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Prostate Cancer | Last Active: 4 hours ago | Replies (14)
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The thing is, using abiraterone first can give you an extended amount of time of non-progression of your cancer. This Lancet article discusses why using abiraterone first makes sense.
https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(19)30688-6/abstract?mc
cid=c2dca8aa74&mc_eid=99575fc699
These drugs last only so long before your body starts to have a rise in PSA. I was able to stay on abiraterone For 2 1/2 years before moving to Darolutamide. I would hope Darolutamide will work for three or four more years. I know it’s very unlikely that abiraterone would last 5 1/2 to 6 1/2 years before my PSA would start rising. I think using both has given me more time.
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In contrast, the TITAN study showed a significant advantage of starting on Apalutamide with ADT right away for mCSPC (to the point that they had to unblind the study partway through, because it would have been unethical to leave the control group on placebo).
Starting on Abiraterone and then progressing is part of the old-school thinking (try one thing, then move on something stronger when it fails); as you know as well as or better than I, the new thinking over the past few years is to hit metastatic prostate cancer hard up front with the best you've got (hence doublet and triplet therapy).
That doesn't mean the older approach is necessarily wrong; it will take many more years of research to establish that definitively.