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How long does your oncologist have you on ADT?
Prostate Cancer | Last Active: Sep 28 12:11pm | Replies (69)Comment receiving replies
Casodex is only required for two weeks before Lupron (etc.). Of course, if you start with Orgovyx you can skip Casodex.
They do not offer chemo if somebody is just castrate resistant. I have never been offered chemo because it is generally inappropriate if you don’t have metastasis. I have had PC for 15 years and castrate resistant for 6. My one spinal metastasis was zapped with SBRT, appeared 2 years ago.
I’ve heard from many people that have had triplet therapy and in almost every case it’s because they had multiple metastases found upon diagnosis or after a drug holiday. In cases where there are n five or fewer metastasis, they usually like to use SBRT rather than chemo right away.
When somebody becomes castrate resistant, they are almost always given an ARSI, NCCN calls for it.. Those include Zytiga, apalutamide, Enzalutamide, and Darolutamide.
I like Darolutamide a lot, It has worked quite well for me And many other people, I know.
Apalutamide has worked quite well for some people and is now involved in a study where people who are castrate sensitive stay on it, and it prevents them from becoming castrate resistant. It’s a study so no final results are available yet. Maybe Darolutamide works the same!
You said
‘I did not say every cell is castrate resistant.”
If you review what I said, you will see I said “ not every cell is castrate resistant as you mentioned.”
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❝Apalutamide has worked quite well for some people and is now involved in a study where people who are castrate sensitive stay on it, and it prevents them from becoming castrate resistant.❞
Absolutely right! The TITAN trial completed in 2020 and published in 2021, just before I was diagnosed later that year (luckily for me my onco team was following it). The trial focussed on ADT+Apalutamide to treat metastatic castrate-sensitive prostate cancer (mCSPC) before it became castrate-resistant, and the results were so dramatic (both for slowing progression and increasing overall survival) that they were forced to unblind the trial early and allow the control group the option to start taking Apalutamide as well instead of placebo.
The trial failed to reach median overall survival — after 4½ years, over half the experimental group was still alive, and a large minority were still castrate-sensitive, despite the fact that a de-novo diagnosis wasn't required, so many participants had already had mCSPC for years before the study started.
Since then, other studies have shown similar results for Enzalutamide and Darolutamide with mCSPC. It's rapidly becoming standard of care to add a -lutamide to ADT immediately for mCSPC, instead of "saving it for later" if/when castrate resistance happens.