What's after H

Hello Amanda (AFLMF) 

The first question has many answers. It's normal to be given a 1st generation HT product such as Prostrap, Zoladex and Decapeptyl. These work for most people - sometimes forever sometime the body becomes "Hormone Resistant" and they stop working.

The newer 2nd generation HT products are Abiraterone, Apalutamide, Darolutamide and Enzalutamide. Sone of these have only just been made available in the UK as NICE were unhappy at the cost.

I am sure someone (hello Alwayshope) will post to give us the technical details between the two as it's beyond me but I must admit i am interested myself.

Best wishes - Brian

Hi Amanda.

The second generation drugs are Enzalutamide, Abiraterone, Aptalutamide and Darolutamide. They are all very effective. Which one your husband is put on is down to the experts and can work for anywhere between months and years. It all depends on how the cancer reacts to them. They are usually used to control the cancer initially and shrink it, making the radiotherapy or chemotherapy more effective. How long your husband will stay on them is determined either by how long they continue to be effective or, if the PSA comes down to a very low level after chemotherapy or radiotherapy, then they may be stopped as long as it stays there. The injections/implants reducing the testosterone level usually works for many years and these are the ones which give the most side effects.

Bicalutamide is the first generation of antiandrogens, the second generation work a lot more strongly by blocking the testosterone from binding to the cancer cells thus starving it of its food. The injections/ implants work by stopping the actual production of testosterone.

For anyone interested I have attached a link to the evolution of antiandrogens.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8977476/

Hi Amanda (AFLMF ), I have been on Zoladex (first gen HT) for 7 years.  Just starting to loose its effectiveness with me.  Darolutamide will be next for me (in addition to Zoladex).  Best wishes. David

Thank you,.that's really helpful x

Thanks, really appreciate your.reply x

Thanks

This is really helpful x

Thanks for this David

Very helpful 

Good.luck with the next step

X

I have been delving into how the different hormone therapies work - thanks Millibob  Brian, you set the nerd in me off. In particular Abiraterone works in a different way to Enzalutamide, Aptalutamide and Darolutamide. Abiraterone affects a specific metabolic pathway CYP17 which can also stop testosterone production and this has led to research into producing new drugs which seem to have less effect on the heart, liver and kidneys so ones to watch out for in the future. Different modes of action may make it possible to sequence types of hormone therapies when the first one stops working which is particularly important for those who are on the treatable but not curative pathway. This then got me thinking about food and food supplements which act in a similar way on these metabolic pathways and how they interract with medication e.g. grapefruit and Seville oranges (marmalade) are contra indicated if you have chronic kidney disease or are taking blood pressure tablets amongst other things. Thujone (found in some sage, mint, rosemary...) can affect kidney function. Some supplements can affect how well prescription drugs can work by either increasing or decreasing their effectiveness through this metabolic pathway, and sometimes to a dangerous level, therefore, it is important that we let the doctors know of all supplements that we propose to take.

I somehow thought there may well be more information forthcoming.

It's better than sitting in the sun eating ice cream and drinking coffee.

Thanks very much (and for the original post above) - Brian.