Apalutamide & chemo advice

Hi CCG.

Yes I am currently on Apalutamide and I suffer with hot flushes and fatigue and increase in belly weight gain 

We have already got a blood pressure monitor and I do use it from time to time but everything is always fine.

My cancer is also in my bones and my consultant seems to be happy in leaving the chemo in my back pocket for the time being as my PSA has dropped so much since I started the HT.

He has also told me that I might not be strong enough to have the chemo currently??

This is due to my Stroke that I had in 1998 at the age of 32. 

To be honest 12mnts down the line from diagnosis I still feel as strong!!!!

Prostate Worrier.

Hello CCG .

Your dad has a plan now and I will try and answer your questions.

1. From my husband's experience with Prostap (injection) and Enzalutamide (2nd generation antiandrogen) the side effects came mainly from the Prostap and were not really made worse by the Enzalutamide. Your dad hasn't been on Zoladex for that long so he may or may not find that he suffers more as time goes on but he is working to ameliorate them by exercising.

2. With the blood pressure, I take and record my husband's once a week. This will give him a baseline of what his is. What we have found is that there is some variation summer to winter but only slight and his BP has remained stable apart from when he was on chemotherapy (I recorded the BP twice a day). Some HT treatments can raise the BP but this should not be a problem provided it remains within the guidelines for his age and provided it doesn't show any irregular beats - a good quality cuff machine should give you an indication of this. Occasionally a treatment can cause a drop in BP which can also be a problem.

3. A more tricky question. Recent research indicates that starting chemotherapy earlier rather than later can improve overall survival provided the patient is fit enough to take it. What I have done is give you a link to a video by an American oncologist who has produced a series of thought provoking ideas. This one is on bone mets. I think I would confirm with the oncologist exactly how many bone mets your dad has as the video appears to indicate that if he has more than 5 then chemotherapy would be indicated. This video also gives you a good idea on what follow on treatments are available at this time for bone mets.

https://youtu.be/04crGGfIX18?si=uu87OjgrxwrSf5cS

As an adjunct to question 3. I have attached a link to an up to date (2023) analysis of trials involving Triplet therapy which gives definitions of high and low volume disease and when Docetaxel chemotherapy might be used in first line treatment but also note the limitations of the trials to date.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10136811/

Hello CCG,

Further to Alwayshope's responses, I am just starting triplet therapy - my first chemo infusion is being carried out later today. I have started a blog (see tabs at top of page) called Prostate Cancer Recurrence and will be recording my experience as I progress with treatment which might (hopefully) be informative for anyone considering this.

As far as blood pressure is concerned, outside of prostate issues I have had what is called "white coat" blood pressure for about 45 years since a GP first told me I had high blood pressure when I was 22 years old and put me on medication. This just means that my BP is always high when a doctor takes it but is normal at other times, and this has only been fully recognised by doctors in recent years. I now take my own readings on my own machine and provide details to my GP every 6 months. 

If you are buying a machine just make sure it is a recognised and reliable one from a reputable retailer (such as Boots etc.). When starting I suggest taking readings including pulse rate about the same times morning and evening for 7 days and then average the figures out. This should give you an accurate idea of your Dad's regular BP reading, after which you can probably relax to a routine suggested by AH. The 7 day readings are what I provide my GP with at their request.

I wish your Dad all the best with his treatment.

Hi Prostate Worrier, thanks so much for sharing this. Amazing news that’s 12 months down the line you are feeling as strong, keep it up! X

Thank you so much Always Hope, your answers are always so informative and helpful, I learn so much from you!! 
we will defiantly discuss and think about Chemo, the video is great, thanks for the resources. 
take care x

Hey Excavator,

Thanks you so much for this helpful post, I will use the instructions you have shared to keep on top of dads BP. 
take care and thank you again for responding to my post x

I hope everything went well yesterday with the first chemo session. Stay safe.

Thank you very much, it went very well after 3 attempts to insert the cannula (although I have previous experience of that).

I feel remarkably well this morning so fingers crossed, although it's very early days. Anti-sickness meds and steroids end today but they're obviously doing a great job job for now.

Thanks again.

Great news! Fingers crossed for you it stays that way.