Psa rise

It means that his cancer isn't particularly bothered by the normal hormone treatment and so something a bit stronger is needed. Enzo works very well for some men and it will be good to get another scan to see what's going on.

Do you have copies of the diagnosis letter? If so, could you check whether dad had a biopsy when he was first diagnosed and, if so, whether the letter said he had adenocarcinoma? Adeno is the most common kind but there are at least 27 types of prostate cancer. Some react to hormone treatment better than others so it would be useful to know which kind he has got.

Well hopefully enzo will have a better and more long-lasting impact. If not, it might be worth pushing for a late biopsy just to check that it is not one of the rarer types.

Concentrate for now on having a very special Christmas and storing up lots of happy family memories - worry about |January in January :-)

So dad has had his onco appointment to discuss latest scans and treatment plan. The scans don't show any further spread - bone mets as before and no soft tissue, so phew to that. But of course his psa has continued to rise markedly. He starts the enzalutamide tablets along with prednisolone tomorrow and the hormone injections are to continue. Feeling a mix of relief for the scans but still dread. I hope it works out. Thank you piglet for taking the time to telll me about your husband, it is encouraging to hear news of someone responding well to these drugs.

Brief update: after his 3rd month on Enza, Tony's PSA has crept down a little more. ALPS still coming down too. This means we can go on holiday as planned without worrying. Wooohooo, Canaries, here we come!
Marje

AC - I may be out of date, I certainly hope I am.

My source for my statement was:

The CDF panel concluded to give patients and clinicians the
choice of treatment with either enzalutamide or abiraterone prechemotherapy
but not both. The CDF panel was aware that
abiraterone required prednisolone and routine blood tests
whereas enzalutamide did not and it noted too that slightly
different patients were recruited to the two studies. It did not
conclude that there was any robust evidence to conclude that one
drug was better than the other (despite their different total
scores). The only exception to this rule of the CDF allowing either
enzalutamide or abiraterone would be if patients developed doselimiting
toxicity to one or other of these drugs within 3 months of
commencing treatment; in these uncommon situations, patients
would be allowed to switch from one drug to the other as long as
there was clearly no evidence of disease progression.

which can be found here:

https://www.england.nhs.uk/wp-content/uploads/2015/09/cdf-decision-summ-enzalutamide-prechemo-mcrpc.pdf

and here:

https://www.england.nhs.uk/wp-content/uploads/2015/09/cdf-decision-summ-abiraterone-prechemo-mcrpc.pdf

It isn't a popular thing to write on here but the trial data showed that if Abbi fails then Enza will also fail, and vice versa. That is why NICE made the decision not to allow both ( as quoted above). There are people who find it hard to believe or accept, because Abbi and Enza work in very different ways but generally, the most important thing at that stage is for the oncologist to use all the information about a man's disease behaviour, progression, what worked well or not, etc to judge whether Abbi or Enza is going to be the best bet.

There are men on here who fought for one after the other, but I suspect this is an emotional rather than rational response ... the idea that there were two drugs to try and then suddenly the option of both was ripped away rather than any evidence that it would extend their life. Or perhaps not everyone reads the trial reports.

Alathays continues to campaign for it in Ireland but his disease is so atypical it would probably be worth the fight in his case!