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Deciding about 2-year ARPI (Xtandi) being added to lupron treatment
Seeing my oncologist today for the 6-month lupron injection. Radiation is scheduled for late October.
The doctor says he recommends the ARPI because my recurrence after the prostatectomy, which was 9 months ago (my PSA now is 0.37) is high-risk: In his words: "If you have decided to proceed with radiation therapy, the options for systemic hormonal therapy range from (1) androgen deprivation therapy (ADT) with leuprolide or orgovyx for six months, to (2) ADT in combination with an ARPI (abiraterone acetate plus prednisone, or enzalutamide) for two years. Based on your young age [ I am 67 years old, by the way], good health, and high-risk features of your disease (pT3bN0, Gleason 4+3 with tertiary pattern 5 and multifocal positive surgical margins, short interval from surgery to PSA rise), I favor ADT in combination with an ARPI (abiraterone acetate plus prednisone, or enzalutamide) for two years. "
I am going to discuss the ARPI option with him, since I dread the two years of hormone bombardment and even more, the possible long-term side effects since Xtandi (the drug he recommends) has been around only for 10 years so they can't possibly know how it might effect someone 15 or 20 years down the road.
In short, I'm considering just going with the ADT-lupron plus radiation, hoping for very long-term or permanent remission with that approach.
Thoughts, anyone? Has anyone here been on a similar regime?
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One of the major problems with ADT is that you can become castrate resistance within 18 to 30 months If just on ADT. It took me 2 1/2 years To become castrate resistant on ADT alone. Median survival after you become castrate resistant is two years. I’ve been castrate resistance for six years, but then my Gleeson score was only 4+3. The fact is the median means that as many people died less than two years as more than two years, Not a risk that’s nice to consider.
An ARPI can keep your cancer at bay for a lot longer and safer than ADT alone. Xtandi (Enzalutamide) can be hard for some people to live with. Much better and just as effective is Nubeqa (Darolutamide). It has many few side effects and doesn’t pass the blood brain barrier so it doesn’t cause the brain fog that Xtandi can. Ask your doctor if you can have that instead. I’ve been on Nubeqa For two years and have had no side effects that I can attribute to that drug.
Your biopsy shows you have a serious problem with it spreading beyond the prostate. In those cases, it is highly recommended to be on an ARPI as well as ADT. That can extend your overall survival.