Castration Resistance

Hi there, I am happy to share my father's journey from castrate sensitive to castrate resistance. He was diagnosed de novo in June 2023 at 67 y/o, and started Triplet Therapy shortly thereafter (6 cycles of Docetaxel Chemotherapy, Lupron/ADT and Nubeqa/Darolutamide). Everything went well and his PSA went from 800+ right down to 0.1. In February 2025 (around 18 months after starting triplet therapy), his PSA went up to 3.43, then up to 8.54 by April 1, 2025, when he started Cabazitaxel (Jevtana) and Prednisone. He also continues to receive Lupron every three months. Currently after 4 cycles of Cabazitaxel, his PSA is down to 4.02. We are hoping it goes down even further. Best of luck to you and I hope you stay hormone sensitive as long as possible.

It doesn’t sound like Cabazitaxel is working as well as it could. Have they mentioned, including carboplatin along with the Cabazitaxel? That is frequently what they do when the PSA does not to go down significantly. You should ask your doctor about that. A PSA of 4.02 is pretty high, I’m surprised they haven’t already used carboplatin.

Hi there, I am happy to share my father's journey from castrate sensitive to castrate resistance. He was diagnosed de novo in June 2023 at 67 y/o, and started Triplet Therapy shortly thereafter (6 cycles of Docetaxel Chemotherapy, Lupron/ADT and Nubeqa/Darolutamide). Everything went well and his PSA went from 800+ right down to 0.1. In February 2025 (around 18 months after starting triplet therapy), his PSA went up to 3.43, then up to 8.54 by April 1, 2025, when he started Cabazitaxel (Jevtana) and Prednisone. He also continues to receive Lupron every three months. Currently after 4 cycles of Cabazitaxel, his PSA is down to 4.02. We are hoping it goes down even further. Best of luck to you and I hope you stay hormone sensitive as long as possible.

I think you're in good shape! Nubeqa is to stop the process by which cancer cells become castrate-resistant, which would typically be around 18-20 months of treatment. As cowboys used to say, "You're cutting them off at the pass." Congratulations on a comprehensive treatment plan! How are the side effects? I'm just on Orgovyx, but until I was about 5 weeks past radiation, I was really beaten down most of the time. Some energy is slowly returning.

Why did you stop Nubeqa? I thought Nubeqa and Orgovyx work together to keep things at bay.

I have only been prescribed Orgovyx with radiation and my PSA is being monitored. I am considering adding or switching to Nubeqa after one year rather than following the first recommendation to stay only on Orgovyx fir two years.

If you are able to keep your PSA undetectable with Orgovyx alone, it gives you a longer window of drug treatment future. Each drug only last so long, If you can hold off starting Nubeqa Then when you really need it, it will last a longer time.

If your PSA is kept undetectable and, doesn’t rise then adding Nubeqa really gains you nothing.

Any cancer that escaped radiation is likely to become CR at 18 to 20 months, unless I’m missing something. My purpose with Darolutamide is to stop any cancer cells before they become CR.

Apalutamide was the lutamide they were looking at to stop the cancer cells be becoming castrate resistant. Maybe Darolutamide will work the same way.

Darolutamide seems most compatible with my Afib and with perhaps fewer side effects than other -lutamides. No action anticipated before December.