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Is Apalutamide a possible next step?

Mark smith

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Jim , I have been silent observer of your network for sometime and have recieved a great deal of information and support from your posts. Thank you. 

My PC journey started some 9 yrs ago at 50 yo. 
I have had radical Prost , external beam / stereo tactic radiation , chemo bladder and part colon removed , Zytiga etc etc 

PSA going up now .45 to .75 still low but ‘ there is movement at the station ‘ and the beast is back. 

What’s your knowledge of Apalutimide and its approval in OZ ? When might it be approved or is it a $10,000 hit per month . 

Any articles or references to articles appreciated . 
Just getting my ducks in a row before I see Medical Oncologist 

Good luck and keep up good work 


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Apalutamide has only been trialed for the: "treatment of non-metastatic castration resistant prostate cancer in combination with androgen deprivation therapy".

Sorry, this is not where you are.


As a guide to others: Apalutamide is quite like Enzalutamide. PBAC is currently considering a proposal by the company to list it on the PBS. First applications do no usually get approved, but they begin a negotiation on price.


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Jim , so no options left ? 

Just throw some hopefuls at it ? Chemo , Lutetium , immunology 
Any structured treatment plan you are aware of ? 
Or with Hormone Resistant Metastic Prostate 
Cancer we are at end of formal treatment regime ? 
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Hi Mark,


It would be good to know what your original Gleason Score was at RP, and what recent imaging is telling you (ideally a PET/CT scan with gallium 68-PSMA) . As you point out, your PSA, while rising, is still low - but as you also say, now is a good time to explore possible options for further treatment. If the PSA shows continued serial increases, there are a few possibilities that you may want to explore.


My first thought is to discuss with your medonc a re-run of docetaxel (Taxotere), or trying cabazitaxel (Jevtana) a second line chemotherapy that is often effective when docetaxel fails. Both of these are on the PBS list 


Have you looked at radium 223 (Xofigo) - specific for bone metastases - which finally is very likely to be subsidised early in the New Year. The current trial another radiopharmaceutical - lutetium 177-PSMA 617 (the TheraP trial) - is showing great promise, and may be worth checking out. 


You might consider raising with your oncologist the possibility of gene tests for somatic (or possible germline) BRCA1/2, ATM or mis-repair mutations ( a 25% possibility with heavily treated patients), for which a PARP inhibitor like olaparib (Lynparza) could be beneficial.


There is a similar possibility that your cancer may have progressed to a small cell neuroendocrine version, in which case combination treatment with a platin might be considered. (Note that this variant is usually accompanied by low PSA).


There is a small (10-15%) cohort of advanced guys who respond to immunotherapy - especially the PD-1 inhibitor pembrolizumab (Keytruda) - which. There are a number of clinical trials going on that are investigating combinations of this approach with other treatments, with a view to lifting the success rate..


As you can see, there  are many pathways that your disease might take - and an equal number of weapons that are becoming available to deal with them. We advanced guy are lucky to be living in a period when there is so much good news coming out of prostate cancer research.


Best wishes,



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It would be of interest for us to be aware is specifically what medications are your currently prescribed and in what doses.  With that information we know not to suggest what is already in place, or may know of medications that might prove effective to be discussed with your treating physician.


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I hope you have not been distracted by side issues.

The earlier post by Alan Barlee contains words of wisdom.

In particular:

  • if docetaxel chemotherapy held the disease at bay for some time, it will often do so again.
  • Cabazitaxel chemotherapy will often work when docetaxel chemotherapy no longer works.

I would be happy to chat to you on the phone. 

Just leave a message on my answering machine.

Phone number is the last thing on JimJimJimJim.com.

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You are welcome to start a discussion on Cannabis oil or whatever with high quality information, but not in this posting, which is about Mark Smith's question.



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