Stage 4 prostate Cancer: Firmagon + Abiraterone?

Hi @vickyjayne, weclome. I adjusted the title of this discussion a little to reflect that question you're asking fellow members. Allow me to bring @9876 @pauljay @mikesuess @403211th @donnelson @norske46 @rso @rxharleydude into this discussion as they have experiences with degarelix (Firmagon) abiraterone (Zytiga) and/or enzalutamide (Xtandi).

Here are a couple of related discussions:
– Enzalutamide (Xtandi): Anyone have experience with this drug? https://connect.mayoclinic.org/discussion/xtandi/
– Zytiga for Prostate Cancer https://connect.mayoclinic.org/discussion/zytiga/

Vickyjayne, I think you are asking the right questions about what benefits do the additional hormone therapies bring for your brother. I know others will share their experiences, but I might also suggest your brother ask his oncologist too. His oncologist can answer more specifically what the benefits are for him. Is your brother tolerating the Firmagon injections well?

I am new to the prostate forum. I want to know how to compare brachytherapy plus possible ADT (e.g. luperon) for 3 to 4 months to radical prostectamy (hopefully nerve-sparing). Which has the greatest chance of permanent cure and which has the greatest likelihood of all side effects (especially incontinence and ED) disappearing after say 6 months.thanks

Suggest you also ask about Darolutimide. Recently approved and avoids the addition of prednisone.

Good add, @msciulli.

Here's more info about darolutamide (Nubeqa) and it's recent (Aug 2022) approval:
- FDA approves darolutamide tablets for metastatic hormone-sensitive prostate cancer https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-darolutamide-tablets-metastatic-hormone-sensitive-prostate-cancer

Has darolutamide been recommended for you Msciulli?

You can research doublet or triplet therapy for prostate cancer and the results will help you answer your question.

I'm a layman, not a medical professional so keep that in mind.

Basically, there's three ways you try to stop the role of testosterone in prostate cancer:

Production from the testicles.
Production from the adrenal glands.
Uptake by the prostate cancer cells.

The firmagon does the first

The other two get after the 2nd and 3rd ways testosterone is involved.

He may want to talk to his medical team about triplet therapy, adding chemotherapy or radiation if his health permits.

Something to keep in mind is a large drop like that in PSA may indicate that the androgen sensitive cells have largely died off in his early treatment. What's left are some androgen sensitive cells thus the continued use of Firmagon. There are cells who are not sensitive to the Firmagon thus radiation and, or, chemotherapy may kill those.

Anyway, search doublet or triplet therapy and discuss with your medical team.

Here's one link to introduce you to the subject - https://pubmed.ncbi.nlm.nih.gov/36058809/

Kevin

Hi @vickyjayne, weclome. I adjusted the title of this discussion a little to reflect that question you're asking fellow members. Allow me to bring @9876 @pauljay @mikesuess @403211th @donnelson @norske46 @rso @rxharleydude into this discussion as they have experiences with degarelix (Firmagon) abiraterone (Zytiga) and/or enzalutamide (Xtandi).

Here are a couple of related discussions:
– Enzalutamide (Xtandi): Anyone have experience with this drug? https://connect.mayoclinic.org/discussion/xtandi/
– Zytiga for Prostate Cancer https://connect.mayoclinic.org/discussion/zytiga/

Vickyjayne, I think you are asking the right questions about what benefits do the additional hormone therapies bring for your brother. I know others will share their experiences, but I might also suggest your brother ask his oncologist too. His oncologist can answer more specifically what the benefits are for him. Is your brother tolerating the Firmagon injections well?

March of 2022 I had a psa of 80 w Pelvic lymph node (2) involvement, Gleason 7 ++,
Treated w 39 IMRT sessions (May-June) and 6 mos LUPRON (Local provider).
PSA (Aug 2022)=1.2
Stared ABIRATERONE (Zytiga) Sept 1 2022.
PSA on (Sept 19, 2022)=0.4
Refresh of LUPRON on Sept 22, 2022
This is a brag for Mayo (Phoenix).
This would not be possible without Mayo's willingness to work with the VA. Thanks to the VA for working w Mayo.
Despite the rosy numbers I still have a long and difficult journey.
The treatment is not without SIDE EFFECTS.
I am happy to am happy to answer any questions.