Zytiga failed, starting Xtandi. What to expect for my dad.

I am super sad today. We got the news that Zytiga is failing and my dad is going to be switched to Xtandi. My dad has been feeling amazing and I’m so scared that the Xtandi wll change that. He was diagnosed with Stage IV, bone mets everywhere, Gleason 10, PSA 64 in November 2017. He had a great response to Zytiga and his PSA went from 64 to .2 then started raising to .6 then to 2. Today-4wks later it is 3.5. He looks great and is feeling great so this is very difficult news for us. I am scared. He was doing so well with minimal side effects and the Zytiga only worked for 7 short months. Oncologist was going to start taxotere but decided to try Xtandi. What should we expect? Any advice is very much appreciated.

[Dan59]

Hopeseeker, Has he had any scans to confirm progression on zytiga? In my experience I got at least 2 yrs out of xtandi after zytiga failed. In some men xtandi can cause fatigue, I took mine at night and slept an extra hour in the morning, and it held my cancer stable. Since failing xtandi I have been on chemo since 2/17 (Taxanes, Docetaxol then jevtana), and considering going back on xtandi as sometimes doing chemo can reverse the arv7 and make xtandi or zytiga work again. Has he had genetic profiling. There are new drugs in targeted medicine for Men with specific mutations.if a sample of biopsy is available still he can have it sent to Foundation 1. There is also a Guardant 360 blood test with 2 vials of blood that can be done for genetic testing. There are new things promising things in late stage clinical trials, Darolutamide, apalutamide,Proxalutamide, ect.... In the last decade we have seen more progress in Advanced stage 4 Prostate cancer, then the previous 50 years.

I wish you the best

[Hidden]

Just rising PSA.

No pain anywhere either.

At the very beginning when he first started Zytiga after a couple of months he did scans and there was no progression at that time, in fact his scans came back great. Most of the mets cleared up.

[Dan59 in reply to Hidden]

Hopeseeker, I think scans would be appropriate to asess zytiga, and another psa to confirm the increase in psa, It could be a baseline for xtandi if you go that route. There was some talk in the past of zytiga lowering psa after a few small rises, and there have been studies on actually taking the zytiga with food increasing absorption and making it work. Also there was a paper on switching steroids to low dose Dex making zytiga work again. All things to discuss with the hopefully expert openminded Medical Oncologist.I think it is important to get all the time out of each one of our bullets. The really good news is how good he feels. Keep us posted on what He decides.

Ps. Guardant 360 genetic test is now covered by medicare.

Dan

[Hidden in reply to Dan59]

Dan I appreciate your input so much. Thank you! May you be blessed with many many more years. I’ve been following your posts and you sure give me hope and you’re inspiring! Keep fighting. Never give up.

[boseley]

The numbers you are quoting are almost an exact copy of my situation. I want to try Lutetium 177 so will be having this discussion with my oncologist later this month. Good luck and keep posting please.

Howard

[Hidden in reply to boseley]

Howard-let me know what your onc says about Luteium 177. I’m not familiar with that. I am learning so much from everyone on here. May you be blessed with good outcomes.

[vandy69]

Good Thursday Morning Hopeseeker,

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

I had an 18 month run with Zytiga and then 12 months with Xtandi. Have not had bone mets, but many lymph nodes and liver.

For bone mets, usual option is Radium 223 (Xofigo). Is your Dad being treated by a Medical Oncologist who specializes in PCa?

With aggressive cancer, aggressive treatment is needed and quality of care matters.

Consider a Guardant360 liquid biopsy, which requires only 2 vials of blood. It will provide any genetic defects, most do not yet have treatments, but some do. After one of my tests, I was able to take Lynparza, a PARP inhibitor, because of an identified defect.

As some have responded, recent scans are in order to understand exactly where the cancer is.

If Xtandi fails, then chemo with Docetaxel may be next option, and it is not as bad as it once was.

Best wishes. Never Give In.

Mark, Atlanta

[Babytth]

I didn’t respond to Zytiga or Xtandi. Nor did I respond to XOFIGO therapy. Finally my oncologist put me on Docetaxel combined with Carboplatin..a super charged chemo regimen. It did work to bring down my PSA, but it without side effects which required a blood transfusion post chemo. After six rounds, the effects of the chemo lasted about 2 months after which my PSA began to rise again. I am now on Cabazotaxel or Jevtana for another six rounds. Side effects are minimal by comparison....let us hope its effects are more long lasting!!

[Hidden]

Apc is a dam rollercoaster ...emotionally cruel to all concerned. There isn’t a majic bullet for any of us so far.. It hurts to see someone we love in fear and suffering.. really sucks...But this is a chance for you to realize how important every day that you spend with dad Is now. Also how important your own health and welfare really is. He is feeling good. Take advantage of that if you can. Take care of your life. Live healthy and love dad.. Be a positive voice to him. That’s all that you can do.. just be there and love him... The greatest gift in the world ,in my opinion.... he already has ,YOU!😎

[charlesmeyers1964]

u realize that a normal psa for a healthy person is from 0-4.0 so why worry your still in the normal range

charlie

[DaughterOnAMission]

How is he doing now? What was the next step?