Question

Yes abiraterone has some nasty side effects if you have a heart condition it’s especially troublesome. The thing is, it is the best way to start if you can handle the side effects. You do have a very serious case of prostate cancer And with a Gleason nine and cribriform they want to try to hold off recurrence so they give you abiraterone. You could try it for a few months and if it was real troublesome, move on to one of the lutamides. The thing is Enzalutamide (Xtandi) also has a lot of serious side effects for some people, Darolutamide (Nubeqa) has the fewest side effects?.

Has your PSA reached undetectable with just Eligard? If it has you could stay with just Eligard until your PSA started rising again. That’s how my prostate cancer was handled, but I was a Gleason seven.

If your PSA is undetectable you should talk to your doctor and ask him If abiraterone is absolutely necessary at the current time. Maybe he can give you specific risk information, so you can make a decision.

Out of interest, I thought it would be useful to collect the approvals for the different common ARSIs. Mini-glossary at the end. Please verify everything you read here, since it's based just on some quick web searches.

1st gen ARSI:

Abiraterone (Zytiga): mCRPC; mCSPC only for high-risk; both also require the steroid Prednisone

2nd gen ARSI:

Enzalutamide (Xtandi): nmCRPC, mCRPC, mCSPC; sometimes nmCSPC if there's a high risk of recurrence
Apalutamide (Erleada): nmCRPC, mCSPC
Darolutamide (Nubeqa): nmCRPC; mCSPC (with Doxecetol, a chemo drug)

Mini-glossary:

nmCSPC - non-metastatic, castrate-sensitive prostate cancer
mCSPC - metastatic, castrate-sensitive prostate cancer
nmCRPC - non-metastatic, castrate-resistant prostate cancer
mCRPC - metastatic, castrate-resistant prostate cancer

While all these guidelines you have listed here Apply in most cases there are quite a few exceptions.

Many people that I know through Ancan.org are on Darolutamide and are mCRPC, including me. Many doctors are prescribing it. No chemo either.

Thanks for the extra context. From what I've seen, the chemo is only for using Darolutamide with mCSPC, based on the results of the ARASENS trial, so it wouldn't apply to your mCRPC.

Sounds very similar to my diagnosis. Gleason 9 and no metastasis. I had radiation for a month and have been on lupron and abiraterone for a year. So far, so good. PSA is maintaining at 0.0.

Can you tell me more about what you know regarding heart side effects while on abiraterone?

Thanks for responding. How are the Abi side effects for you?

Google says
Abiraterone, a drug used to treat advanced prostate cancer, can cause serious cardiovascular side effects, including heart rhythm problems, hypertension, and heart failure. These side effects can be particularly concerning in patients with pre-existing heart conditions.

You are so lucky. diagnosed 3/2019 PSA 43 Gleasons 7-9 RP 5/2019 38 lymph nodes removed, 8 with PC, all nerves too. RT then ADT and the horrors of Lupron begun, 2 sessions over 2 years, quit both due to horrible SE's. PSA 0.03 then started to rise again . Now Abiraterone only. Done with Lupron. Bad SE's with this similar to Lupron. How bad? Can maybe crawl to the toilet from bed. Nausea, hot flashes, very weak, dizzy spells, dry mouth at night, almost suffocating. sore all over. Major brain fog. Impossible to get more than 1 hour of sleep. I now understand how some just give up. Suicide while rare, does happen.
Lacco

I never had high blood pressure until I started taking abiraterone. Within a few months, my blood pressure went up so they started me on a couple of different blood pressure medicines. By the time I had stopped taking abiraterone, 2 1/2 years later, I was on a third blood pressure medication. Since I stopped abiraterone I have reduced one of the drugs in half, the high blood pressure has stayed with me, but with the pills it’s actually pretty low 92/49 on Tuesday, but it’s usually in the low 60’s maybe 100/60 average. I went in a few months ago to get minor surgery to remove a cyst. They took my blood pressure and it was 86/48, I think that was below what they were allowed, to do surgery. I had no symptoms of low blood pressure, checking a second time showed it was only slightly higher. After the procedure completed, I checked the notes to see what they had to say, My blood pressure was listed higher than it actually was, in the notes.

This has happened with other people as well, A common problem.

The other issue I had was that abiraterone brought back my ancient history afib. I had 2 afib events, one in 2004 and another in 2006 then in 2021, 10 months after starting abiraterone, I had a third. Two more happened before my oncologist pulled me off abiraterone 2.5 years later. No problem while on Darolutamide for 20 months.

Depending on the heart issues, some doctors may not prescribe abiraterone.