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Treatment choices clearer for men with mets starting ADT


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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


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Jim - nice summary of what's become a complex area!


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