Too late for Chemo, now Apalutamide?

Hello Chappy123 . There is a protocol called Triplet Therapy which is a combination of the hormone injection, a second generation antiandrogen such as Darolutamide or Enzalutamide, plus chemotherapy Docetaxel - this protocol achieves the optimum results if the combined chemo and second generation antiandrogen are started concurrently within 12 weeks of first starting hormone therapy. From my husband's experience he was given chemotherapy 3 years after being diagnosed following a recurrence and will soon be starting another course 16 months after completing his last course for a progression so basically chemotherapy can be given at any time but it doesn't seem to be as effective when administered after a recurrence or progression. As for Apalutamide there has been a recent publication which reports from the TITAN trial that it offers considerable benefit for men with multiple bone mets when given for hormone sensitive prostate cancer (newly diagnosed).

https://urosource.uroweb.org/resource-centres/EMUC24/261000/abstract

I was not aware of a time limit on radiotherapy as it is used in both the curative and the palliative setting - my husband had 33 sessions of EBRT to the pelvic area when first diagnosed in July 2020, had 5 sessions of SBRT in April 2024 to the upper abdomen and is probably having more targeted radiotherapy next week to a bone met in the femur. How metal implants would affect radiotherapy I don't know and is something you need to ask the experts but I should think it depends on where the metal is.

I am sure others will be along with their experience but please feel free to ask any questions.

Really appreciate this reply has given me a lot to think about. Radiotherapy isn’t definitely off the cards but Oncology are in discussions with with the Spinal team. I visit Infectious Diseases next week so hopefully they may add some clarity.

Sorry to hear your husband has had such a tough time.