Zytiga

[rxearl]

I have had 5 sessions on taxotere and now after the last chemo he is going to put me on zytiga or xtandi pills and said I will need to stay on them and my Lupron every 4 months. Just wondering if anyone has gone this route? My psa is down to 9 from 1400. Thanks for your help.

[ctarleton]

I would be interested in what your last 5 PSA readings were, and the extent and responsiveness of any mets to either bones or lymph nodes. Some oncologists might consider letting the PSA hit a nadir and then starting Zytiga or Xtandi after 2 consecutive rises, or a rise, perhaps, above some number, and/or upon certain symptoms or radiology results, etc. You seem to have already had ADT + Early Chemo, per the CHAARTED Clinical Trial findings. There have been other Trials showing benefits for ADT + Early Zytiga. Other posters here (e.g. Gregg57) are asking their oncologists very similar questions as to "timing and sequencing" of these agents, and weighing their options, even while the "science" may still be out on this subject for some time to come.

[BigRich in reply to ctarleton]

Ctarleton,

I started Lupron in May, 2017. I am going to test for the AR-V7 gene variant. If test is negative, I will take early Zytiga.

Rich

[BigM62 in reply to BigRich]

Did your oncologist agree to the genetic test or are you doing it on your own? I was diagnosed a month ago with stage 4 with extensive mets to spine. Oncologist started me immediately on casodex, lupron, doxetal chemo, and zymeta. Just got my 2nd chemo yesterday and my PSA is down from 11 (yes, that was my starting max PSA - even with mets) to 4.5. So seems to be working, but my cancer is agressive and im worried by the time i get a new scan it will be too late if it isnt working.

[BigRich in reply to BigM62]

I initiated the test; however, my MO agreed with me. My blood gets drawn next week for the test.

Rich

[rxearl in reply to ctarleton]

My PSA went to 180 then 150 then 125 then 9.8 and today it was 5.2 so it seems to be going the right way with only more chemo session left.

[Dr_WHO]

I did not follow your exact route. After being on Lupron for a year my medical oncologist added Zytiga to the mix last June. This was based on the results from the Stampede and Latitude trials which showed a significant impact on longevity using a mixture of two different hormonal therapies at the same time vs starting Zytiga only after Lupron failed. My MO is convinced that the mixture of Lupron with Zytiga will soon become the standard treatment option.

Please remember that you must take Zytiga with Prednisone. The major side effect of Prednisone for me has been very, very intense dreams. Not nightmares, just intense. For that reason I am on 5 mg/day vs the standard 10 mg/ day.

Also, please make sure that Zytiga is covered by your insurance. Without insurance it would cost me $300/day for Zytiga. As it is, I pay $22/month.

[chucko in reply to Dr_WHO]

How did you get $22 for 30 days of Zytiga. I have Medicare + Humana part D and I pay $85 per day.

[Dr_WHO in reply to chucko]

I am to young for Medicare (they found the cancer when I was 58). I have retirement insurance from work though Blue Cross/Caremark of New Jersey- even though I live in Michigan. I pay over $1,000/month for my insurance but it is worth it.

Caremark may also cover it because I have a rare form of cancer that is hard to treat or even detect. That is why even with yearly exams (digital since I was 40, PSA since I was 50) thatthey did not find it until it was advanced.

[BigRich in reply to Dr_WHO]

Studies have shown that metformin extends duration of Abiraterone. Have yo dicussed this with your doctor?

Rich

[BigRich]

Will do. The test during validation had no false positives and less then one percent false negatives.

Rich

[Dr_WHO]

I am to young for Medicare (they found the cancer when I was 58). I have retirement insurance from work though Blue Cross/Caremark of New Jersey- even though I live in Michigan. I pay over $1,000/month for my insurance but it is worth it. Caremark may also cover it as I have a rare form of prostate cancer (ductal) that tends to be quite aggressive.

[Dr_WHO]

That is the truth!