectable for a year. With Zytiga I was undetectable for one month in that 2 1/2 years And my PSA kept jumping all over the place

There’s a link to an article in the Lancet about The best sequence of using the Drugs.
https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(19)30688-6/abstract?mc_cid=c2dca8aa74&mc_eid=99575fc699

From what you describe, he may now be castrate resistant - After a year of apalutamide and the Eligard shots with Stage 4 Prostate Cancer...the hormone therapy isn't working anymore..."

You ask two questions, about chemotherapy and what is going to happen next...

The forum is responding based on the clinical information you provide, more would strengthen the responses - Gleason Score, Grade Group, has he had surgery, if so, the pathology report, treatment timeline, age, overall health, any co-morbidities

Generally, chemotherapy works to reduce the cancer burden. I did six cycles of Taxotere starting in January 2017, I was 61 and in pretty good shape both physically and health wise.

I assume they determined his ECOG status:

The Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) scale is a tool used to assess a cancer patient's ability to function and care for themselves:
What it measures
The ECOG PS scale measures a patient's ability to perform daily activities, walk, work, and care for themselves. It also describes the patient's symptom status.
How it's used
The ECOG PS scale is used to help guide clinical decisions and prognostication. It's also used to select patients for clinical trials and standard cancer treatments.
How it's scored
The ECOG PS scale uses a 5-point scale:
PS 0: Normal activity
PS 1: Some symptoms, but still near fully ambulatory
PS 2: Less than 50% of the day in bed
PS 3: More than 50% of the day in bed, but not bedbound
PS 4: Completely bedridden

I did lose my hair, it grew back, a few of the nails turned black and blue, they came back, I had chemo mouth but ate pretty much normal diet. I did continue to work, went to the gym, did yard work, rode my bike...My infusions were on Thursday, with the anti-nausea medications they put in first to prevent vomiting from the Taxotere infusion, I felt "pretty good" the first 24-28 hours, then would crash for the next 72-96 hours, then feel better for the next two weeks and start over again. The side effects are cumulative, the fatigue hit hard on the 4th infusion.

As to what's ahead, the possibly many treatment choices to manage his prostate cancer (see the article I attached). If you have not already, familiarize yourselves with those. Reading through the NCCN Guidelines for Advanced PCa and the Prostate Cancer Foundation which has excellent resources can inform you of those treatment options so you can discuss with his medical team.

It's not over!
https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1459
https://www.pcf.org/
Kevin

@melcanada Apalutamide is much newer than Zytega, and the "-lutamides" in general are a bit like miracle drugs for some cancer situations (that may or may not apply to yours).

Apalutamide is also, unfortunately, very expensive. In Canada, it costs nearly CA $5,000 (US $3,500)/month; in the U.S., it can cost 4 or 5 times that much. Ontario did add Apalutamide to the formulary in early 2022, so it's covered by the Ontario Drug Plan, the Trillium Drug Benefit, and most private insurers. There's also a patient-access programme that your oncology team might be able to enroll you in, if there's some issue with coverage.

From what people have told me Cabazitaxel is easier than docetaxel on the body. If you have an ability to make a choice, that would be a good one to pick.

We have full coverage $ Wife at Ministry, plus OHIP at 80 years senior Thanks
Is it Darolutamide not the best after Chemo and all else I have been on?

App is Erleady

I can't comment on which is best after chemo, unfortunately, but I think it's safe to trust your oncologist's recommendation for any of the -lutamides.

Sadly, the big pharma companies are slow getting their drugs approved in Canada -- they focus first on big markets like the EU and U.S., and leave us for the second round -- so we often lag a couple of years. Apalutamide has been in the Ontario drug formulary since 2022 (I needed special approval to start on it in 2021); Pfizer got Health Canada approval for Orgovyx only at the very end of 2023, and it's not in the Ontario formulary yet (which is weird, because it's priced exactly the same as Firmagon, at about CA $315 == US $225 / month). I don't know what the status of Darolutamide is.

Thanks everyone for all the information and all your help..
I see the Oncologist in 2 weeks, so fingers crossed. Not sure what the Gleason score is but don't know it.