Castration resistance

I became castrate resistant 2 1/2 years after starting ADT. My oncologist actually put me on Biclutamide for a year and then Zytiga for 2.5 years. I started having some real heart issues with Zytiga So I switched over to Darolutamide and I have been undetectable for 20 months. It has been six years since I became castrate resistant. These newer drugs really help.

The one metastasis I had was on my spine on L4. Had it zapped a couple years ago with SBRT.

Now the bad news

While the median overall survival (OS) for mCRPC patients is often cited as around two years, it's crucial to understand that this is a median, meaning that half of patients live longer than this, and half live for a shorter duration.

Survival times vary greatly among mCRPC patients, influenced by factors like the extent of the disease (where it has spread, whether it is high volume or low volume disease, etc.), overall health, and response to treatment.

There’s been a clinical trial to try to delay castrate resistance by going on ADT plus Apalutamide. It might also work with Darolutamide, but that’s not part of the trial.

Trials like LATITUDE and STAMPEDE have shown that adding abiraterone to standard androgen-deprivation therapy (ADT) can significantly improve survival and delay disease progression in men with metastatic hormone-sensitive prostate cancer. These trials demonstrated that abiraterone, when used earlier in the disease course, can be effective in preventing or delaying the onset of castration resistance.

Lots of different options, If only Zytiga wasn’t so hard on the body.

If your cancer hasn't metastasised yet, it may never come back. If it has (like mine), consider that I've been on ADT + Apalutamide for nearly 4 years, and castrate resistance hasn't happened yet. 🤞

That won't be the case for everyone, but starting an ADT and an ARSI like Apalutamide or Abieraterone (Zytiga) *at the same time* (instead of one after the other, like they used to do) has rewritten the book on time to castrate resistance with advanced prostate cancer. See, for example, the TITAN, LATITUDE, and STAMPEDE studies.

On top of that, radiating the prostate (if you still have it) and attacking the individual tumours *right at the start* — with external radiation for oligometastatic, or chemotherapy for polymetastatic — has been shown to be far more effective than waiting until the cancer progresses and escalating to one treatment after another. Some oncologists refer to this approach as "doublet therapy" (with radiation) or "triplet therapy" (with chemo).

Best of luck!

Thanks Jeff! So have the newer drugs allowed a longer time from the start of ADT to castrate resistance and/or castrate resistance to death? My doctor said I will be on ADT for 3 years, but I think it will be for life due to the aggressiveness. When do most men go into remission, before castrate resistance, after, or can it be either?

Thanks North! I guess I’m doing doublet - Firmagon (already started) and Zytiga (starting in a couple weeks) with radiation (also starting in a couple weeks). I asked if I can do chemo right after radiation, but Dr said no. 50 years old and trying to be aggressive as possible up front. Thanks!!

If you have only a few metastases, then radiation makes more sense; if you have many, then they sometimes offer chemo or Pluvicto instead. The idea is to attack the metastases at the roughly same time as you're shutting down the testosterone supply (at source and destination) and destroying the "mothership" tumour in the prostate.

My “mothership” was taken out on May 22 but I had positive margins. Now they have to deal with some local daughter ships. 🙂

If you are just on ADT the average time to castrate resistance is 2.5 years, exactly what it took me.

It definitely appears that adding an ARSI can extend that time.

Discuss this with your doctor, see if the clinical trials will sway the doctor to get you on an ARSI as well.