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I need advice to help make a decision.......
Prostate Cancer | Last Active: Dec 3 10:37am | Replies (59)Comment receiving replies
Hi @jeffmarc . I didn't say it no longer needs testosterone. What I said it doesn't need YOUR testosterone. The way my oncologist explained it was that the cancer evolves to a point where it makes its own small amount. ZYTIGA® works by interrupting the androgen-making process at an important step. It inhibits androgen at 3 sources—the testes, the adrenal glands, AND the tumor itself. This is the difference from other ADT therapies.
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That's a good point. Abiraterone acetate (Zytiga) isn't ADT at all; it's a first-generation reception inhibitor (from the mid-1990s) meant to work together with ADT or physical castration to inhibit testosterone uptake by cancer cells, as you mention.
The second-generation -lutamides (Apalutamide, Enzalutamide, etc), which have come out over the past 5 years or so, do the same thing more effectively, but they're not suitable for all cases, which is why oncologists still often recommend Zytiga.
For mCRPC, I think @jeffmarc mentioned that some oncologists like to sequence, starting with Zytiga and then escalating to a -lutamide when Zytiga stops working, but he can fill in the details there; for mCSPC, the TITAN study showed that starting with Apalutamide+ADT immediately is highly effective (that's what they did for me right at diagnosis in 2021, and my PSA is still undetectable, < 0.01, as we enter 2025).
Disclaimer: not a medical professional, etc etc