Started Lupron monthly shot on June 7th and Zytiga on June 19th.
PSA at start of treatment was 31. At latest lab test on June 28(three weeks on Lupron and 10 days on Zytiga) it was 2.4.
Is that considered a good response ?
I told my MO I'm taking Milk thistle while on treatment to protect the liver.
She was skeptic as she cant know the interaction between Arbiraterone and milk thistle , since it was never tested.She wonders that maybe Milk thistle may be interfering with Arbiraterone absorption . Any take on that ?
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dorke
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That is a great response! Your oncologist is probably monitoring your ALT levels, which is an early indicator of liver damage - a rare occurrence. Only 6% of men taking it had ALT levels over 5x the upper limit of normal. They would reduce the dose if you experienced ALT levels over 2.5X the upper limit of normal. There have been no publications or descriptions of the clinical features of hepatotoxicity with jaundice associated with abiraterone therapy. So it seems you are taking a cure for a problem not likely to occur. Since it is an antioxidant, I'd be concerned that it interferes with some of the cancer-killing natural processes (e.g., apoptosis and killer T cells).
I do have some history of slightly elevated ALT enzymes.Fatty liver was suspected but never confirmed with Ultrasound so thats the reason I prefer to be cautious with my liver during treatment
You are probably not taking enought to make any difference to your response to Zytiga.
A common area of concern with potential interactions is whether there is an impact on liver enzymes involved in drug clearance - cytochrome P450 (CYP) enzymes.
According to a 2014 Thai study [1]:
"The available evidence indicates that, at commonly recommended doses, ... selected herbs including Echinacea, Ginkgo biloba, garlic, goldenseal and milk thistle do not act as potent or moderate inhibitors or inducers of CYP enzymes."
A 2013 Dutch study reported that [2]:
"Milk thistle and P. ginseng predominantly showed CYP3A4 inhibition in vitro. However, in clinical studies these CAM did not cause significant pharmacokinetic interactions with midazolam, irinotecan, docetaxel and imatinib. Most likely, factors as poor pharmaceutical availability, solubility and bioavailability contribute to the lack of significant clinical interactions."
Wiki: [3]
"Abiraterone acetate is a CYP3A4 substrate and hence should not be administered concurrently with strong CYP3A4 inhibitors such as ketoconazole, itraconazole, clarithromycin, atazanavir, nefazodone, saquinavir, telithromycin, ritonavir, indinavir, nelfinavir, voriconazole) or inducers such as phenytoin, carbamazepine, rifampin, rifabutin, rifapentine, phenobarbital.[22][21] It also inhibits CYP1A2, CYP2C9, and CYP3A4 and likewise should not be taken concurrently with substrates of any of these enzymes that have a narrow therapeutic index."
I don't think that milk thistle would be classed as a strong CYP3A4 inhibitor.
Forgot to mention that milk thistle can speed up metabolization of estradiol. Which would not be a good idea when using E2 to induce androgen deprivation.
I agree that Doctors dont know everything and they are reluctant to try things they dont know but there is a point in this argument.
You may have enough knowledge to argue with doctors and feel confident, but most of us are not in this position and we have to choose whom to follow.
The moment we start to doubt the competency of our doctors, the people that we ,literally,put our lives in their hands,whats left ? follow our heart ?Can we (most of us) make rational decisions ?
Typically, we want polyphenols to be at pro-oxidant levels for cancer.
There is a long history of milk thistle use for liver issues. Presumably this does not require high doses.
A standard OTC dose may help the liver deal with the effects of cancer treatments, but I wouldn't expect it to have much effect on the cancer or on cancer drug efficacy.
My doctor had a patient that was doing great but then started to slide, found out that the patient was doing mega doses of vitamin C on his own, it was preventing the drugs from working. Not to say that some stuff doesn’t work but listen to the people that are trying to save your life
Hello Dorke, a good response to docetaxel is considered to be < 0.2 ng/ml, but this is not the same as what you are presently taking. Follow the rate of decline. Search on PubMed for references pertaining to PCa and milk thistle. Milk thistle may improve response to therapy as an adjuvant. Phil
PSA drop from 31 to 2 is excellent, and my expectation is on the next PSA test in a few months it will be below "1" .....Dont forget on your next blood draw, the doctor should be having your testosterone level checked, just to make sure the Lupron + Zytiga is lowering it significantly (which it almost always will, but lets check) I dont have any opinion or insight into the Milk Thistle ...I am on my 9th month of Lupron (ELIGARD, every 6 month injection) and Zytiga, and my PSA is .1 (1/10th of 1) ..it was 364, then a few months later 29, then a few months later .4, then .1
If you tolerate the Lupron injection well, you doctor will likely switch you to a 3 or 6 month injection. ("Eligard") The reason we dont do that out of the gate, is because if you have a bad reaction to the Lupron, we cant remove it, per se. (Eligard, in a 3 or 6 month injection, sits under the skin and slowly melts over time, but it would be tricky to get it back out )
Nalakrats is right about LifeExtension's European Milk Thistle. LE came out with it about 3 or 4 years ago. They tweaked the formula for greater bio-availability. Flor-Essence is also good for liver detox. Medicinal Traditional makes an organic, dandelion, leaf and root tea.
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