Medication questions

[Canoehead]

I’ve been here for a little while now, but I still consider myself sort of a newbie, so I have a few medication questions that I hope some of you can help me with.

Firmagon v. Lupron. Presently taking Firmagon, but I think my MO may want to switch me to Lupron. They do the same thing, and Firmagon is a shot every 4 weeks while Lupron is every 3 months. I keep reading that Lupron on average leads to castrate resistance within 2 years, and I’m wondering whether that’s true for all ADTs or unique to Lupron?

Zytiga v. Xtandi. Just had my last Docetaxel infusion today, and the plan is to now add Zytiga to my meds. Have read suggestions here that Xtandi may be better at preventing the development of castrate resistance, but it is currently only FDA approved for those who are already castrate resistant. My doctor, subject to insurance approval, may be willing to go off label and prescribe it anyway. That saves Zytiga for a rainy day. Opinions?

My PA told me Effexor is an effective treatment for hot flashes. It’s mainly an anti depressant, and while I don’t think I’m depressed, I do have a fair number of days when I have no motivation, which I attributed to medication related fatigue, but who knows. Anyone have experience with Effexor for hot flashes?

Lastly, I have developed some mild numbness in my fingertips as a result of the Docetaxel. Will this resolve after I stop Chemo, and if so, how long will it take? All I got from doctor is maybe in 6 months.

By way of context, I am 67, still employed half time in a management job where i have to be sharp and alert in public situations. I have stage 4 metastatic to bones and lymph nodes in pelvis. Have responded well to initial treatment with PSA dropping from 36 to 0.14 in 2 months.

Thanks for all the great help and info on this site.

[Tall_Allen]

Castration resistance occurs whether you are on ADT or not. Castration-resistant cancer cells are there from the start:

journals.plos.org/plosone/a...

stm.sciencemag.org/content/...

That's why the extra androgen inhibition provided by early use of Zytiga and the destruction of all cancer cells by docetaxel lead to extended survival.

As to whether Xtandi or Zytiga is better pre-castration resistance... There is an arm of the STAMPEDE trial that will someday tell us that. Among, castration-resistant men there was no difference in overall survival, but progression-free survival was longer with Xtandi.

onlinelibrary.wiley.com/doi...

ncbi.nlm.nih.gov/pmc/articl...

In the hormone-sensitive setting, Xtandi tested very well:

thelancet.com/journals/lano...

I know a man who uses Effexor for hot flashes. He says it reduces them somewhat. If you don't want to take another drug, acupuncture has proven to be effective in randomized, blinded clinical trials. Probably the best is an estrogen patch, which serves double duty at controlling the cancer. Take tamoxifen with it (and with Xtandi) to prevent breast effects. Megace patches are sometimes used too.

If you are on continuous ADT (rather than intermittent ADT), you may wish to consider orchiectomy rather than shots.

[BigRich in reply to Tall_Allen]

Is there any type of PCa cells that docetaxel will not destroy?

Rich

[Tall_Allen in reply to BigRich]

Yes - many rare types; e.g., neuroendocrine,signet ring cell, squamous cell, etc. It will also stop working on ordinary metastatic cells eventually. After docetaxel, Jevtana may work.

[BigRich in reply to Tall_Allen]

Thank you for a comprehensive reply.

Rich

[garythomas]

Hi Canoe,

I have been on Lupron since Dec 13 and am still hormone sensitive.

I still get hot flashes using 150 mg daily Effexor.

Regards,

Gary

[Tjc1]

I take megestrol also called magace for hot flashes. Wipes them out totally. I take effexor for depession it gives me night sweats.

[Hidden in reply to Tjc1]

I've heard some alarming things about Megace and Prostate cancer. Here's a quote I snagged from a previous post on this site:

Adding to NOT prescribing Megace is this commentary by Dr. A. Oliver Sartor, another physician who specializes in research and treatment of recurring and advanced prostate cancer: “"Megace® is used at times for patients who have hot flashes, and at times for patients to boost their appetite. But in prostate cancer, Megace may interact with the androgen receptor, particularly mutants, and cause excessive cancer growth. And you can actually get responses by withdrawing Megace. I do not prescribe the use of Megace in prostate cancer patients. "

[Tjc1 in reply to Hidden]

Get responses by withdrawing magace?

[Canoehead in reply to Hidden]

Ruling that one out.

[vandy69]

Good Tuesday Morning Canoehead,

I have been in this battle for almost 6 years (please see bio for complete treatment history).

I have taken Lupron, Firmagon, and now Trelstar. Personally I don't think it matters, but every 28 days and flu like side effects of Firmagon led me to switch.

I had Zytiga before Xtandi, got about 18 months from former and about 12 months from latter. Currently trying a rechallenge with Xtandi.

Dr. "Snuffy" Myers prescribed Vivelle dot estrogen patches to moderate side effects of ADT, but I got blood clots after a year of use.

Consider genetic testing with Guardant360 liquid biopsy, as it requires only 2 vials of blood. Your cancer may have defects that point to other drugs. Mine did.

My Med Onc recommended 100mg B6 orally daily to moderate peripheral neuropathy. I also iced my hands and feet during Docetaxel infusion.

Best wishes. Never Give In.

Mark, Atlanta

[Canoehead in reply to vandy69]

Great info. Many thanks.

[JimVanHorn]

Hi, I use Tylenol generic arthritic strength 650mg 8 hour timed release that I buy at a drug store for hip pain and hot/cold flashes. I have been on Lupron for 7 years now and the hot/cold flashes are minimal now. I hope you find a therapy and stick with it. I am not sure that changing agents is to an advantage. keep truckin'.

[Joeym1040]

Effexer is effective for hot flashes. I had bad hot flashes every 45 minutes nothing worked for me except effexor. Started with 75mg daily 4 yrs ago now on 37.5 mg every other day. Be careful, you uh just can't stop effexor suddenly. Have to wean yourself off it.