Erleada (apalutamide) + Eligard (leuprolide) not working anymore

Chemo can help a lot to cut back the cancer. It’s a lot easier on people than it was years ago. You could buy yourself a cold cap that can prevent you from losing your hair.

After chemo, there is Pluvicto Which works with some people to greatly reduce their cancer. Sometimes people do this before chemo. Ask your doctors what they think and what your insurance will cover

If you can get your PSA down, you might ask your doctor about BAT treatment. This is where you get injections of testosterone every month, which can confuse and even kill the cancer, but it may reset your body so that you can go back to the apalutamide again, and it will work again.

Not sure if you have tried Zytiga yet. If not, ask your doctor if it be worth a try. It works differently than apalutamide but you usually usually take it before apalutamide.

Are you working with a place like the Mayo Clinic? You should have a top notch oncologist working on your case. Optimally you should have a Genito urinary Oncologist, the ones that specialize in prostate cancer. Medical oncologist work on all different types of cancers and cannot specialize in prostate cancer and keep up with the latest thing going on.

Have you had genetic testing? Have you had somatic testing? Both of those would be necessary at your stage.

I started chemo one month after diagnosis, stage 4 metastasized to bones. I had 10 rounds and although not all pleasant you can do this if that is what Dr. suggests. I wasn't concerned with side effects, just hoping they could control the cancer. I haven't found any of the treatments to be nice to me but 19 months in, still moving forward. If I have to do again to help moving forward, no problem. I'm curious why if psa has been rising since April you haven't had different treatments. Psa might not be the end all fact but is only thing I can go by for me. It starts going up, it will definitely get my attention. I wish you all the best on your journey. Best to all.

My husband has been Stage 4 for many years. He started on Zytiga and prednisone in January of 2020 and it kept his cancer in remission for three years. Perhaps it or Xtandi are treatments to try before chemotherapy.

Xtandi is Enzalutamide, essentially the same as Apalutamide as far as the problem is concerned. Almost definitely would not help.

Zytiga might, since it works differently.

Did first chemo for bone mets Easy No issues Second week every bone in body hurt Had pain meds Prayer It went away Feel great DO IT
Been on Xtandi Radium 223 Xgeva and Zoloddex PSA 40 before chemo I am 80 8 years since radiation out

I am in the Same Boat. I am on Eligard/dexAmethasone 3.10 years in PSA start slow rise in February. Have been placed on STEP-UP trial wait list NCI-type place. Complications happened. PMSA Pet Scan showed some concerning spots. Enter radiation oncologist looks like I won't make STEP-UP trail cut for this round. Darn.

If you are only on Eligard, then the next step is usually to start with Zytiga. If you are just working with the urologist, it’s time to move up to a real oncologist. A Genito Urinary Oncologist is a prostate cancer specialist. A medical oncologist works on all different types of cancer so they can’t specialize in prostate cancer and don’t know all the latest developments.

A GU oncologist Would work along with an RO to make sure the medicine you take matches what the standards of care call for. Once you get a metastasis, you should probably continue on Eligard along with another drug like Zytiga.

Going to a center of excellence like the Mayo clinic could get you a top-notch oncologist. Depending on where you live, there may be one near you if there is no Mayo.