Apalutamide and extreme fatigue

Hi--I'm a dad with a lot of the same stuff going on as your dad. I had TURP about three weeks ago myself for a blocked urethra after my radiotherapy, and I've been on Apalutamide for 10 months now. I also take Dutasteride. My Gleason score was 4+3=7 when I was diagnosed in January 2022. 

Sadly, I haven't experienced the loss of appetite as your father has and so am as fat as ever (haha), but I can defo relate to the rest of his experience. Depression and fatigue have characterized my journey with PC treatment. I had to take a leave of absence from my job because I could not sleep and was so tired all the time. 

There is hope, my friend: 10 months in, I am looking at the end of my Apalutamide and Dutasteride therapy in two more months (actually 7 weeks). I have also felt much better after the TURP surgery because I do not need a catheter and can urinate normally. Additionally, because of the Apalutamide and Dutasteride, my PSA is .001 and 'undetectable.'

What I'm trying to say is that just four months ago was the darkest time of my life. Radiotherapy, Apalutamide, Dutasteride, catheterization, extreme fatigue, depression, no working. Now, I'm feeling better, radiotherapy's done, I can see the finish line with Apalutamide and Dutasteride, the TURP has helped immensely, and I've begun exercising again. I am not out of the woods, but I am not deep in the middle of them anymore, either. 

There's a phrase I say to myself a lot these days: "The only way out is through."

Best of luck to your father and to you. We can do this. We can definitely do this. 

Have any of you suffered with memory problems as I've been on apalutamide for around 11 weeks combined with Zoladex (started Feb '24)? I have noticed that my memory, concentration and ability to process comples data has declined heavily over the last 6 weeks and thinking of stopping. Tiredness has been an on / off problem and easy to fall asleep with vivid dreams for shortish naps.

(2 bone metastates in pelvis)

Having said that my original Gleason score 3+3+6, PSA never above 7 apart from an odd aberrant one of 9 about 15 months ago was down to 3.2 from Zoladex at the start of Apalutamide, down at 0.5 5 weeks ago and last week's blood test down to 0.025.

I have been on Zoladex since my PC diagnosis in late 2021 and more recently on Apalutamide as my PSA was doubling every three months. Brain fog the whole time. I am managing it, but it has slowed me up (or should that be down). I had a couple of sessions with a neuropsychiatrist and a brain scan but was discharged, with my brain fog put down as 'treatment related'.

Initially no major side effects with the Apalutamide, but after five weeks they started to kick in. Fatigue - on top of that I was already experiencing from the Zoladex - and also mild dizziness. The most noticeable side effect for me is stiffness and pain in my joints, especially my hands. I have an appointment with rheumatology, but that is not until May 2025, such is the waiting list. I have my monthly review with my oncologist in a couple of weeks and I will see if I can be bumped up the waiting list but without much hope of that. I think I will have to seek some private treatment before then if this does not improve.

Medroxyprogesterone has helped with my night sweats, so I am able to get a little more sleep than before, although the Medroxy did take about three months before it started to work. I found that chronic lack of sleep has been a factor in both the level of fatigue and brain fog.