JimJimJimJim Posted August 3, 2019 Share Posted August 3, 2019 Jim Marshall (not a doctor) said ... Some men are metastatic when they begin hormone therapy (ADT) We say these men have metastatic, hormone sensitive prostate cancer (mHSPC for short). In the video linked to below, Christopher Sweeney, Professor, Medicine, Harvard Medical School, Dana-Faber Cancer Institute explains that the 3rd-year results of the ENZAMET clinical trial he is leading makes advising men on the appropriate treatment clearer. Firstly, whether there are a lot of mets or not, every man should have both at some time in their treatment: Chemotherapy with Docetaxel: and One of Enzalutamide, Apalutamide, Abiraterone. If a man has high volume disease: Fit for chemotherapy (and not unnecessarily afraid - 'chemophobic'): Start with ADT and Docetaxel chemotherapy Unfit for chemotherapy (or unwilling): Start with ADT plus one of Enzalutamide, Apalutamide, Abiraterone. If a man has low volume disease: Start with ADT plus one of Enzalutamide, Apalutamide, Abiraterone. When PSA is no longer under control, change to ADT plus Docetaxel chemotherapy. So far the trial has found, at the three-year mark, no strong benefit to having the triple therapy some men had on the trial: ADT + Docetaxel + Enzalutamide, but more side effects. That may change with more time. In Australia as of 4 August 2019, the favoured treatment for high volume chemo-fit men is covered by the PBS. The favoured treatment for low volume men is available, but not covered by the PBS. Submissions have been made by vendors to have this PBS coverage. Other names: Enzalutamide - Xtandi Abiraterone - Zytiga Apalutamide - Erlyand® in Australia, Erleada® in USA High volume disease - Having 4 or more bone mets, at least one beyond pelvis and spine, and/or non-bone mets only in lung or liver. ... end Jim The article is not on this site. If you click on the link, you will be taken to a site where we do not control the content. So, please be careful about what you read there, and ask your doctor about anything you read. You may need to subscribe to the site to view the article. If the site is temporarily or permanently unavailable, you may receive an error message. https://www.urotoday.com/video-lectures/asco-2019/video/mediaitem/1323-embedded-media2019-06-05-12-20-36.html?utm_source=newsletter_6829&utm_medium=email&utm_campaign=contemporary-management-strategies-for-hormone-sensitive-prostate-cancer Link to comment Share on other sites More sharing options...
alanbarlee Posted August 4, 2019 Share Posted August 4, 2019 Jim - nice summary of what's become a complex area! Alan Link to comment Share on other sites More sharing options...
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