Don't Let Prostate Cancer Define You: Bernnie's Story of Strength and Living Well

By Astellas Pharma US, Inc. and Pfizer Inc.

Bernnie, a then 63-year-old active and hard-working construction operator from the South, always considered himself healthy, so when he started feeling nauseated before his morning coffee one day, he thought it would pass. Over the course of a year, he experienced frequent nausea, along with cold sweats and hot flashes, and lost over 50 pounds. He knew something was wrong.

"I didn't want to go to the doctor," said Bernnie, "because I knew it was going to be bad news." In addition to having a swollen leg, his primary care physician discovered a golf ball sized lump on his neck. A biopsy of Bernnie's lymph nodes indicated prostate cancer and he was referred to a urologist.¹ When his prostate specific antigen (PSA) levels – a blood test used to assess for prostate cancer – came back, the numbers were incredibly high.² "My PSA levels were at 12,000, and my doctor said that was the highest he had ever seen," said Bernnie. The lump on his neck turned out to be a tumor, indicating his cancer had spread beyond his prostate. Bernnie was diagnosed with stage 4 metastatic castration sensitive prostate cancer (mCSPC) that day. mCSPC is prostate cancer that has spread to other parts of the body and responds to a hormone therapy or surgical treatment to lower testosterone.³

About Prostate Cancer

About 13 out of every 100 American men will get prostate cancer in their lifetime.⁴ In fact, there are 3.3 million men living in the U.S. today who were previously diagnosed with prostate cancer.⁵ Like some other illnesses, prostate cancer may be easier to treat if caught at an early stage,⁶ and it can be detected by routine screening tests and examinations.² When detected early, surgery or radiation therapy may have the potential to cure the disease.^3,7

However, when diagnosis is delayed – as in Bernnie's case – prostate cancer can spread to other parts of the body. Prostate cancer cells often depend on hormones – also called androgens – to grow.³ When the cancer cells are dependent on hormones, they are called "castration sensitive," because inhibiting these hormones may slow the growth of prostate cancer tumors and cells.⁸

The Journey From Diagnosis to Treatment

"When I heard 'stage 4,' my heart just sank," Bernnie said. "I was prepared to go home and get my affairs in order, wondering how much time I had left." But his doctor did not dismiss Bernnie's case, even though his PSA levels were the highest he had ever seen in his long career practicing medicine. They discussed potential treatment options for Bernnie, including XTANDI^® (enzalutamide), a type of prostate cancer treatment known as an androgen receptor inhibitor (ARi).⁹ Androgens are a group of hormones that include testosterone. ARis, like XTANDI, help decrease how often androgens like testosterone connect with an androgen receptor, and thereby may slow the growth of prostate cancer tumors and cells.⁹ This is how XTANDI was shown to work in laboratory studies. Clinical significance is unknown.

XTANDI is a prescription medicine used to treat men with four kinds of advanced prostate cancer, including mCSPC. This includes patients like Bernnie whose cancer spread to other parts of his body.⁹

XTANDI may cause serious side effects including: seizure, a brain condition called PRES, allergic reactions, heart disease that can lead to death, falls and bone fractures, swallowing problems or choking that can lead to death. Please see more about these serious side effects and Important Safety Information below and read the Patient Information for more information.⁹

Bernnie and his doctor discussed the possible risks and benefits of XTANDI, and he started treatment almost immediately. After he began treatment, he monitored how he was feeling each day and adjusted his schedule as needed. When he was feeling okay, he worked and continued supporting his wife, a breast cancer survivor who also lives with heart issues. Bernnie saw his doctor regularly to check in on his treatment progress and his PSA levels.

Life for Bernnie Now

Bernnie lives on 13 acres of land, and when he is able to, he enjoys outdoor leisure activities like hunting, fishing and cooking. He works part time, spending quality time with his wife and family at their home.

"I don't think like I'm sick," said Bernnie. "I do my best to carry on and take care of myself and my responsibilities. When I visit friends and family, I don't like to talk about having cancer, because I don't want them to worry about me if they don't have to, and I'd rather just enjoy their company."

Bernnie has regular visits with his doctor to monitor his condition and treatment plan. He acknowledges that when he feels tired, he does not fight it – he takes it easy and gives his body a break, and then he is "up and at it again" when he feels rested.

Over the past three years, Bernnie has built a positive relationship with his doctor and encourages those newly diagnosed with prostate cancer to seek out a doctor that they feel they can trust.

A Community Advisor

Thanks to his hopeful outlook, Bernnie's story has become known to those in his hometown and doctor's office. He's always quick to offer support to other patients when asked and encourages others to, "don't ever give up hope, because there's always hope."

Bernnie now recognizes the importance of early detection and encourages others to get their annual exams and bloodwork, and to talk to their doctor immediately if they suspect something may be wrong. Even if it is bad news, potential treatment options exist – just like there were for him.

"As my doctor had outlined, my case was very bad, but I'm still here and doing well." His advice to men who have been recently diagnosed is to realize that there are always reasons for hope.

Learn more about prostate cancer testing and diagnosis and whether XTANDI might be a treatment option for you or someone you care about. See how others are living their journey — watch more patient stories on XTANDI.com.

This is Bernnie's experience with XTANDI and may not be reflective of other individuals' experiences. Bernnie was compensated by Astellas and Pfizer to share his story. That was his experience at the time of publication.

What is XTANDI?

XTANDI is a prescription medicine used to treat men with prostate cancer that:

• no longer responds to a hormone therapy or surgical treatment to lower testosterone
  OR
• has spread to other parts of the body and responds to a hormone therapy or surgical treatment to lower testosterone
  OR
• has not spread to other parts of the body and responds to a hormone therapy or surgical treatment to lower testosterone, and who are at high risk of cancer spreading to other parts of the body.

It is not known if XTANDI is safe and effective in females or children.

Important Safety Information

What should I tell my doctor before taking XTANDI?

Tell your doctor about all your medical conditions, including if you:

• Have a history of seizures, brain injury, stroke, or brain tumors.
• Have a history of heart disease, have high blood pressure, or have abnormal amounts of fat or cholesterol in your blood (dyslipidemia).
• Are pregnant or plan to become pregnant. XTANDI can cause harm to your unborn baby and loss of pregnancy (miscarriage).
• Have a partner who is pregnant or may become pregnant.

• • Males who have female partners who are able to become pregnant should use effective birth control (contraception) during treatment with XTANDI and for 3 months after the last dose.
  • Males must use a condom during sex with a pregnant female.

• Are breastfeeding or plan to breastfeed. It is not known if XTANDI passes into your breast milk.
• Take other medicines. XTANDI may affect the way other medicines work, and other medicines may affect how XTANDI works. These include prescription and over-the-counter medicines, vitamins, and herbal supplements. Do not start or stop any medicine without talking to your doctor.

How should I take XTANDI?

• Take XTANDI exactly as your doctor tells you. Take your prescribed dose once a day, at the same time each day. XTANDI can be taken with or without food. Swallow XTANDI capsules or tablets whole with enough water to make sure that you can swallow all of the medicine successfully. Do not chew, dissolve, or open the capsules. Do not cut, crush or chew the tablets. Your doctor may change your dose if needed. Your doctor may also change your pill size or stop treatment if you have swallowing problems.
• Do not change or stop taking your prescribed dose of XTANDI without talking with your doctor first.
• If you are receiving gonadotropin-releasing hormone (GnRH) therapy, you should continue with this treatment while taking XTANDI unless you have had surgery to lower the amount of testosterone in your body (surgical castration).
• If you miss a dose of XTANDI: Take your prescribed dose as soon as you remember that day. If you miss your daily dose, take your prescribed dose at your regular time the next day. Do not take more than your prescribed dose of XTANDI each day.
• If you take too much XTANDI: Call your doctor or go to the nearest emergency room right away. You may have an increased risk of seizure if you take too much XTANDI.

What are the possible side effects of XTANDI?

XTANDI may cause serious side effects including:

• Seizure. If you take XTANDI, you may be at risk of having a seizure. Avoid activities where a sudden loss of consciousness could seriously harm you or someone else. Tell your doctor right away if you lose consciousness or have a seizure.
• Posterior Reversible Encephalopathy Syndrome (PRES). If you take XTANDI you may be at risk of developing a condition involving the brain called PRES. Tell your doctor right away if you have a seizure or quickly worsening symptoms such as headache, decreased alertness, confusion, reduced eyesight, blurred vision or other visual problems. Your doctor will do a test to check for PRES.
• Allergic Reactions. Allergic reactions have happened in people who take XTANDI. Stop taking XTANDI and get medical help right away if you develop swelling of the face, tongue, lip or throat.
• Heart Disease. Blockage of the arteries in the heart (ischemic heart disease) that can lead to death has happened in some people during treatment with XTANDI. Your doctor will monitor you for signs and symptoms of heart problems during your treatment. Call your doctor or go to the emergency room right away if you get chest pain or discomfort at rest or with activity or shortness of breath during your treatment with XTANDI.
• Falls and Bone Fractures. XTANDI treatment may increase your risk for falls and bone fractures. Falls were not caused by loss of consciousness or seizures. Your doctor will monitor your risks for falls and bone fractures during treatment with XTANDI.
• Swallowing Problems or Choking. Severe swallowing problems or choking, including life-threatening problems or death can happen in people during treatment with XTANDI, because of the size of the XTANDI capsules and tablets. Swallow each XTANDI capsule or tablet whole with enough water to make sure that you can swallow all of the medicine successfully.

Your doctor will stop treatment with XTANDI if you have serious side effects.

The most common side effects of XTANDI include:

• muscle and joint pain
• feeling more tired than usual
• hot flashes
• constipation
• decreased appetite
• diarrhea
• high blood pressure
• bleeding problems
• falls
• bone fractures
• headache

XTANDI may cause fertility problems in males, which may affect the ability to father children. Talk to your doctor if you have concerns about fertility.

These are not all the possible side effects of XTANDI. For more information, talk to your doctor or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

For further information, please talk to your doctor and click here for Patient Information and Full Prescribing Information for XTANDI.

References

1. American Cancer Society. Tests to diagnose and stage prostate cancer. Updated March 21, 2025. Accessed June 12, 2025
https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/how-diagnosed.html.

2. Screening Tests for Prostate Cancer. American Cancer Society. November 22, 2023. Accessed June 4, 2025.
https://www.cancer.org/cancer/types/prostate-cancer/detection-diagnosis-staging/tests.html

3. American Cancer Society. Hormone therapy for prostate cancer. Updated November 22, 2023. Accessed June 12, 2025.
https://www.cancer.org/cancer/prostate-cancer/treating/hormone-therapy.html.

4. Prostate Cancer Risk Factors. CDC. August 27, 2024. Accessed June 4, 2025.
https://www.cdc.gov/prostate-cancer/risk-factors/index.html

5. Key Statistics for Prostate Cancer | Prostate Cancer Facts. Accessed January 12, 2024.
https://www.cancer.org/cancer/types/prostate-cancer/about/key-statistics.html

6. Prostate Cancer Early Detection. National Comprehensive Cancer Network (NCCN). March 11, 2025. Accessed June 4, 2025.

7. American Cancer Society. How radiation therapy is used to treat cancer. Updated December 27, 2019. Accessed May 7, 2024.
https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/radiation/basics.html.

8. National Comprehensive Cancer Network. NCCN guidelines for patients: Advanced-stage prostate cancer. Updated 2024. Accessed August 1, 2024.
https://www.nccn.org/patients/guidelines/content/PDF/prostate-advanced-patient.pdf.

9. XTANDI [package insert]. Northbrook, IL; Astellas Pharma US, Inc; Accessed May 30, 2025.

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