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Stage 4 PC

Posted by talebn @talebn, 12 hours ago

I am 72 years old, diagnosed with metastatic prostate cancer:

6/1/2026 PSA 13.4
10/1/2026 MRI revealed Locally invasive and metastatic PC PIRADS 5
3/2/2026 Gleason Score 4+3=7
26/2/2026 PSMA-PET scan revealed the following:
There are multiple radiotracer-avid lymph nodes in the common, external, and internal iliac regions, as well as in the retroperitoneal region, metastatic. For example:
Left periaortic lymph node measures 1 x 1 cm with SUVmax 9.1
Right external iliac lymph node measures 1.1 × 0.9 cm with SUVmax 9.3

There are few radiotracer-avid bone lesions, metastatic. For example:
C6 vertebral body with SUVmax 5.4
Anterior arch of the right 3rd rib with SUVmax 10

I am relatively active, no smoking, no drinking, no chronic illness, exercise one hour daily yoga and moderate power training, and eat healthy meals.
My urologist has prescribed Casodex and then Zoladex after 3 weeks, while my oncologist suggested replacing Casodex with Zytiga. My urologist still insists on completing 3 months on Casodex and then deciding.
10/2/2026 Started Casodex
2/3/2026 Zoladex 10.8mg injection
I am not having any serious symptoms except for little brain fog, even my overnight frequent urination has significantly improved.
After 3 months my psa is down to .45 and testosterone is .035 and all my urinating symptoms disappeared.

I met today with my oncologist, who strongly recommended changing my anti-androgen therapy from Casodex (bicalutamide) to a second-generation androgen receptor pathway inhibitor, either:

* Xtandi (enzalutamide), or
* Zytiga (abiraterone + prednisone).

He also referred me to a Radiation Oncologist who suggested 39 sessions of vmat radiation to the prostate and surrounding followed by SBRT radiation for the bone lesions.
What side effects should I expect from going to Xtandi and from the radiation?

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Profile picture for Jeff Marchi
Jeff Marchi | @jeffmarc | 10 hours ago

Xtandi is Enzalutamide, Nubeqa is Darolutamide. They worked very similarly. If you wanted to have a choice, you would prefer Nubeqa. It does not pass the blood brain barrier so does not cause additional brain fog over what you have now. Xtandi Tends to cause fatigue for a lot of people, Nubeqa Doesn’t normally cause any side effects for most people.

I was on Zytiga for 2 1/2 years. It gave me high blood pressure and has caused me to have five afib events. It works well for some people, but if you have any heart issues, you really want to question using it. I had no heart issues before Zytiga. It also has much more serious side effects than Nubeqa or Xtandi. That’s because it reduces your testosterone even lower than the ADT drug you are taking and that causes more hot flashes and increasing side effects like bone loss and muscle deterioration.

You appear to not be in the United States so you may not be able to get Nubeqa.

You definitely want to get going on that radiation. You seem to have a good number of metastasis and you want to get treated before you get more. Once you hit five or six metastasis, they want you do chemo and you want to avoid that as much as possible. VMAT Is a good option it does 3-D radiation around your body and can reduce the amount of radiation to other organs.

With a 4+3 Gleason score You have a very treatable disease. Prostate cancer is a chronic disease for almost all of us not a deadly disease.

REPLY
1 reply
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talebn | @talebn | 10 hours ago
In reply to @jeffmarc "Xtandi is Enzalutamide, Nubeqa is Darolutamide. They worked very similarly. If you wanted to have a..." + (show)
Profile picture for Jeff Marchi @jeffmarc

Xtandi is Enzalutamide, Nubeqa is Darolutamide. They worked very similarly. If you wanted to have a choice, you would prefer Nubeqa. It does not pass the blood brain barrier so does not cause additional brain fog over what you have now. Xtandi Tends to cause fatigue for a lot of people, Nubeqa Doesn’t normally cause any side effects for most people.

I was on Zytiga for 2 1/2 years. It gave me high blood pressure and has caused me to have five afib events. It works well for some people, but if you have any heart issues, you really want to question using it. I had no heart issues before Zytiga. It also has much more serious side effects than Nubeqa or Xtandi. That’s because it reduces your testosterone even lower than the ADT drug you are taking and that causes more hot flashes and increasing side effects like bone loss and muscle deterioration.

You appear to not be in the United States so you may not be able to get Nubeqa.

You definitely want to get going on that radiation. You seem to have a good number of metastasis and you want to get treated before you get more. Once you hit five or six metastasis, they want you do chemo and you want to avoid that as much as possible. VMAT Is a good option it does 3-D radiation around your body and can reduce the amount of radiation to other organs.

With a 4+3 Gleason score You have a very treatable disease. Prostate cancer is a chronic disease for almost all of us not a deadly disease.

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@jeffmarc Many thanks for your reply, you are absolutely right, Nubeqa is not available in my country Lebanon so I have chosen to go Xtandi.

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lag | @lag | 7 hours ago
In reply to @talebn "@jeffmarc Many thanks for your reply, you are absolutely right, Nubeqa is not available in my..." + (show)
Profile picture for talebn @talebn

@jeffmarc Many thanks for your reply, you are absolutely right, Nubeqa is not available in my country Lebanon so I have chosen to go Xtandi.

Jump to this post

@talebn If you can get it in Lebanon, you might try Zytiga with prednisone. My husband took it with minimal side effects and it kept his Stage 4 cancer suppressed for over three years. He then went onto Xtandi, but it had terrible side effects for him. So keep in mind that you may need to try several oral meds, and that Zytiga is one you should try if possible. It does not cause bad side effects in every man who takes it.

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1 reply
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talebn | @talebn | 45 minutes ago
In reply to @lag "@talebn If you can get it in Lebanon, you might try Zytiga with prednisone. My husband..." + (show)
Profile picture for lag @lag

@talebn If you can get it in Lebanon, you might try Zytiga with prednisone. My husband took it with minimal side effects and it kept his Stage 4 cancer suppressed for over three years. He then went onto Xtandi, but it had terrible side effects for him. So keep in mind that you may need to try several oral meds, and that Zytiga is one you should try if possible. It does not cause bad side effects in every man who takes it.

Jump to this post

@lag Many thanks for your reply,
I will go with Zytiga and radiation now, hopefully I will tolerate the side effects.

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