Knowing when to stop a treatment and when to hang on and "give it time" has become a more difficult issue with all the new drugs we now have at our disposal. A good example is abiriterone acetate (aka Zytiga). Most clinicians recommend waiting for 12 weeks before deciding if Zytiga is working, but a recent study has suggested that this is too long and that 4 weeks is better. Read the advanced prostate cancer post about this study at:
advancedprostatecancer.net/...
Joel
New study on a similar theme:
"Dynamic changes of alkaline phosphatase are strongly associated with PSA-decline and predict best clinical benefit earlier than PSA-changes under therapy with abiraterone acetate in bone metastatic castration resistant prostate cancer."
ncbi.nlm.nih.gov/pubmed/269...
-Patrick
On enzalutamide I realised the PSA was rising and the I was getting bad side effects. Time to give up.
I think it will vary patient to patient.
Just an extra point - one fellow cited by the Royal Marsden in the UK had been on Abiraterone for 5 yrs
Zytiga/abiraterone acetate (in company with Prednisone, Lupron, and Avodart) PSA results. Please note below that one might conclude Zytiga was failing and stop the medication when they should have stayed on a few more months to make sure.
Begun with PSA 2.55ng/ml on 9/2/11
9/23/11 1.61 ng/ml
11/2/11 1.28 “
12/22/11 0.72 “
2/9/12 0.75 “
3/26/12 0.9 “
4/23/12 0.87 “
Then PSA began steady elevation and I stopped Zytiga, but then learned that I should not have stopped because Zytiga has this propensity to be dropping, then show elevation, then kick in again and drop, so returned to Zytiga in
Mid June 1.17ng/ml
7/12/12 1.12 “
8/13/12 0.9 “
9/10/12 0.74 “
10/22/12 0.55 “
12/14/12 0.55 “ (held steady)
3/4/13 0.521 “
4/29/13 0.407 “
7/1/13 0.319 “
9/3/13 0.351 “ (slight rise, but in early August ended up in ICU with diverticulosis having inflamed and erupting, and being on the blood thinner warfarin, ended up constantly bleeding for 32 hours before oral and injected Vitamin K countered the blood thinning and finally coagulated. With all that blood loss I ended up anemic with RBC, HcT, and HgB blood levels all below the lowest level noted in appropriate range and they remain there as of 9/10/13. Advice given is that it may take until December before these levels come up within normal range. I am not concerned by this recent PSA reading since it could be the result of this trauma to my system, or there are several factors….time of day of blood draw, calibration of lab equipment, etc. But, we shall see with next blood draw in November 2013. So far, EXCELLENT results from the prescribing of Zytiga two years ago.
11/8/13 0.352ng/ml, so 1/1000th increase – I can “live” with that!
1/6/14 0.384ng/ml, Sneaky Pete is sneaking up on me again, so up 0.032ng/ml. Seems insignificant, but this has been a continuing, though very slow, elevating since earlier nadir of 0.319ng/ml on 7/1/13; an overall 0.065 over 6 months. I can continue to be happy if it continues no more rapid a rise than this since even in 10 years it would only get up to 1.68ng/ml…wouldn’t that be nice?
3/7/14 0.379ng/ml, so decrease of .005ng/ml
6/30/140.531ng/ml
9/29/14o.527ng/ml
2/2/150.55ng/ml
6/15/150.66ng/ml
10/19/150.868ng/ml
12/7/150.895ng/ml
1/18/160.902ng/ml
2/8/160.964ng/ml
AND COUNTING. My personal PSA level at which I will consider a change in options is 2.0ng/ml and at the current rate of rise that could be another 3 years or more.
Zytiga/abiraterone acetate (in company with Prednisone, Lupron, and Avodart) PSA results. Please note below that one might conclude Zytiga was failing and stop the medication when they should have stayed on a few more months to make sure.
Begun with PSA 2.55ng/ml on 9/2/11
9/23/11 1.61 ng/ml
11/2/11 1.28 “
12/22/11 0.72 “
2/9/12 0.75 “
3/26/12 0.9 “
4/23/12 0.87 “
Then PSA began steady elevation and I stopped Zytiga, but then learned that I should not have stopped because Zytiga has this propensity to be dropping, then show elevation, then kick in again and drop, so returned to Zytiga in
Mid June 1.17ng/ml
7/12/12 1.12 “
8/13/12 0.9 “
9/10/12 0.74 “
10/22/12 0.55 “
12/14/12 0.55 “ (held steady)
3/4/13 0.521 “
4/29/13 0.407 “
7/1/13 0.319 “
9/3/13 0.351 “ (slight rise, but in early August ended up in ICU with diverticulosis having inflamed and erupting, and being on the blood thinner warfarin, ended up constantly bleeding for 32 hours before oral and injected Vitamin K countered the blood thinning and finally coagulated. With all that blood loss I ended up anemic with RBC, HcT, and HgB blood levels all below the lowest level noted in appropriate range and they remain there as of 9/10/13. Advice given is that it may take until December before these levels come up within normal range. I am not concerned by this recent PSA reading since it could be the result of this trauma to my system, or there are several factors….time of day of blood draw, calibration of lab equipment, etc. But, we shall see with next blood draw in November 2013. So far, EXCELLENT results from the prescribing of Zytiga two years ago.
11/8/13 0.352ng/ml, so 1/1000th increase – I can “live” with that!
1/6/14 0.384ng/ml, Sneaky Pete is sneaking up on me again, so up 0.032ng/ml. Seems insignificant, but this has been a continuing, though very slow, elevating since earlier nadir of 0.319ng/ml on 7/1/13; an overall 0.065 over 6 months. I can continue to be happy if it continues no more rapid a rise than this since even in 10 years it would only get up to 1.68ng/ml…wouldn’t that be nice?
3/7/14 0.379ng/ml, so decrease of .005ng/ml
6/30/140.531ng/ml
9/29/14o.527ng/ml
2/2/150.55ng/ml
6/15/150.66ng/ml
10/19/150.868ng/ml
12/7/150.895ng/ml
1/18/160.902ng/ml
2/8/160.964ng/ml
AND COUNTING. My personal PSA level at which I will consider a change in options is 2.0ng/ml and at the current rate of rise that could be another 3 years or more
"Cholera Vaccine for Prostate Cancer Patients"
Moving on to Provenge 
Too late for most men here, but Insist on pelvic MRI before submitting to a biopsy
Lupron failing 
