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Advanced Prostate Cancer
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Enzalutamide Resistant already?

After my husband's PSA did not respond to zytiga, after rising post docetaxel while on Lupron and Casodex, he was switched to Enzalutamide. His PSA went from 6 to 1.0 ( August to September 12) in a month, now a month later( September 12-October 28) it's already back up to 1.6. Is he really already resistant?

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I would suggest that I have seen many cases including mine where the psa will go up a little and than down again, especially with a .6 rise I would give it a while. It is important that we get the most out of the limited therapies that we have, I say stay the course. I am not a Dr. just long time patient who has read many post and been through all therapies

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Thanks Dan59, this cancer sucks!!!!!

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Hubby’s PSA started going down rapidly during Docetaxel and then suddenly one month it shot up again. Dr. Said this was normal during chemo. Unfortunately the 5 cycles of chemo did not work. Cancer continued to spread.

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with a capital S.

Good Luck and Good Health.

j-o-h-n Friday 11/02/2018 4:32 PM EDT

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Need to know more. I'm not a doctor. I have stage 4 prostate cancer, M1, 5 month doubling time , Gleason 9, PSA 31 at diagnosis. Currently I've been on Lupron close to 7 years, 2.5 on Lupron alone. Currently I've been 3.9 years on Xtandi and Lupron. PSA has been .02 for 3.5 years. So, how old is he? Does he smoke? How long has he been diagnosed? Does he still work? Did they keep him on Lupron while they tried Zytiga then Xtandi. Does he take supplement? PSA at diagnosis? Things like that would be helpful.

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I would get two more PSA values to decide if he really became resistant.

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If he did not respond to Zytiga, it is likely that he will not respond to Xtandi very much either. Maybe see if his PSA goes over 2 and a bone scan is showing progression before writing it off completely.

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As far as I know, it is not recommended to change treatments based on PSA alone.

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When Casodex quit working for me, I switched to Nilutamide and my PSA went back to undetectable in 3 months. I am still on Nilutamide 6 years later. Other antiandrogens are Flutamide, Apalutamide and Darolutamide. Enzalutamide may work, just give it a couple of months.

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Just goes to show we never know which ones will work, so we have to try them all, and get the most out of all medications. I responded well to nalutamiide/nilandron as well, beofre switching to keto.

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As already mentioned by Tall_Allen if he is resistant to Zytiga he will be more likely also be resistant, or develop resistance more quickly to Xtandi. The best way we currently have to monitor and confirm resistance is with a genetic blood test call the AR-V7 test.

This test should be paid for by Medicare after December 10, 2018.

There might be a way to reverse resistance to Xtandi. This is totally "off label," unproven and out side of the envelop.

Joel

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We’ve been so surprised several times during cabitzitaxel and xtandi to see it rise several times then drop. Emotional rollercoaster. From pulling out the POLST form, then making plans six months out.

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My husband’s PSA went up slightly too and then down. He got a good 6 months on zytiga and about four on Xtandi.

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