Comparing the Second Generation Hormone Therapies | Ask a Prostate Expert, Mark Scholz, MD
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- čas přidán 9. 07. 2024
- As of early 2021, the FDA has approved four second-generation anti-androgen mediations: Zytiga (abiraterone acetate), Xtandi (enzalutamide), Erleada (apalutamide), and Nubeqa (darolutamide). Here, Alex asks medical oncologist Mark Scholz, MD, how these medications work and how they compare to one another, especially regarding side effects.
0:05 How exactly do second-generation anti-androgens treat metastatic lesions?
1:33 What are the possible side effects of the four second-generation anti-androgens? How do they compare?
3:06 Are any of the four second-generation anti-androgens more appropriate than the others for men with heart problems?
3:56 What are some ways to mitigate the side effects of second-generation anti-androgen medications?
5:01 How do second-generation hormone therapies tend to affect PSA?
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When I first went on lupron I could feel some fatigue, but it wasn't too bad. Once I became hormone resistant my urologist put me on erleada. I felt no further fatigue by going on erleada (still on lupron). After about a year my PSA started slowly rise and my urologist referred me to an oncologist that put me on chemo. When my PSA wasn't coming down fast enough my oncologist referred me to a nuclear doctor that gave me six cycles of pluvicto (lutetium-177). Upon completion of my pluvicto treatment my oncologist put me on xtandi instead of erleada, he said the reason was that I was on blood thinner -- and that there was some kind of interaction between my blood thinner (xarelto) and erleada. Now I've noticed a marked increase in fatique since being on xtandi. I've been taking my xtandi tablets in the morning but I'm going to switch to taking the tables in the early evening, hoping that the brunt of my fatigue takes place while I'm sleeping. When I next see my oncologist I'm going to tell him about my fatigue and see if he can switch me to nubega since Dr. Scholz says it doesn't cause fatigue.
When you post a video its great my knowledge keeps growing! 👍🙏
Another great video....Keep them coming, please and thank you...
Thanks. Another great video and very informative. A like the humour on naming Hunter.
Quick correction: in the on-screen blue dialig box from 0:44 to 0:57 it includes Zytiga as a hormonal agent which blocks androgen receptor activity. Yes & NO! Zytiga is a sex hormone synthesis inhibitor, not an androgen receptor blocker like Xtandi, Erleada, and Nubeqa (and Casodex etc. before).
Another idea for patients that do not respond to Enza: First try to knock the PSA down low with maybe a PSMA-RL therapy, which seems that it is fairly often quite effective. Once that is done, as the PSA maybe even under one again, retry the enza? The basic question is... if someone doesn't respond to enza maybe because they tried it too late, if they have success with another therapy, might it make sense to retry it?
Thanks for your great video ! I am 74 and currently on a 3-monthly Eligard injection. I had radio therapy nearly a year ago, but recently my PSA has risen again to 12. My oncologist has recommended Darolutamide (Nubeqa), starting soon. I’ve had gynocomastia (breasts) since puberty. Is there any link between gyno and susceptibility to prostate cancer ? My late dad had prostate cancer too, but died at almost 78 from a rare type of leukaemia - probably from his visit to Hiroshima in late ‘45 during his service with the Australian Navy Occupation Force in Japan. Kym (74) in Darwin, Australia - where Royal Darwin Hospital has the modern Alan Walker Cancer Centre - with free treatment under our Aussie Medicare scheme. Nubeqa (Darolutamide) is free under Australia’s Pharmaceutical Benefits Scheme (PBS) but there’s a prescription fee of $30 or just $7.70 if you’re over 65.)
Can you give an overview about the combination of Relugolix With definitive radiation Therapy. Thanks!
Been on Lupron for 3 months and am only having moderate hot flashes.
Just curious, can you start using these "second generation hormone treatment drugs" if you have previously been on Zoladex too, or just if you have been on Lupron? Thanks in advance! 😄
How long do you need to wait to see if it is working? My Dad took enza for 2 months and didn't see his PSA fo down so they stopped it and restarted doce.
I really hate his doctor. I KNEW that you need to start 2nd gen early for the best chance to work. I told him that and he just ignored this and proceeded to wait until psa was up to 8 before starting. Grrrrrrrr
my psa is 1600, gleason 7s and two 8s; how do i choose initial treatment
I would like to ask why the removal of the Testes is not discussed as a treatment method. This would remove Testosterone from the patient without some of the side effects associated with the drugs. What are the percentages of Trans individuals that have had a surgical change from male to female that go on to experience Prostate cancer? Has a study been conducted?
side effects arent from the drugs
There is a trial that shows a greater efficacy of combining a couple of 2nd gen hormone blockers and docetaxel together. I am curious... would a doctor that practices standard of care be able to do this if the patient requested it? Maybe not 2 2nd gens, but perhaps one and docetaxel together? I read that there is some sort of synergy between the spindle interference of docetaxel and the 2nd gens.
Our helpline might be able to help with your questions. You can find our contact info here: pcri.org/helpline
@@ThePCRI Jonathan is a great guy, but I think this is more of a question in response to this video. Dr. Scholz said that 2nd gen works better when PSA is low. The question is: does that carry through to a situation where the patient can "reset" the PSA with another therapy, say PSMA RL?
Also: here is a tip for another video, perhaps. A video about treatment related Neuroendrocrine prostate cancer. Apparently this happens to a sizable portion of men whose cancer stops responding to the 2nd gen hormone blockers.
Thank you
If I’m on Zytiga for last 11 months and PSA is now down to 0.02, should I switch to Nubeqa? I have high BP and have a history of cardiac ailment in the family. Thanks
Our helpline might be able to help you with that question. You can find the contact info here: pcri.org/helpline
Equal efficacy across the four , subtle toxicity difference. Not so subtle differences in thought leader incentives: Monthly costs : aberaterone $150, Nubeqa: $13 000, Xtandi $13000, darolutamide $11 500. I'd stick to aberaterone.
Abiraterone is the most commonly used medication in that setting because there is the generic available that is so much cheaper, but there may be a specific reason why a doctor may want to try one of the other ones instead, for example, if the abiraterone causes a strange side effect in someone that is not related to having low testosterone, then the person's physician may want to try a different medication to see if it makes that side effect go away.
In these cases, the companies that make Nubeqa, Xtandi, and Erleada all have financial aid programs for people making under a certain amount (generally its around $130,000-$140,000 for a household, but it varies) that will cover the most or the entire cost, but there are other rules to qualify, for example, you must have private insurance.
if you have radical prostatectomy. with Gleason 6 on one side and 9 on the other with psa 19.Post surgery psa .9 .Getting ADT Elegard. Will start radiation therapy plus zytiga for sclerotic lession in pubic bone area..Should the person be concerned with side effects?
Hello,
Feel free to contact our helpline if you would like more information at pcri.org/helpline, but we also have these videos discussing the side effects of salvage radiation and hormone therapy.
Video on side effects of salvage radiation: czcams.com/video/63Pu5HjYLyM/video.html
We have several videos on the side effects of hormone therapy, but this one is most comprehensive: czcams.com/video/efza9vq-cg8/video.html
You talk about Lupron quite a bit but hardly mention Firmagon which is what my Urologist prescribed. Why would Firmagon be recommended over Lupton?
In this context, "Lupron" is just being used as shorthand for any luteinizing hormone-releasing hormone (LHRH) agonist (Firmagon, Lupron, Trelstar, Eligard, etc.)
Got a question on this video.....how long is it before patients have to have second generation hormone treatments on average after first generation hormone therapy! Thank you!
The other night I rubbed my stomach and I felt a really shocked prick felt like I was being stabbed with something small anyway I couldn't see anything so I grabbed my camera turn the flashlight on it and I blew up the area where I was being poked once I got the light on it I can see that there was something very tiny fine like a couple of strands of here but very strong I'm sticking out of my stomach I'd say about 2/16 of an inch I grabbed the hold and I pulled on it and it wouldn't come out and it was in there very strong so I proceeded the pull on it I got it out of my stomach it was on the top of my skin I put it on the mirror and I put the camera on it soon as the camera got side of it it jumped up as a second generation hormone Crystal very powerful this color was green and yellow clear I can see something in it it almost looked like it was a cylinder of some salt and it came up noncastrative cancer prostate cancer now I myself am unaware of any cancer never have gone to see a doctor about any cancer why would I find this on my skin sticking out of me I'd love to get some answers on this because anybody that I've asked they think I'm crazy as I said this is a very fine Crystal and I can absolutely see in it like there was some type of mechanisms in it should I be worried because it came up not castrated prostate cancer now I've never even checked before never mind medicated for anything like that
Been taking Xtandi for 3 months and I don’t notice any side effects whatsoever.
good luck getting a man on andro deprivation to weight train...not going to happen. muscle mass cannot be increased on andro deprivation.