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Apalutamide or Darolutamide & Docetaxel....HELP!

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User
Posted 16 Oct 2024 at 20:49

Hi, my dad has been recently diagnosed with stage 4 metastatic prostate Ca.

He has been having the Prostap injection and his PSA level was 1294. We now have to choose between adding Apalutamide or the triplet therapy Darolutamide and Docetaxal chemotherapy. The consultant wasn't very helpful and said there isn't evidence comparing the 2. My dad is 65 with peripheral arterial disease (blood clot in thigh) but otherwise fit and well. I can't find any clear guidance between the 2 to help us choose. Obviously the side effects are more prolific with the triplet therapy so if the Apalutamide success would be similar, I think my dad would go for that.can anyone help, add any insight or has any experience at all. Thank you in advance for taking the time to read this.

Edited by member 17 Oct 2024 at 05:57  | Reason: Not specified

User
Posted 19 Oct 2024 at 06:51

Morning Deb.

I'm sorry to hear about your dad's condition, but lovely to see you are doing your very best to help him. Welcome to the forum. 

I have no experience of the treatments but this link may help.

https://prostatecanceruk.org/prostate-information-and-support/treatments/apalutamide

Your enquiry is quite specific, there won't be many on here who feel qualified to respond. You may get better help and support from the specialist nurses.

Edited by member 19 Oct 2024 at 06:54  | Reason: Additional text

User
Posted 19 Oct 2024 at 08:01

You can read the side effects of all the medications online I’m aware apalutamide may affect his heart condition. I’m not too sure about the others. What I did was to look at all the side effects with my husband before we decided which medication would be best. I hope this helps. 

User
Posted 22 Oct 2024 at 13:20
Hi Deb

I was on Apalutamide for two years from February 21 after being diagnosed in Oct 2020, with a PSA of 384. Coupled with Zolodex injections every 3 months. Apart from fatigue and some low moods it seemed to work very well.

I came off it in February 2023 with PSA untraceable and haven't had any further medication, PSA is still only 0.8 and feel as well I've ever done.

Good luck with everything.

Regards, Stuart

User
Posted 22 Oct 2024 at 14:46
If you want the best chance of a long remission it's probably best to go for the triplet therapy up front.

Regarding suitability for treatment I would hope your oncologist is taking that in to consideration. They should be advising you on the risks associated with the treatment options.

User
Posted 22 Oct 2024 at 16:34

Hi, I just wanted to reach out and say I'm in a very similar situation to you and feeling the burden of responsibility. My Dad was diagnosed late Dec 23 with advanced prostate cancer, with extensive bone mets. He's previously a very fit and active 70yr old. He was slightly mismanaged on diagnosis (very long story) so, although his Urologist advised he had a Gleason Score of 10, his Oncologist advised that the biopsy could not be considered accurate as he had already started hormone treatment. 

I had done by own research and spoken to the very patient and knowledgeable nurses from this site, so was adamant that I wanted him to have triplet therapy. However, like your Oncologist, ours very much did not think the evidence to support Triplet therapy outweighed the risk of chemo. My Dad was having to self-catheterise frequently throughout the day at this point, so obviously at increased risk of infection and sepsis etc. My Dad really didn't want to have the chemo and I didn't want to push him.

My Dad did respond well initially and his PSA fell significantly, however, after 8 months his PSA began to double and we've now been advised he is castrate resistant and he has just started chemo. The good news being he appears to be relatively pain free, despite disease progression and is managing chemo well. 

It's all just a minefield and I'm just so grateful for this site.

User
Posted 22 Oct 2024 at 17:55

Exactly and my Dad is staying very positive so we're following his lead. I keep telling him he needs to stay as healthy as possible for as long as possible because he's my unpaid PA and does a lot of grandparenting 😍.

I know deep down we went with the right choice. I firmly believe that if they felt one particular option or treatment would give better outcomes they would be advocating for that. I obviously can't help but wonder if we'd gone for triplet therapy first whether we would have had less progression, but then he could quite easily had had a really nasty infection and been very unwell from that. I have always found when I get very overwhelmed giving the nurses a call on here is very helpful. They're so knowledgeable and calming.

 

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User
Posted 19 Oct 2024 at 06:51

Morning Deb.

I'm sorry to hear about your dad's condition, but lovely to see you are doing your very best to help him. Welcome to the forum. 

I have no experience of the treatments but this link may help.

https://prostatecanceruk.org/prostate-information-and-support/treatments/apalutamide

Your enquiry is quite specific, there won't be many on here who feel qualified to respond. You may get better help and support from the specialist nurses.

Edited by member 19 Oct 2024 at 06:54  | Reason: Additional text

User
Posted 19 Oct 2024 at 08:01

You can read the side effects of all the medications online I’m aware apalutamide may affect his heart condition. I’m not too sure about the others. What I did was to look at all the side effects with my husband before we decided which medication would be best. I hope this helps. 

User
Posted 22 Oct 2024 at 13:20
Hi Deb

I was on Apalutamide for two years from February 21 after being diagnosed in Oct 2020, with a PSA of 384. Coupled with Zolodex injections every 3 months. Apart from fatigue and some low moods it seemed to work very well.

I came off it in February 2023 with PSA untraceable and haven't had any further medication, PSA is still only 0.8 and feel as well I've ever done.

Good luck with everything.

Regards, Stuart

User
Posted 22 Oct 2024 at 14:46
If you want the best chance of a long remission it's probably best to go for the triplet therapy up front.

Regarding suitability for treatment I would hope your oncologist is taking that in to consideration. They should be advising you on the risks associated with the treatment options.

User
Posted 22 Oct 2024 at 16:06

Thanks everyone, it's all been a bit overwhelming and a lot of information thrown at us all at once. With none stop appointment after appointment but that is definitely a good thing!

Regarding the treatment choices, the CNS and oncologist said it was our choice and simply gave us a few leaflets which explained what each drug was and listed side effects...

When I asked which they would recommend or which had the better success rate we were told there wasn't any evidence comparing the two, and both had performed quite well. They said it had to be our decision and couldn't say which to choose.

I've done so much reading but cannot find a study comparing the 2 options, so my dad has decided to go for the Apalutamide option as the side effects appear much less than the chemo, unless I told him to do otherwise after researching. I am just so worried that I could be responsible for him making the wrong choice. But if he feels this is the best option for him at this time I'll go with that and I can see some success stories on here with Apalutamide, he's tolerating Prostap really well so far and says his pain is much less.

User
Posted 22 Oct 2024 at 16:34

Hi, I just wanted to reach out and say I'm in a very similar situation to you and feeling the burden of responsibility. My Dad was diagnosed late Dec 23 with advanced prostate cancer, with extensive bone mets. He's previously a very fit and active 70yr old. He was slightly mismanaged on diagnosis (very long story) so, although his Urologist advised he had a Gleason Score of 10, his Oncologist advised that the biopsy could not be considered accurate as he had already started hormone treatment. 

I had done by own research and spoken to the very patient and knowledgeable nurses from this site, so was adamant that I wanted him to have triplet therapy. However, like your Oncologist, ours very much did not think the evidence to support Triplet therapy outweighed the risk of chemo. My Dad was having to self-catheterise frequently throughout the day at this point, so obviously at increased risk of infection and sepsis etc. My Dad really didn't want to have the chemo and I didn't want to push him.

My Dad did respond well initially and his PSA fell significantly, however, after 8 months his PSA began to double and we've now been advised he is castrate resistant and he has just started chemo. The good news being he appears to be relatively pain free, despite disease progression and is managing chemo well. 

It's all just a minefield and I'm just so grateful for this site.

User
Posted 22 Oct 2024 at 17:01

Hi Becky, it is a minefield and it's the short space of time you're given to make the choices.

I'm glad your dad is responding well to the chemo and not suffering badly with the side effects. I think one of the things my dad is struggling with is that he said recently he's never really gone to the doctors much and now it feels like he's there or the hospital weekly! He seems pretty set on giving the hormone therapy a go and like you, I don't want to push but I also want the best for him. Suppose all I can do is like you make sure I support him through this and whatever is thrown at us ❤️

User
Posted 22 Oct 2024 at 17:55

Exactly and my Dad is staying very positive so we're following his lead. I keep telling him he needs to stay as healthy as possible for as long as possible because he's my unpaid PA and does a lot of grandparenting 😍.

I know deep down we went with the right choice. I firmly believe that if they felt one particular option or treatment would give better outcomes they would be advocating for that. I obviously can't help but wonder if we'd gone for triplet therapy first whether we would have had less progression, but then he could quite easily had had a really nasty infection and been very unwell from that. I have always found when I get very overwhelmed giving the nurses a call on here is very helpful. They're so knowledgeable and calming.

 

 
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