Optimal Duration of Hormone Therapy

@jeffmarc

Jeff - do you know if Madicare covers Nubeqa no matter what ?
We listened to your advise that you gave another patient couple of months back and "demanded" Nubeqa and we got a prescription. We personally can not THANK YOU enough since we would not know how to navigate the system or what to ask for. 🙏💗
Now we are waiting to see if it will pass Kerberos keepers in insurance 😑. MO thought that there should be no problems, but I am wondering and keeping my fingers crossed.

@surftohealth88
There is one issue. It is not FDA approved for mCRPC. So people with metastasis, and that are castrate resistant may have a little bit of a problem. I know I didn’t have a problem, but I know a lot of people over at ancan.org We’re able to get it prescribed, even though they were in this situation. It’s sort of crazy that Non-metastatic nmCRPC Are approved for it. I suspect it comes down to the fact that they don’t want to pay for a clinical trial to prove something they know is just a given.

It would be interesting to hear what the final result is of this request.

If you are castrate sensitive, which I suspect your husband is, it shouldn’t be a problem

@jim18
I had a focal ablation IRE nanoknife first, followed by IMRT and ADT. I believe for those like me still having a prostate makes it more difficult to determine when failure occurs? I'm expecting my PSA to rise somewhat after ADT is completed. I'm guessing a slow rise and stabilization would be a good thing? I've read that PSA of .2 to .5 is considered successful. I'll ask my MO next time I see her what to expect regarding success vs. failure.

@surftohealth88 If the MO said no problem than it should be approved. The key is the request for approval should medically exclude Zytiga as an alternative. The approvers are just looking at the $$$ and Erleada, Nubeqa, Xtandi are all so similar in cost insurance does not care. But a year of Zytiga is $100K less than any of the 3 ARSIs. For switches, PSA is now rising even with Zytiga is gold; then come heart issues, etc.

@swl1956 PSA will jump up within a few months after the return of testosterone. Studies have shown less recurrence (over 10 years) if that jump is less than 0.5 PSA. Get both total PSA and total testosterone tested. A lot of hot flashes and staying undetectable after ADT ends is related to slow/no return of testosterone. Effectively still on ADT until testosterone returns. After the initial jump expect either a stable PSA (especially for small jumps) or a slow decline. Recurrence is defined at a PSA rise of 2.0 above nadir but the probability of having cancer is > 60% if PSA increases by 1.0 above the nadir. That is the early RT treatment disconnect similar to RP of 0.1 vs official 0.2 PSA level.

@jeffmarc

APPROVED ! : )))

I was hoping that there will be no problem since sriddle1 (@sriddle1) and Ucla got it and their husbands had the same situation - node involvement. They had persistent PSA , not classical BCR situation like my husband but treatment plan could be extrapolated.

And I agree with what you said Jeff - nobody will repeat clinical trials for every single subgroup and there is no reason for that actually.

Yes, my husband is ADT "naive" and he is not castrate resistant. We also ordered PSA test and testosterone test couple of days back and uPSA is 0.025 and total T = 18 !!!! (down from 746 ) in just 2.5 weeks. 🧿

*pheeeew Perhaps I should go and buy LOTTO ticket today , or something lol , Jupiter is in my sign this month 😋 , that must be IT !!! ha ha *knock the wood, touch the red, hold the horse shoe, spit 3 times and so on and so on ...