This complete guide to Bipolar Androgen Therapy (BAT) should be your stepping-off point if you are interested in using BAT to treat your castrate-resistant prostate cancer (CrPC).
Several men have asked us if they are better off having 177Lu-PSMA-617 (Pluvicto) or Xofigo, a radiopharmaceutical drug that treats bone metastases. There is no simple answer, and the answer is not the same for each of us. Making a sound decision can be helped by understanding the mode of action and the limits of each treatment.
LYNPARZA (olaparib) and RUBRACA (rucaparib) are PARP Inhibitors that were FDA approved in May of 2020 for men with castrate resistant prostate cancer who also have certain genetic mutations. The FDA also approved certain Companion Diagnostic genetic tests to go along with the decision making to use these PARP Inhibitors.
There is a lot of information now available with these recent developments which makes decision making confusing.
There are several possible side effects that can result from receiving radiation treatment. The most common of these side effects include the development of scar tissue that makes it hard to urinate (pee), defecate (poop), and in some instances, link the activity of either peeing and pooping together; bladder or colon bleeding and diarrhea.
Abiraterone, enzalutamide, apalutamide, and docetaxel could be considered for this patient population (castrate sensitive prostate cancer patients), noted Taplin. "None of us can [confirm] that one [option] is better than the other; [the treatment decision] needs to be individualized [by weighing the] pros and cons [with each agent] for each patient," Taplin concluded.
Prostate cancer treatments, particularly hormone therapy (ADT) can have a significant effect on speeding up the process of thinning and weakening the bones. There are some available treatments (Zoledronic acid aka Zoladex and denosumab aka Xgeva) which are designed to slow down or reverse this process; however, they are known to have many adverse side effects themselves. These side effects can include severe fractures of the femur which could limit survival and cataracts. For this reason, these treatments are usually used later, when men become castrate resistant and metastatic.
The European Medicines Agency (EMA) has recommended that the use of Xofigo (Radium-223) be restricted. The restrictions, because of safety and efficacy concerns in men with castrate resistant prostate cancer (mCRPC), include that Xofigo can be used only after two other treatments have been taken; when other therapies cannot be used and not in combination with other 2nd line hormone therapies.
Initially being diagnosed with metastatic, or advanced prostate cancer is not great. Metastatic prostate cancer is not curable and will be terminal if you don’t die from another cause.
We now have a number of what we consider second-line treatments for prostate cancer, drugs like Zytiga, Xtandi and Taxotere (chemotherapy).
We are beginning to recognize the value of the early use of these second line drugs along with first line ADT for men who are initially diagnosed with metastatic prostate cancer.
Since abiraterone acetate (Zytiga) was approved for men with metastatic prostate cancer, it is well known that taking the drug with food in your stomach as opposed to having an empty stomach enhances the amount of drug that becomes active. Given the very high cost of Zytiga, many men have been tempted to take fewer pills along with a meal.
