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We need others' info on Stage 4 prostate cancer.
My husband was diagnosed with stage 4 prostate cancer with PSA 32.6 last December. Until November 2025, he did not have any symptoms and never had any PSA levels taken all his life. He's 77. Since it metastasized to his bone when it was found, he suffers from severe pain on areas affected. The first treatment recommended was ERLEADA pill once daily. He's been on it for almost a month. Level was taken at 3 weeks and his PSA went up to 38.2. I read that that is expected for some patients and will eventually come down in 3 months or so. The good thing that we observe is the pain on his shoulders have subsided to a tolerable state but the pain on his left leg affects his walking ability (Not bad as long as he is not walking).
My question is does anyone been treated with ERLEADA and how is it affecting you? We appreciate any response to this message.
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I think he needs ORGOVYX too..ask your oncologist...with Stage IV metastic, he might even need triplet ( chemo) as well...
I have Stage IV, am on Orgovyx and Nubeqa and had 45 EBRT sessions..I think your hubby definitely may need radiation too..
But dont lose hope, many on this site have similar and recovered ! you may need to change oncologists tho..
I've been on Erleada since 2021 for bone-metastatic stage 4 prostate cancer, combined with androgen-deprivation therapy (ADT).
I've personally never heard of Erleada causing an initial testosterone (and perhaps, PSA) flare up. It is common for some types of ADT to trigger a flare: GnRH agonists like Lupron and Eligard do it, while ADT GnRH antagonists like Orgovyx and Firmagon do not.
My PSA was initially 67.9. Firmagon + Erleada reduced it to to 11.6 in under 3 weeks, and to undetectable in a couple more months (where it has remained for over 4 years). But every patient responds differently.
It would be very unusual for somebody to only be on Erleada, As others have pointed out. You always wanna be have somebody on at least double therapy with a ADT plus anARPI (Erleada). The most common types of ADT are Lupron, Orgovyx, Firmagon or Eligard. Did your doctor discuss those with you?
Was this a choice you or your husband made that they didn’t want ADT? It does have a lot of side effects, but I’ve been on it for eight years and I’m 78 and have no significant problems with it. Some people do have a lot of issues.
Erleada is apalutamide, It works quite well, but has some side effects that are troublesome For some people. Some people get fatigue from it, for example. Nubeqa (Darolutamide) Has almost no side effects for most people, Fatigue is extremely unusual. If he has a problem with that drug, he might ask the doctor about whether it’s worth switching.