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What can I expect when Erleada added to Trelstar? Other options?
With Gleason 6, had prostatectomy in 2007. PSA showed increase in 2013. From 2014 to 2024 ADT with Zytiga, Casodex, and Orgovyx. PET CT with Illuccix in 2024 located cancer solitary site in abdominal lymph gland. Radiotheraphy in 2024 limited to avoid harm to other organs. PET CT with Palarify in 2025 located cancer solitary site in abdominal lymph gland. Resumed ADT with Trelstar in 2026. PSA 2.43 before Trelstar; PSA 1.74 after first Trelstar; PSA 1.89 after second Trelstar.
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They are frequently prescribed together for prostate cancer.
https://www.oncolink.org/cancer-treatment/oncolink-rx/apalutamide-erleada-R
Most of your side effects will likely come from the testosterone deprivation due to Trelstar, but Erleada occasionally can add some additional ones.
There is a phase 3 trial underway for using Erleada without ADT (like Trelstar). It's called LIBERTAS, and preliminary results should be out early in the new year.
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1 Reaction@jeffmarc
Thank you for your reply. I have valued the replies you have provided others.
Concerning Erleada, I was focused the additional side effects. The link provided information on how to deal with the likely and unlikely side effects, which is helpful.
An underlying issue that I will feel better if I share: I am debating whether to seek a new oncologist, which would require an hour of travel. I am 89 and travel is a concern. My current oncologist is local but does little to foster communication. My feeling during appointments is that I would not need to be present, that he has a treatment routine that he follows. I was concerned that I had the second Trelstar injection before the second lab results were known. Despite the 3.5 hour one-way travel to an appointment, for 10+ years I had Dr. Heath as my oncologist so I am used to quality care.
Thanks again for your reply--and reading my underlying issue.
Charles Long
@stevenmarks
At your age, I would want to be on Darolutamide (Nubeqa ) instead of apalutamide (Erleada) Because it has fewer side effects and doesn’t cause brain fog.
You seem to be concerned with the side effects And that is the most effective thing to do.
I have never heard of anybody getting trelstar injections. Usually, it’s Lupron, Eligard or Firmagon for injections. Orgovyx for the pill. It does the same thing as the other drugs, but I have no idea if there are side effects that are different.
@stevenmarks ARSIs (Erleada,Xtandi,Nubeqa) are more effective than Zytiga and do not require prednisone. As Jeff said Nubeqa tends to have fewer side effects. The only purpose of Trelstar, Lupron, Orgovyx, or Firmagon is to lower testosterone. As long as your testosterone is low it does not need to be replaced. The Orgovyx pill usually has less side effects. The fact that the ADT is not lowering your PSA much indicates a ARSI is probably required.