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Abi now, or maybe enzalutamide later

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Prostate Cancer
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Posted 7/7/2017 12:01 PM (GMT 0)
No metastases (see signature), after six months firmagon PSA running 0.02/0.03. Seems, maybe due to Latitude and Stampede, that my insurance now covers abiraterone (not to say it isn't still pricey). I hesitate to jump in because
1) most seem to prefer enzalutamide over abiraterone, and I assume I will become metastatic at some point and insurance will cover it.
2) the deeper I get into ADT now, the less likely I will qualify for clinical trials for apalutamide, darolutamide, and other stuff that some thinks holds great promise.
My doc is generally for this move. [He ran the local branch of a trial matching firmagon, firmagon+abiraterone, and abiraterone arms for ADT naïve patients, but those results are not yet available.]
Should I jump into abiraterone? Thank you for your thoughts
Posted 7/7/2017 5:05 PM (GMT 0)
You are having a really excellent response to Firmagon. The STAMPEDE trial included some men who were not metastatic and a few with recurrent PC. Abiraterone did not increase overall survival in either of those groups. It did extend failure-free survival, however. The other thing worth thinking about is the added toxicity: Grade 3-5 adverse events went up from 33% to 47% when abiraterone was added. I think both points you make are very valid considerations.
Posted 7/7/2017 6:02 PM (GMT 0)
My indebtedness to Tall Allen grows by the day--what an extraordinary grasp of the subject.
I do not consider the PSA readings of .02, .03 etc. to be "really excellent" in that my first (brief) round with Firmagon saw my PSA go to undetectable and stay there while I was castrate.
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