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Adverse effects of ADT for aggressive tumors

Prostate Cancer | Last Active: 4 days ago | Replies (18)
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@northoftheborder

All great information. I'll just add that the second generation ARSIs (the so-called "-lutamides") have had stunning results for situations where they're tested and approved, both for delaying castrate resistance and for delaying progression after castrate resistance.

In my layperson's opinion, the main reason still to take a first-generation 30+-year-old ARSI like Zytiga would be either that you live outside the U.S. and there's no -lutamide approved yet for your cancer situation, or you live in the U.S. and your insurance will pay only for the older stuff (which is out of patent, and thus much less expensive).

Here in Canada, at least Apalutamide, Enzalutamide, and Flutamide (maybe more) have Health Canada approval, though Enzalutamide's approval was just last year, so it might not be in the provincial formularies yet.

I've been on ADT + Apalutamide (Erleada) for mCSPC since 2021, and consider it my miracle drug. 🙂

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Replies to "All great information. I'll just add that the second generation ARSIs (the so-called "-lutamides") have had..."
shelby29 | @shelby29 | 4 days ago

I was taken off zytiga after 11 months because I suffered a heart attack. (Gleason 8 with cribiforms, stage 3tb)
Do lutamides affect the heart like zytiga?

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jeffmarc | @jeffmarc | 4 days ago

After my fourth reoccurrence, I was put on abiraterone. It Only got my PSA down to undetectable one time in 2 1/2 years but for 2 1/2 years it did not fail me and gave me 2 1/2 more years of very low PSA numbers before I moved onto Darolutamide.

With someone who has had reoccurrences it’s just a matter of time before the drug they pick (Zytigaor a lutamide) stops working, That’s the one thing we all face if you have advanced prostate cancer. Your cancer will eventually defeat the drug you are on and you have to move on to something different. I may get four years on Darolutamide Before my PSA starts to rise again, But Zytiga gave me another 2 1/2 years since I started with it. Very unlikely Darolutamide will work for 6.5 years. That is a hypothetical, Darolutamide May not last me four years, but whatever amount of time it gives me zytiga gave me 2 1/2 more years without reoccurrence.

Yes, the side effects of Zytiga aren’t desirable, but going there first can give more time before stronger measures are needed.

Then there is the Lancet article I have posted many times that recommends the best sequence is Zytiga followed by a lutamide.
https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(19)30688-6/abstract?mc_cid=c2dca8aa74&mc_eid=99575fc699

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