Choice of Zytega vs chemotherapy

[Dino24]

I was recently diagnosed with prostate cancer with metastasis to multiple areas of the spine and pelvis. I have started Firmagon injections, 2 thus far and psa has dropped from 22 to 0.5 in 5 weeks. I had a second opinion at Yale/Smilow Cancer center today and the Dr. recommended switching to Lupron with a choice of chemo or Zytega. I would appreciate any information to help me make this decision soon as there is apparently a 3 month window to begin with best results. Thank you all. These message boards are very helpful.

[Tall_Allen]

It's controversial, but I would lean towards chemo first if I had multiple (4 or more) distant bone metastases or visceral mets, Zytiga otherwise. Here's an article discussing options:

pcnrv.blogspot.com/2017/06/...

[Dino24 in reply to Tall_Allen]

Thank you for the article

[Dino24 in reply to Tall_Allen]

The doc said it was a matter of choosing which side effects you wanted...like a menu. He said the chemo may leave me with numbness in my fingers and feet and as a practicing chiropractor that wouldn't work. I need to look up and see if those are long term effects.

[Tall_Allen in reply to Dino24]

Neuropathy is usually temporary but may last several weeks to several months. Keeping fingers and toes iced during the infusion may mitigate neuropathy. Zytiga has the same grade of side effects, although different in kind.

[tango65]

Recent meta-analysis give an advantage to Zytiga or do not show any significant difference between Zytiga and docetaxel in overall survival

ncbi.nlm.nih.gov/pubmed/290...

ncbi.nlm.nih.gov/pubmed/297...

ncbi.nlm.nih.gov/pubmed/302...

ncbi.nlm.nih.gov/pubmed/295...

[Tall_Allen in reply to tango65]

STAMPEDE actually RANDOMIZED patients to either Zytiga or Docetaxel and found no difference. This is MUCH more definitive than any meta-analysis based on retrospective data.

academic.oup.com/annonc/art...

[tango65 in reply to Tall_Allen]

I agree. I posted the link to the Stampede study (last one in the post)

ncbi.nlm.nih.gov/pubmed/295...

but I forgot to mention that it was a direct comparison.

[Tall_Allen in reply to tango65]

Yes - not all research studies have the same value

[Schwah]

I did both. 4 rounds of chemo and lupron and then immediately started Zytega and lupron and ive continued that for 14 months. PSA steady at an undetectable .02. My MO’s theory was that all studies showed lupron plus Zytega early was better than either alone and chemo and lupron early was also better than either alone. So if A+B is better than A or B alone and B+C is better than B or C alone then shouldn’t A+B+C be even better ? Most of the recent studies have shown earlier is better than later. I asked for a second opinion at ucla and they said it made sense and that they’d love a clinical trial with all 3, but, until there is proof they could not recommend. Although they saw nothing in the chemical make up of all 3 that should negatively impact the other 2. Anyway that’s my choice. Good luck with whatever you decide.

Schwah

[Dino24 in reply to Schwah]

Thanks. I was wondering the same thing regarding all 3 at the same time

[Schwah in reply to Dino24]

Yes a little out of the box but seems like a logical next step. Both the early lupron with Zytega and the early lupron with chemo reduced deaths 40% plus over lupron alone. Seems clear that the chances are very good that all 3 would be even better. And....I started zometa with Celebrex which clinical trials showed to reduce deaths 22% with minimal side affects. Remember that HIV was once incurable until a “cocktail” of a number of drugs was able to give people durable remissions.

Schwah

[AlooGobi in reply to Schwah]

Schwah,

We’re in a very similar boat. I’m a very young guy (42) dx’d with Gleason 9 oligometastatic PCa, 3 bone mets - one in each hip and micro at t4.

DX’d in July w Psa at 2.5 jump from 1.7 end of May. Mild urinary symptoms. Self referred for Mri to private clinic on a hunch.

Medical curiosity. They suspected small cell, and a genetic mutation. First oncologist gave me a handshake and best wishes.

No genetic mutation (3 major screenings), adeno not small cell, and no circulating tumor DNA whatsoever. Also had PSMa pet within a month. Onc said yes bet this one will light up! Didn’t light up. Just the 3 mets.

Down to .2 after one shot of Zoladex and a month of bicalutamide.

I too found an oncologist at a major centre who subscribes to the kitchen sink for oligo theory and am doing a trial with definitive treatment intent.

On Docetaxel, Zoladex, Abiraterone (and prednisone) and zoladronic acid concurrently. Asymptomatic but I cry at random tv commercials now.

Halfway through chemo. Surgery is next. Then radiation to the bed with curative intent at 100gy and SBRT to the Mets.

All to be done within 9 Months. If any nonsense, Germany is next. Young kid, family devastated, top of corporate ladder, all the things.

Nice meeting y’all.

[Fitzbruce1 in reply to AlooGobi]

I commend you on your aggressive protocol! My MO is too conservative for me. While I still feel good I want to kick it in the ass like you are!

Good luck to you!

[Spyder54 in reply to Schwah]

Schwah,Just came across your thinking above from a post 3 years ago. Isnt it crazy that now (TA & Scholz back then too) many believe A+B+C should be the SOC (standard of care)? Confirmation how good this HU site is, and has been. This HU site will probably be on the leading edge of CURE a year or two ahead of mainstream thinking.

Our best to you and yours,

Mike

St Pete (& Santa Barbara)

[Hidden]

No doubt, chemotherapy with hormone injections. I am biased toward early aggressive intervention. It worked for me over 14 years ago with mets to my spine. However, as your Oncologist a simple question, “Doc if you were in my shoes, if you were me today, what would you do? In 2004, I asked the same question to my two Radiation Oncologists. Both gave the same answe.... I would find the best Medical Oncologist out there who specializes only in Prostate Cancer, not a generalist, preferably some one in research and academia. Some who on top of their game and ahead of the curve.

Gourd Dancer

[Dino24 in reply to Hidden]

Thank you. The oncologist is the head of oncology at Yale who's specialty is prostate cancer

[spikezoey]

My husband opted for zytiga with degarelix (he had lupron but he got brain fog, which didn't happen with degarelix). He was diagnosed June 1, 2018. He's an avid bicyclist and had a double century ride scheduled for September (which he completed), so it was a no brainer to do something that would help continue his lifestyle. He is 51, gleason 9, mets all along his spine and in some other areas - i.e., too many to count. He started with alk phos 919 and PSA 239 and in three months is down to alk phos 70 and PSA 0.19.... so it's working. And if you didn't know he had cancer, you couldn't tell. He's since added metformin and avodart based on other studies showing that they help.

[Dino24 in reply to spikezoey]

Fantastic! I can relate to this as friends have told me I have never looked so fit, trim and healthy. I've been training for the Camino de Santiago de Compostela Frances pilgrimage for about a year. When I tell them what is going on their mouths drop. I really dislike telling them the situation the first time

[spikezoey in reply to Dino24]

I hear you! It's so astonishing to folks (it was to us as well!) that my healthy young (to me) hubby should have had such a crazy diagnosis! I'm glad you are still keeping active - that makes all the difference from what I've seen. Living with the PC instead of dying of the PC.

We've actually had the camino on our bucket list for a bit, so that may be on the docket for 2020. (We've already booked a ton of things for 2019, so 2020 it is.) We're pretty certain he's still going to be ok at that point (or we are planning for that, anyway), as average time before ADT failure on Zytiga + degaralix (or lupron) is 31 months, and hubby's very dramatic PSA drop in just three months points to it lasting longer.

Good luck in whatever you choose!

[Hirsch]

There is some opinion to start with Zytiga and ADT..

Then one adds doxataxel when Zytiga is no longer working..

[leo2634]

Hi Dino, I've been on Zytiga as my first line of treatments for 8 months now and PSA has been undetectable since first month. My MI opted for that first and so far I have no regrets. It does have some side effects hot flashes, ED but both are tolerable and manageable.

[Apollo123]

I took the Zytiga option so far it’s going well. 👍

[Shooter1]

Started with lupron dropped PSA from 62 to 6.5. Then added chemo which dropped PSA for first 4 cycles. Started to rise before #5 and added Xtandi (then on all three). Finished 9 cycles of chemo and terminated acct combined side effects were to great. Continued Xtandi at 160 mg until I was a complete invalid. Cut dose to 120 mg and started to improve within 3 days. Cut to 90 mg and was back to work as a Rail Road Engineer in 2 weeks after 75 days out of service. . PSA now steady in 0.130 range with 90 mg dosage. With PT physically improving every week. Now time to retire at 68. (middle of next week).

[Dino24 in reply to Shooter1]

I’m 68 also. Congratulations! Enjoy

[j-o-h-n]

to Dino24 (chiropractor):

Decisions, decisions decisions.... Make one and never look (at your) back....

Good Luck and Good Health.

j-o-h-n Tuesday 10/09/2018 6:02 PM EDT

[Hidden in reply to j-o-h-n]

I agree. When it comes to treatments, there's no rear view mirror, only the road ahead.

[j-o-h-n in reply to Hidden]

I once looked back and almost died when I saw my ex-wife standing behind me with a knife... Thank goodness I woke up.....

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 06/01/2019 1:13 PM DST