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Treatment options, advice please😊

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User
Posted 30 Aug 2025 at 08:57

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Questions about potential treatments for PC with widespread bone mets...

https://community.macmillan.org.uk/cfs-filesystemfile/__key/communityserver-components-imagefileviewer/communityserver-components-avatars-00-00-34-09-24/4UQRZTB6HQTO.jpg_2D00_126x126x2.jpg?_=638891146818949121

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I have posted a few times over the last few days and thank you to those who have already given some really valuable advice about treatment options......but we need more!!!😊.....so our options are - 

1. Stay on Degarelix only (he will be on this for life)

2. Take Degarelix and add either abireratone, Enzalutamide or Apalutamide

3. Triplet therapy - Degarelix, darolutamide and docetaxel.....

My bio has all relevant details.

Triplet therapy seems sensible, hit this hard and fast but it doesn't mean its the right choice at the moment, we know chemo will be in the toolkit for later if needed. 

Paul is leaning towards option 2, he has had a great response to the Degarelix with minimal side effects, he doesnt want to be hammered by chemo but equally doesnt want to miss out on the triplet therapy🤦🏻‍♀️ we do know that the chemo can be well tolerated too but I understand his worries. 

Any advice would be greatly appreciated, you guys are living through this and your views are more important to us than the masses of research and information out there♥️

Edited by moderator 30 Aug 2025 at 09:04  | Reason: copy and paste was confusing

User
Posted 30 Aug 2025 at 09:26
Hi Polly1912. I just want to add in a viewpoint I have been thinking about. My OH has always refused any chemo and he quite rapidly moved to metastatic castrate resistant prostate cancer (mCRPC) after radiation treatment. He was put on Abiraterone for 7 months but was primary resistant to that, his PSA kept rapidly rising. A PSMA PET CT scan showed where the active castrate resistant bone mets were and from Jan 2025 when a CT scan showed the 4 original mets with just one met on T6, by July he had mets on T2 through to T7. Reading various research papers I think there can be a situation where the total absence of all testosterone due to Decapeptyl and Abiraterone encourages the castrate resistant cancer cells to either produce their own testosterone or to find a way to grow without it. If that is the case the triplet treatment to throw everything at it seems a sensible way to go if you are prepared to put up with the chemo. At nearly 80 my husband still won't.

Good luck with your decisions.

User
Posted 01 Sep 2025 at 08:27

Great news about the PSA drop so far.  I faced a similar choice almost 3 years ago - except that daralutamide wasn't available on the NHS then. 

I chose option 2, specifically enzalutamide. I've been lucky in that so far it has kept my PSA <0.1.  it's not a pleasant drug to take particularly to begin with. But as others have said fatigue and lack of sex drive are the two most obvious long term effects. Some evidence suggests that daralutamide might have slightly fewer side effects.

https://www.europeanurology.com/article/S0302-2838(23)02814-2/abstract

Evidence suggests life expectancy is shorter with option 1. It's a more difficult choice between options 2 and 3. Depending on whether you want to go aggressive with docetaxel now or keep it for 2nd line therapy later. 

Best wishes

Will

 

 

 

 

User
Posted 01 Sep 2025 at 08:51
Hi Claire, if he's relatively fit for his 56 years take Option 3 and throw the kitchen sink in to flatten it. Great news his PSA has reduced so quickly so he appears be responding well to treatment offered thus far.
User
Posted 01 Sep 2025 at 09:52

Hello Schubert, it such as difficult choice, be easier if his team just made the choice for him! 

He is swaying towards option 2, whatever he decides it will be the right decision.....watch this space! 

I hope your and your OH are doing the best you can be♥️

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User
Posted 30 Aug 2025 at 09:26
Hi Polly1912. I just want to add in a viewpoint I have been thinking about. My OH has always refused any chemo and he quite rapidly moved to metastatic castrate resistant prostate cancer (mCRPC) after radiation treatment. He was put on Abiraterone for 7 months but was primary resistant to that, his PSA kept rapidly rising. A PSMA PET CT scan showed where the active castrate resistant bone mets were and from Jan 2025 when a CT scan showed the 4 original mets with just one met on T6, by July he had mets on T2 through to T7. Reading various research papers I think there can be a situation where the total absence of all testosterone due to Decapeptyl and Abiraterone encourages the castrate resistant cancer cells to either produce their own testosterone or to find a way to grow without it. If that is the case the triplet treatment to throw everything at it seems a sensible way to go if you are prepared to put up with the chemo. At nearly 80 my husband still won't.

Good luck with your decisions.

User
Posted 01 Sep 2025 at 08:27

Great news about the PSA drop so far.  I faced a similar choice almost 3 years ago - except that daralutamide wasn't available on the NHS then. 

I chose option 2, specifically enzalutamide. I've been lucky in that so far it has kept my PSA <0.1.  it's not a pleasant drug to take particularly to begin with. But as others have said fatigue and lack of sex drive are the two most obvious long term effects. Some evidence suggests that daralutamide might have slightly fewer side effects.

https://www.europeanurology.com/article/S0302-2838(23)02814-2/abstract

Evidence suggests life expectancy is shorter with option 1. It's a more difficult choice between options 2 and 3. Depending on whether you want to go aggressive with docetaxel now or keep it for 2nd line therapy later. 

Best wishes

Will

 

 

 

 

User
Posted 01 Sep 2025 at 08:51
Hi Claire, if he's relatively fit for his 56 years take Option 3 and throw the kitchen sink in to flatten it. Great news his PSA has reduced so quickly so he appears be responding well to treatment offered thus far.
User
Posted 01 Sep 2025 at 09:45

Hello Will, thanks for replying. When were you diagnosed? I think the consensus is to chuck everything at it, hard and fast but having looked into it so much more, its just not that easy! Paul is definitely swaying towards option 2, his decision will be the right one. 

Good to hear you are responding well, long may it continue🤞🏻♥️

Edited by member 01 Sep 2025 at 09:45  | Reason: Not specified

User
Posted 01 Sep 2025 at 09:49

Hello Jasper, it is great he is responding well so far and when he was diagnosed we really hoped to be offered triplet therapy, then it was taken off the table but following all his other tests and after meeting with oncologist, she decided that he was a good candidate for triplet therapy, however, she is no way sold it, she was definitely swaying towards option 2 and this was for the same reasons as why it had been offered, because he is so well and chemo could change that! No wonder we are confused! 🤷🏻‍♀️

User
Posted 01 Sep 2025 at 09:52

Hello Schubert, it such as difficult choice, be easier if his team just made the choice for him! 

He is swaying towards option 2, whatever he decides it will be the right decision.....watch this space! 

I hope your and your OH are doing the best you can be♥️

User
Posted 01 Sep 2025 at 10:37

Originally Posted by: Online Community Member

Hello Will, thanks for replying. When were you diagnosed? I think the consensus is to chuck everything at it, hard and fast but having looked into it so much more, its just not that easy! Paul is definitely swaying towards option 2, his decision will be the right one. 

Good to hear you are responding well, long may it continue🤞🏻♥️

 

I was diagnosed in September 2022. I think you're right that consensus is moving towards triplet therapy. I'm not sure that that is based on any hard evidence directly comparing options 2 and 3.  Rather a view that more intensive treatment early while the body is strong might have the best long term outcomes? 

I certainly wouldn't recommend against option 3. I have a friend in the States who was diagnosed more recently and had triplet therapy and who is also doing well. 

 

Best wishes

 

Will

 
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