My first post - what should my Dad add to ADT?

You could ring one of PCUK's nurses or look on YouTube.  This is a good YouTube channel but you'll need to search to find the right video on it:  https://www.youtube.com/@ThePCRI

Hi LOzz if its any help when I was put on Enzalutamide in Feb '21, I had a 30 day course of Bicalutamide also plus ongoing hormone injections, cheers

Bicalutamide is an anti-androgen, blocking Testosterone from getting to Androgen Receptors.

Enzalutamide is an anti-androgen around 8 times more powerful than bicalutamide at blocking out Testosterone.
However, in the event that an androgen receptor is triggered by Testosterone (which will still happen occasionally), Enzalutamide also attempts to prevent two subsequent stages which are required for the cell to multiply, which Bicalutamide does not do.

Abiraterone switches off the small remaining Testosterone which comes from the adrenal glands. It is also an anti-androgen, but that's not its main method of working. It also switches off other essential steroids from the adrenal glands, which is why you need to take a low dose steroid to replace those.

Enzalutamide and Abiraterone can both work after Bicalutamide has failed. However, I think the current best practice is considered to be to start on Enzalutamide or Abiraterone ASAP, which is thought to give the longest protection. I have not seen any data on upfront Bicalutamide followed by Enza/Abi verses just upfront Enza/Abi.

If I was faced with this choice, I would skip the Bicalutamide.

Although Abiraterone and Enzalutamide work very differently, they seem to be broadly similarly effective. Abiraterone is off-patent now and in theory is much cheaper and possibly within reach of personal funding for some people. At least that's the theory - in practice, it still seems to be very difficult to buy it in the UK even with a private prescription at less than the branded Zytiga price. I know some patients have, but I don't know how. One patient I'm supporting is planning to buy it through a family member who lives abroad where it is more easily available at reasonable pricing. Enzalutamide on the other hand is still protected by patent and hence unaffordable for most people. (Its patent doesn't have much longer to go though.)

So if I were faced with this, I think I'd go with Enzalutamide. That might leave me with the option of trying self-funded Abiraterone after Enzalutamide stops working, which you can't do on the NHS.

But also ask your oncologist what pros and cons they can think of between the two.

Edited by member 25 Aug 2024 at 12:14  | Reason: Not specified

Hi there

Sorry but I seem to have a deal of trouble replying directly to your message. 

Yes, I am still on Bicalutimide (I have been on it since mid 2019).  I was put on it because my PSA was creeping up and it had the desired effect of returning it to virtually undetectable. The latter is still the case with me (12 years after diagnosis) and HT is the only treatment I have had. A recent full body scan shows absolutely no evidence of cancer in my bones (previously extensive) which was wonderful news.

I am not saying I recommend your Dad choses Bicalutimide as we are all different and his Onco seems to infer there is little to choose between them. However, it has worked very well for me and it is worth a try as some cancers are very hormone sensitive.

Wishing all goes well for you and yours and I hope that my experience gives you all some encouragement for the future.

Tony

Edited by member 13 Sep 2024 at 08:55  | Reason: Not specified