Advanced Prostate Cancer
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Advance P CA age 83

My father 83 active astute at work everything was diagnosed with in april 2016 with a gleason 5+4 and PSA of 49. with Bone mets to sacral spine and sacral Lymph nodes. Was in excruciating pain due to the inflammation in the lower right leg hip area. Started Eligard 22.5 with Bicalutamide PSA dropped to .3 but no ts up to 6.8 as of 2/17/17. Docs are recommending xtandi or zytiga. need to know which works better first to avoid resistance to the next one. Dr also said Provenge is something to consider and this is the time to do it.















Any experiences/suggestions will be helpful.



7 Replies

As a veteran of Xtandi, Zytiga, Xofigo and Provenge, I would suggest getting your Dad on Xofigo first. Xofigo gets radium-223 (alpha particle radiation) to your bones. Xofigo lessens or takes away bone pain, and sometimes heals bone metastases. It did for me, and it has few side effects. It is the best of the four by far.

Zytiga with prednisone is a much kinder medication than Xtandi if you must use one or the other. It was also the more effective of the two for me.

If your Dad uses second tier ADT (Zytiga or Xtandi) you should ask your oncologist about estradiol patches to keep his bones strong while taking ADT.

Provenge is most successful when your cancer is stable. It would usually follow the use of Xofigo.

Your Dad can have several more years of good life without pain. I wish him and you the best.



The first thing I would do is stop the Casodex. It's not an uncommon occurrence that Casodex stops working correctly and ends up feeding the cancer.

Ending Casodex will not be a long-term solution. So you do need to think about your next steps, as you've already done.

Provenge is best given as early as possible. I disagree with Bob's comment that it's usually given after Xofigo. Provenge does take a period of time to arrange to obtain, so I suggest that you work on that now.

Provenge does take a period of time to arrange to obtain, so I suggest that you work on that now.

Unfortunately, research has not yet made it clear which drug should come before which drug. (Xofigo, Xtandi and Zytiga). I suspect that it differs for each individual depending upon their genetics. You should talk with your doctor now about doing some genetic screening to find out which of these drugs might have a better result.

Xfigo is an excellent drug, but will only affect bone mets which in your father's case is OK. Usually it's given later in the treatment protocols however there's a lot of good evidence that indicates that earlier use may actually have it's advantages.

Between Xtandi and Zytiga, I think that Xtandi is a better drug. I basis on the clinical trials because it showed what I believe is a longer survival advantage. They both have significant side effects and unfortunately they both choirs cross your assistance with the other. There's no way to avoid this. Currently, there is some research looking at Ways to stop this cross resistance.

Ways to stop this cross resistance.



Hello Joel. Just finished my 15 session of Jevtana. PSA went up from 136 to 150. This is my third year advance prostate cancer. Started with Zytiga took 8 jars for 8 months. Then 8 sessions of Taxoder with daily prednisone of 10mg the side effects on the Taxoder was bad and unbearable. The doctor said we move to JEVTANA and I did till today 15 sessions every 21 days with Prednisone. Today my doctor said that in the next two weeks will do an FDJ with a PT scan and decide maybe Xtandi tablets or another can't remember the name I am not good at absorbing drug names. As for Xtandi i had earlier read about it in yourhealt forum.

any advice is highly appreciated



I am not an expert but I think that both Bob and Joel have said some useful things.

First of all, on the drug to take first:

Joel recommended stopping the Casodex. This may or may not help and, when it does, it may not help for very long. However it sometimes helps and it may be worth trying because it's always better if you can get a good effect from stopping a drug rather than starting yet another new one. Your Dad's doctor may have a good idea about whether this is worth trying in his particular case.

As for the Zytiga vs. Xtandi question, from what I've read and heard from others on this group, I think Bob and Joel are both right. Xtandi is the more powerful drug which may work for a longer time than Zytiga, but Zytiga has fewer nasty side effects. Many people have complained of exhaustion from Xtandi.

Xofigo was originally intended as a medication for bone pain. It can extend life if a man's primary metastases are in bone, but it won't extend life if the main danger is from metastases in "soft tissue" like lungs, heart, brain, liver, etc. If hormone therapy relieves the pain (it may or may not) then Xofigo would be unneeded. If hormone therapy does not relieve the bone pain, but the pain is concentrated in a single spot, I'd be inclined to ask for direct radiation to that spot rather than using Xofigo - which radiates bones that are not painful too. The Xofigo could be held off for use if bone pain becomes general.

As for Provenge or other immunotherapies, I think they're a good idea, and I think your father's doctor is right to recommend them now rather than later. As Joel says, Provenge works better sooner than later, and there is some evidence that it works best of all when combined with working ADT. Apparently, if the ADT knocks down the cancer, the immune system stimulated by Provenge can sometimes really damage it. However if the cancer is out of control, Provenge may be overwhelmed by it. There are also some new immunotherapies in development (called "checkpoint inhibitors") that show great promise and it might be possible to get into a clinical trial of one of them - though trials are often restricted to younger men.

Finally, there is chemotherapy. For a young man with PCa, a combination of ADT + chemo is thought to be an effective treatment. For an old man, the chemo might be very stressful.

It sounds like your father's doctor knows what he's doing. Hopefully he can answer questions and guide you through the best path.

Good luck.



Thanks- I posted again today as I wasn't sure how to get back in my account but I did.

I don't know much about zofigo. How is it administered and side effects etc?


You may be confusing two different treatments.

Zytiga is a pill that is taken once a day along with prednisone pills twice per day. It blocks the synthesis of testosterone in the body causing hormone sensitive tumor cells to die or become dormant.

Xofigo is an injection containing radioactive Radium-223 ions. The radium binds to growing bone and radiates it. It can be used to stop bone metastases, reducing bone pain and, in some cases (if the bone metastases are themselves life threatening) to extend life.

Xtandi is another pill. It doesn't block testosterone production but does block its uptake in the tumor cells.

There is more about all these drugs on the Internet. Search Google to get full details.

Good luck.



For clarification:

1- Xofigo is only useful for bone mets, it has no interaction on soft tissue. It mimics Calcium which goes to bone. When the drug gets to the bone the alpha radiation that is attached to it radiates the bone met (without much bone penetration which preserves the bone marrow). No Xofigo goes to the soft tissue mets. It is not a medication that is designed to or approved as a bone pain reliever, however most men do get very significant pain relief. It will not have any effect on PSA, but it does provide a life extension (with a higher quality of life given the secondary pain relief factor).

2- Provenge is only approved for castrate resistant prostate cancer with visible mets. There is no evidence about its efficacy for men who are still responding to ADT. However, it is taken along with ADT because you should continue ADT even when castrate.



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