Zytiga & Prednisone: I have a concern... - Advanced Prostate...

Advanced Prostate Cancer

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Zytiga & Prednisone


I have a concern with Prednisone after talking to my pharmacist about affects of combining some medications. My concern is the need for Prednisone. My pharmacist tells me that Prednisone is hard on the kidneys so my concern is ending up on dialysis in the future. But, I have two trains of thought and would like information on both.

1) Everything I've read states that Prednisone itself doesn't deal with the cancer, it deals with the side effects from Zytiga. Now, my question is; why would I take Prednisone in the first place until I find out exactly what side affects I experience from Zytiga? If I'm one of those rare individuals that experience no side affects, or minimal, then why take Prednisone? I'm not saying I'm one of those rare individuals, but it just makes sense to me to find out what side affects I experience before I treat them. Maybe I can live with the side affects, maybe not, but shouldn't we find out first?

2) Another contention I have is this; Approximately 45 minutes after I take the Prednisone (one in morning and one late afternoon), I get the hot flashes. It happens twice a day. I'll explain why this isn't a contradiction to 1); it "seems" that the Prednisone is causing the hot flashes. I don't get them at other times during the day. Usually 45-60 minutes after taking the Prednisone. Along with this and 1), if the Prednisone is supposed to deal with the symptoms of the Zytiga, and hot flashes are a result of Zytiga, and I take the Prednisone and still get hot flashes.....then again, why take the Prednisone?

Mind you, these hot flashes don't hit me as "trivial" things. I can be sitting in a controlled temperature room, and when the hot flashes hit I break out in a sweat....a serious sweat. All over my body, it drips off my face and my hair and clothes get wet from it. I still work fulltime with overtime. I'm currently working 12 hours a day. Much of my work is outside involving large steel structures, which requires me to be on them. And while the temperatures have been decent, my concern is; whats going to happen with the side affects when I'm on a building in 100+F degree temperature?

My Oncologist never mentioned that Prednisone is hard on the stomach. When I emailed him about the hot flashes he prescribed Oxybutynin. Again, if Oxybutynin takes care of the hot flashes (which it doesn't) then why wouldn't I take that instead of Prednisone? It's really frustrating. I hate taking pills, any pills. I went from somebody who didn't take ANY pills 8 months ago, to now taking 8-10 pills a day. And to top that off, as I stated above, now I take a pill to counter the side affects of a pill that I'm taking to counter the side affects of another pill. It sounds like a downward spiral..........

......if the cancer doesn't kill me the treatment will.......

16 Replies

You misunderstand why Prednisone is given with Zytiga. Zytiga impairs the adrenal glands' ability to manufacture cortisol. So you have to REPLACE what was lost. The dose of prednisone is very low - it only replaces what is lost. If you don't use it, you will suffer certain symptoms, due to ACTH excess, including hypertension, hypokalemia, and fluid retention. You are not taking enough prednisone to cause symptoms related to cortisol excess.

You are taking prednisone to replace the amount manufactured during natural circadian rhythms. Hot flashes also occur during the natural circadian rhythms of body temperature. So the effect you observe is not causal.

Oxybutynin is given for bladder spasms. I'm not sure why it works for hot flashes, but it seems to. If you want to avoid taking another pill, acupuncture has reduced hot flashes in randomized clinical trials. Effexor has also shown some efficacy. Estrogen patches are very effective taken with tamoxifen to prevent gynecomastia.

DaC00tie in reply to Tall_Allen

Well it sounds like my oncologist hasn't exactly been forthcoming about Prednisone. And without having this knowledge beforehand, it makes it difficult to ask him the questions when I don't know what questions to ask. When I prompted him about how long I will be on Zytiga and Prednisone, his response was......"indefinitely".

Tall_Allen in reply to DaC00tie

"Indefinitely" is true. No one can predict for the individual how long Zytiga will be effective before resistance sets in.

adlerman in reply to Tall_Allen

A lot of Doctors would seem to benefit from a course in communicating. "Until it stops working for you. It varies from person to person." IMO that would have been a better response than indefinitely which for some people means forever.

adlerman in reply to Tall_Allen

If only drugs worked as precisely as the label says.

My first inclination is to suggest that you keep getting your head around the idea that you and yours are in this for the long term, regardless of how long any individual treatment may actually work. With advanced disease and treatments that lower Testosterone, you will likely be dealing with some level of hot flashes and other side effects indefinitely.

After a while, your peak energy, stamina, and ability to work in the heat may continue to decline, despite your best efforts to stay active, eat a generally healthy diet, and do some good intentional exercising. You may want to start thinking now about your eventual transition away from the kinds of roles and work you have been doing, and transition to other things that may bring you other practical benefits and different satisfactions. Explore your future options and timing considerations for a possibly reduced work load, or a transition to another less demanding job, or a possible disability claim, or an earlier retirement, or some down-sizings, and similar transitions of potential insurance coverages as you continue to live with your disease. Maybe do some estate planning, too. Maybe not all right away or all at once, but sooner rather than later. Some of the time during your current initial treatment might be a good time to start thinking along such lines.

Don't be surprised if just going through some of these kinds of things generates some perfectly normal emotions of sadness over the thought of losing former capabilities and filling former roles due to the combination of your disease + normal aging. It can also bring a sense of positive control, accomplishment, and intangible satisfaction.

Just some thoughts...


DaC00tie in reply to ctarleton

I appreciate your input. Many of the things you have mentioned have already been running through my mind and dealing with it. Keeping my medical insurance is a necessity, therefore working. But, I do have double pensions coming so I am looking into early retirement on a medical. I've been asking those questions and getting what information I can on that. Currently, I'm still early into my treatment as you mentioned, so at this point I'm on an information gathering phase before I make any decisions. Thank you for your response.

Was prescribed 600 mg Gabapentin for foot neuropathy. Didn't seem to do anything for that, but hot flashes almost all went away.

I don’t know what you have read, but as a person who took 30 mg of Prednisone a day, 20 mg in morning and 10 mg 12 hours later for 180 days ( six months), I was told by my research Medical Oncologist, that Prednisone has PCa cell killing properties. During this period, I had weekly blood draws. Armed with three pages of results, he was the best guy to see how my body was reacting. Results that a Pharmacist never saw. I was told up front that I could expect weight gain. And sure enough, over the six month trial, I gained 80 pounds from the Prednisone and Eligard/Lupron injections. Small price to pay, to kill this bastard disease in my opinion. Gain the weight, then take it off through diet and exercise. I my case, that meant three workouts a week with a Personal Trainer several years later. Why didn’t I do this immediately? I was fatigued from all the drugs administered to kill cancer cells.

I also was told to stay out of the Texas heat in the summer. Wondered why until all strength was zapped. You might discuss 100+ heat and your cancer treatment with your Oncologist and Cardiologist. I believe that you are dealing with known side effects and not understanding the impact that cancer drugs play on your weakened system.

Results. I started my journey at 187 pounds 15 years ago, ballooned up to 299 pounds. Today at age 71, I am 225 pounds. My Cardiologist says 220-225 pounds is a good weight considering where I was and all of the drug induced effects on my body.

Question, are you sure that the bulk of your hot flashes are not derived from Lupron? I experienced them for the six year period that I was on Lupron, but the eventually faded away as my body adjusted to hormone injections about two years later. Good luck in killing this bastard.

PS. In reflection, as I aged, my physically activity aged also. :) I stopped fighting wars and surfing at 27; stopped playing fast pitch softball at 40; stopped climbing at 55; damn near stopped all physical activity including mowing the grass at 57 and concentrated on killing cancer and less strenuous activities. Right or wrong, it is what I did.

My advice, deal with your cancer and understand the changes that your body is going through. Age and time in treatment is really insignificant.

Keep killing the bastard. Stay positive.

Gourd Dancer

I really appreciate your response. From the questions I've asked my oncologist and pharmacist, and everything I've read so far, up to this point I hadn't heard that Prednisone had any affect on the cancer itself. I'm still early in my treatment. Lupron injections, so far I've had two. 1000mg Zytiga once a day right before bed. And 5mg Prednisone at 4am and another 5mg at 5pm. During the first month of taking these meds my PSA went from 23.8 down to 0.4. I'm looking forward to my next test results which will be in about two weeks. I've been working out 3 days a week and changed my diet. In retrospect I imagine that if I wasn't doing those things that I would feel worse than I do. I try to remain optomistic, which I normally am. My perspective is one of curative treatment. While it may not be curative or not, that's the frame of mind I'm using. I'm not surrendering to the ideal of doom and gloom, which would be the easy way. In the meantime the wife and I plan something every weekend and I dusted the Harley off and have been riding it more. Next month is a trip to Hawaii for 10 days, one of the islands that I haven't been on yet. Thanks again for your response.

Hirsch in reply to DaC00tie

The Lupron is contributing to the hot flashes. I know you should be better off getting opinions from some of the more knowledgeable members here ratherthan your pharmacy. The pharmacist in question obviously did not know the need for combining prednisone with Zytiga. Your numbers look great. Good luck

A quick search confirms what I was told over 14 years ago that Prednisone helps to induce cell apoptosis. And that is the name of the game - for the little bastards to die!

Study from 1998:

“To evaluate the effects of prednisone on prostate-specific antigen (PSA) in a cohort of patients with "hormone-refractory" prostate cancer. Data were collected from 29 consecutive patients with hormone-refractory progressive prostate cancer who were treated with 10 mg of prednisone orally two times a day. Patients were included in this analysis only if other factors known to influence PSA levels (antiandrogen withdrawal, radiation, and/or other concomitant anticancer therapies) were definitively excluded as potentially confounding variables. The mean and median PSA decline after initiating prednisone was 33% (95% confidence interval [CI] 20% to 46%) and 24% (range 0% to 99%), respectively. Ten patients (34%) had a PSA decline of more than 50% and 4 patients (14%) had PSA declines of more than 75%. The average and median time for progression-free survivals were 2.8 (95% CI 1.7 to 3.8) and 2.0 (range 0 to 11) months. Four (14%) patients had PSA declines lasting 6 months or more. Median survival was 12.8 months. Additional analyses indicated that a PSA decline of more than 50%, compared with less than 50%, was associated with a longer survival. Toxicities included steroid myopathy (n = 4), new-onset diabetes (n = 1), and dyspnea (n = 1). Prednisone (10 mg orally two times a day) can decrease PSA by more than 50% in approximately one third of patients with hormone-refractory progressive prostate cancer. On the basis of comparisons with other data sets, we hypothesize a dose-response relationship between glucocorticoid dose and PSA decline.”

Different study published in April 2018:

“... Prednisone, in turn, is a glucocorticoid that is used to improve symptoms such as pain [6]. It was also shown to inhibit cell proliferation and induce apoptosis in prostate cancer cells [7, 8] , and thus decrease the level of prostatespecific antigen [9]. Accordingly, in multiple studies, prednisone was shown to promote anticancer activity of docetaxel [10][11][12][13][14] . ...”


My Stanford doc told me, when I challenged her regarding the same thing, that prednisone was used to replace the steroids you are losing due to the Zytiga. I wanted to stop this too but they said absolutely not.

DaC00tie in reply to Ldtyson

I too am going through treatment through Stanford. Dr. Shah. Did your doctor tell you what the results would be if you stopped?

Ldtyson in reply to DaC00tie

No they did not. I just trusted Dr. Shrinivas' opinion at this point. On my next appointment I will have a detailed agenda I will send in advance through My Chart. I also voice record all my appointments for playback later so I don't miss anything.

Taking Zytiga + Prednisone + Trelstar injections 4 yrs now. Side effects manageable but annoying. Hot flashes/sweats tiredness and muscle loss. All the best

In future treatments👍🏻

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