An Update To My Profile And Entering A New Phase In My Journey

[BrianE]

I have just had my fourth Zoladex implant and this is a summary my progress since I posted my profile.

After three months my PSA had dropped to 0.5 from its previous 1.0. I was having occasional blood in my urine but was told this should settle down.

At six months my PSA was 0.4. I had begun to experience pain in my left hip and my right ankle was very sensitive to warm (in the shower) water. I was still having blood in my urine. I was told that things were "still holding on".

At seven months I have a stumble and jarred my left hip which caused me extreme pain. I was taken to the ER given morphine and x-rayed . There was no break but a bone scan was advised.

The bone scan showed that the metastases had grown. My GP referred me to a Radiation Oncologist. I was given five treatments of IMBR and I am now free of pain in my hip and can shower without wincing. It is a pity that they and fix fatigue as easily.

Last week my PSA was reviewed. It was back at 1.0 and I was told that Zoledex had failed. I would now have Casodex added to Zoladex my PSA checked in two months. I asked about Zytega ot Xtandi but was lold that there required special approval on the Australian Pharmaceutical Benefits Scheme as they Chemotherapy. I didn't think they were. I will wait to see how things progress and see my my Medical Oncologist who had advised me previously.

I now will have two month wait to see how I get on. At least Louis still gets his walks down by the creak .

Brian

This these are PBS requirement to receive Zytiga for $39.00 instead of $3,900.00

Castration resistant metastatic carcinoma of the prostate

Clinical criteria:

The treatment must be used in combination with a corticosteroid,

AND

The treatment must not be used in combination with chemotherapy,

AND

Patient must have failed treatment with docetaxel due to resistance or intolerance; OR

Patient must be unsuitable for docetaxel treatment on the basis of predicted intolerance to docetaxel,

AND

Patient must have a WHO performance status of 2 or less,

AND

Patient must not receive PBS-subsidised abiraterone if progressive disease develops while on abiraterone,

AND

Patient must not have received prior treatment with enzalutamide; OR

Patient must have developed intolerance to enzalutamide of a severity necessitating permanent treatment withdrawal.

[Tall_Allen]

It sounds like your next step is docetaxel. You are right that Xtandi and Zytiga are second-line hormonals and are not chemo, but it looks like yo can't get subsidized for them. There is an old, cheaper drug called Ketoconazole that acts similarly to Zytiga - perhaps you can get that instead.

[BrianE in reply to Tall_Allen]

I have previously been declared unsuitable for docetaxel by my MO and hope that the PBS accept his recommendation.

[Shooter1 in reply to Tall_Allen]

Tall Allen ; Thought you were right about Xtandi when I started it. Comes labled 'cytotoxic' and full disclosure sheet list half life of radioactivity and all the nasty side effects I have. Not something to take lightly. Seems to work if you can stand it. Says It sticks with you 77 days after you quit and recommends taking prednosome or dexamethasone with it for side effects.

Doug=AZ

[Tall_Allen in reply to Shooter1]

Doug, I think you mean Xofigo rather than Xtandi. (I don't know why the brand names of so many prostate cancer drugs start with Xs and Zs)

[Shooter1 in reply to Tall_Allen]

Looking right at the bottle as I type. Xtandi (enzalutamide) (cytotoxic). Never had Xofigo--It sounds even worse.

[Tall_Allen in reply to Shooter1]

There is no radioactivity in Xtandi. It is certainly cytotoxic - if it didn't kill prostate cancer cells, there would be no point. You don't have to take prednisone with it like you do for Zytiga because it doesn't interfere with cortisol production.

[Shooter1 in reply to Tall_Allen]

i stand corrected. Still tearing me up and info sheet tells Drs they can adjust to 3 or even 2 pills a day and add the steroids if side effects are bad. Will be discussing this with Dr's next week. I need to start feeling better not worse every week. Or find out why???

Doug

[Shooter1 in reply to Shooter1]

Tall-Allen.

New info from Xtandi Dr's sheet. Under elimination: after single dose 160 mg, 85% of the radioactivity is recovered by 77 days post dose.

Under absorption:with daily dosing regiment, enzalutamide steady state is achieved by Day 28, and enzalutamide accumulates approximately 8.3-fold relative to a single dose.

Under Elimination: mean terminal half-life for enzalutamide is 5.6 days, mean half life for N-desmethyl enzalutamide is approximately 7.8 to 8.6 days.

So it builds up in your body getting stronger for 28 day, (X8.3). And does have radioactive properties. News to me, but may explain side effects.

Under clinical studies section : Patients were allowed, but not required, to continue or initiate glucocorticoids ( Prednosone or dexamethosone) for relief of side effects.

So it builds up in your body for a month, stabilizes there and with glucocorticoids added and optional reduced dose of 3 or even 2 pills a day can be tolerated by people with unacceptable toxicity. (me)

Cut back to 3 pills a day, added 10 mg prednosone , felt better and had more energy today than I've had in months. That's in 4 days. Hope to keep improving.

Got to keep up the balancing act with this chemo shxt.

Doug