Zytiga and ADT : I'm interested in... - Advanced Prostate...

Advanced Prostate Cancer

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Zytiga and ADT

jsmith2506
jsmith2506

I'm interested in opinions regarding late edition of Zytiga to ADT treatment. I was diagnosed state IV, Gleason 9, 4 bones metastases with PSA of 11.2. I was started on ADT and so far doing well.....PSA is fluctuating between .01 to .06 over 18 months, I started treatment 5/2017) During that time in my research I began to notice that the standard of care at this point that with my current assessment that Zytiga/Prednisone is given with ADT at diagnosis for longer remission. However, I was started only on ADT (Lupron/Zometa/Biculatimide). My question is: Is it too late to start Zytiga with ADT to extend remission? Much of the reports I have read indicate that it should be started when ADT is started. So was wondering if its too late to get an efficacious remission. Thanks for any comments or suggestions or opinions.

34 Replies
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I don't think there's a cut-off point called "too late" in this line of treatment. Zytiga initially showed improvements in the castrate resistant group of patients many of which would be on classic ADT for an extended time prior. Later, Zytiga was tested in early stages of PCa progression and showed even better results. Thus, we can assume the earlier the better but there's nothing stopping you from starting later. You have quite low PSA for just ADT alone, did you have RP or radiation?

Welcome to the forums!

jsmith2506
jsmith2506 in reply to henukit

No, I didn't have RP or radiation...thank you so much for your relply…...

henukit
henukit in reply to jsmith2506

You have an excellent response to hormone therapy. Talk to your MO and discuss possible options. It could be 6 cycles of chemo [docetaxel] (per CHAARTED trial) or Zytiga (per STAMPEDE).

I just finished chemotherapy and the tumor completely gone. I started quite higher than you, PSA went from 500 to 0.4 (you can see details in the profile). At the moment, I'm looking for the next steps and most likely it will be Zytiga.

jsmith2506
jsmith2506 in reply to henukit

Thanks so much for your response....I see my MO Tuesday...I will discuss these things. Wanted to arm myself with some experiences of others to share with the MO. I appreciate your reponse very much......

I'm in the same boat and trying to decide on Zytiga introduction. Existing observations tell the earlier is better cause as we saw from few trials that later stage effect is less compared to early. There's no data on how early introduction affects onset of castration resistance. I guess one has to decide following gut feeling or simply throwing a dice )))

jsmith2506
jsmith2506 in reply to henukit

:)))….it definitely feels like playing dice with this disease sometimes...I appreciate your response.....

Wow....we are similar on this...I appreciate the opinion.....actually I was thinking in this direction and my MO 3 months tended to agree....thanks for your response....

Read the section titled "What happens if they are used later?":

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

thank you for this article...this will help in discussion with MO

spikezoey
spikezoey in reply to Tall_Allen

Isn't that referring to Zytiga with chemo (docetaxel) versus Zytiga with Lupron, which is what jsmith2506 is working with?

Tall_Allen
Tall_Allen in reply to spikezoey

No.

And definitely go read all that Tall_Allen posted. Doesn't mean you will know what to do for sure. But it will upgrade your regular dice to icosahedron like. :)

jsmith2506
jsmith2506 in reply to henukit

LOL....!! Thanks so much....20 faces certainly are better than 6 though maybe more confusing.....but confusion, contradiction and not sure yets seem to be a part of this new journey.....lol

Hidden
Hidden

Folks, the wait and react is not the way anymore, recent clinical trials suggests full attack strategy up front. Lupron, Casodex, Zytiga/Prednisone is the first wave of barrage!

Yes, I'm 66 and in good health, regular moderate exercise, good diet..I do take a statin for high cholesterol, but otherwise doing ok.....I feel great....I'm keep anticipating the ball dropping one day and all hell breaks loose...which is not healthy thinking of course....:))) But sometimes its difficult not to....but even Lupron has not given me any major side effects....I've had some mild hot flushes, but otherwise that's all I've noticed.....so I seem tolerate side effects well....so starting Zytiga or chemo doesn't scare me like it used to....but we shall see....MO will help me direct the next steps of the journey....I'm not resistant yet so putting on more aggression at this point may be wise.....thanks so much for your opinion.....I have learned so much on this chat site....I'm so grateful its here.....:))

Schwah
Schwah in reply to jsmith2506

Start the Zytega. Its proven to work better earlier than later. Not even a question in my mind. 42% reduction in deaths when used early with adt. Now no tests for starting it a little late like you are but isn’t it pretty obvious it will be better. Some MOs including mind think that agressive early treatment with only a few Mets (ogliometastisis) like you can achieve a long term remission or even a cure. He also had me do radiation on my three mets which new studies show may be somewhat curative. And as a bonus add Celebrex to your zometa. Low side affects and One of those trials (Stampede I think) showed the combination to reduce death by 22%. Go hard and do early. The Zytega was a breeze for me anyway. Tall Allen knows more about it.

Schwah

My MO agreed to switch me to Lupron + Zytiga + Pred after 9 months of Lupron + Casodex. He said let's stop the Casodex and try the Z + P for anther six months and then see what happens. I am oligometastatic, had SBRT, and had a good response to the first 9 months of ADT, but like you, wanted to be more aggressive. They have no good data to support the switch and really don't know how long to do it for or if it will make any difference, but since I asked he agreed.

Edited to add, I feel better on the Z + P than the Casodex. Perhaps it's the Pred. 5mg/day.

My Dad has the same Gleason score as you and he was started on Lupron immediately than we did Provenge along with Lupron then about 2 years later he was put in Zytiga along again with shots and doing well Praise God. So for my dad he started a little later than I read from other cases. Good Luck

That's great and glad your dad is doing well.....thanks so much for the response

It sounds like you are still hormone sensitive. It’s not too late to start. For those of us who were diagnosed before the addition of early docetaxel or Zytiga + prednisone was approved for low volume (oligometastatic) PCa, they can be added to your treatment protocol after starting ADT, and the sooner the better. I don’t think there is a cutoff date.

I was diagnosed in 06/2015 with Stage 4 oligometastatic PCa. Gleason 7 (4+3) with one bone mets to the right inferior pubic ramus. I didn’t add a course of docetaxel until 11/2017 when it was first available for low volume guys like me.

I was initially put on ADT with Lupron + bicalutamide right away. Dropped my PSA to undetectable and testosterone to <7 within a few months where it has (thankfully) stayed in the 3 1/2 years since then.

Also, my one pelvic bone tumor sort of faded into oblivion (interval resolution) on its own over 2 years ago without SBRT, after my Mayo M.O. and I consulted with a Mayo Radiation Oncologist about possibility of doing SBRT back when it still showed up as a hot spot. It has stayed inactive as of my most recent bone scan in 07/2018.

My Mayo Jax M.O. wouldn’t do chemo at first, because the clinical trials apparently didn’t show a statistically significant increase in PFS and OS for oligometastatic guys like me, and it wasn’t approved. They later determined there was enough of an advantage to allow it’s use for oligometastatic patients, at which time my M.O. offered it to me, and I jumped on the chance. After our discussion, we decided on 6 cycles of chemo with docetaxel at 3 week intervals rather than Zytiga. The chemo side effects weren’t much fun, but they were tolerable and fairly predictable, and once you’re done, you’re done. With Zytiga it’s a continuous process and while you may have milder (or at least different) side effects, it is for a much longer time period. Also, it saves the Zytiga for later. My M.O. said adding Zytiga right now will not provide a significant additional benefit, but I would still have to deal with the side effects.

Hopefully, you will have the choice to add either chemo or Zytiga. With the help of your M.O. pick the one that is likely to be the best option for your individual circumstances.

I’m not advocating anything for you, just letting you know how it worked for me.

Best wishes!

Thanks so much for this information. When I was first diagnosed my MO ask if I was more interested in quality of life or a cure. Being ignorant of anything going on I went for quality of life. I think that's why the MO is going for a less aggressive protocol. I didn't realize at the time that chemo has improved a lot, and al though the side effects are significant apparently its not as bad as I imagined in my mind. Therefore, I discuss with the doctor on Tuesday regarding a more aggressive approach. Will see how that discussion goes and go from there. Thanks so much for sharing your history. I have learned so much on this site that I can hardly express my gratitude for it. Thanks so much and glad to hear you're doing well....

henukit
henukit in reply to jsmith2506

Don't slap yourself, it's all individual. I jumped right on chemo because I had sky high PSA with large volume tumor trying to fill the pelvic. This was a no-brainer to chemo-debulk asap. We did discuss Zytiga vs chemo and the choice was easy at that point. Now, being clear from it I can do either: RP, RT, Zytiga or all in a succession. Discuss with MO, get 2nd opinion and you'll feel more confident making decision.

jsmith2506
jsmith2506 in reply to henukit

That all makes sense to me.....thanks for the input....any information helps.....thanks so much..

Just wondering if you're pathology on your biopsy red any ductal histology as I presented the same low PSA couple of dates and a 9 on the Gleason and Bone Mets only one I've been on Lupron only for 18 months PSA .01 Lupron kicking my ass though I still try to work construction can only go about 6 hours a day lucky I work for myself fellow brother in arms Kevin

Yes...some of the seminal duct was involved...sounds like you're having a good response ffrom from ADT...wishing u continued luck

Had my prostate removed Feb6th 2018. PSA was 91.7 Aggressive cancer 3-4 grade. Had a Lupron Shot Feb14th. About 2 months later,, started Radiation,,39 days. About a month after radiation,, started Zytiga and Predisone,, 4 tablets,and 1. 1st test PSA was <.01. November 15th 2nd test. Both my radiation guy and urogoly doc wanted me to start Zytiga as soon as possible,,like 6 months. Been on it for 2 months now, 22 months to go. Also had my 2 Lupron shot. Next one if in Feb.2019. Wish you the best. Side effect mostly Hot Flashes ( Suck). Other side effects not to bad,, tired a lot,, some muscle lost. Good Luck, just remember losing 1 battle doesn't mean you lost the war. hahaha

Thanks so much for taking the time to respond. Sounds like you're doing great. Hearing other's stories is very encouraging....thanks so much and wishing you continued progress....

I started taking (along with Lupron) Zytiga/Prednisone 8 months after last chemo treatment of docetaxel. I wanted to keep aggressive with this disease. My MO at Mass General Hosp in Boston agrees with my aggressive approach to fighting this disease. Other than the side effects of fatigue, I feel great and have a fantastic life.

My Husbands MO threw the kitchen sink at him... Lupron first,

Zytiga 30 days later,

Jevtana 45 days later (10 total rounds complete) and today is his first Radium injection. PSA undetectable, sex life still good, he fights the fatigue w/regular exercise (weight training, cardio) and a nap if necessary.

Sending love n light to ALL OF YOU GREAT WARRIORS!!

to jsmith2506: You ask a question and va-voom, look all the responses you get. Ain't this a great site? As for as shooting craps is concerned and you want to teach a particularly bad die a lesson by “punishing” it, put in your freezer (next to your ex-wife's body).

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 11/08/2018 5:32 PM EST

jsmith2506
jsmith2506 in reply to j-o-h-n

LOL....!!!! Thanks for the advice.....and yes, this is an awesome site. I've learned so much.....

Last month at the European Society of Medical Oncologists (ESMO) annual meeting there was a report on a study that showed good results from radiation to the prostate in newly diagnosed metastatic PC patients, especially those with fewer mets esmo.org/Press-Office/Press...

You are still pretty early in your treatment, so this might be something you should ask your oncologist about, or maybe get a consult with a radiation oncologist who keeps up with the state of the art. Of course, it’s possible that Medicare might balk at covering it right now since it's so new.

jsmith2506
jsmith2506 in reply to BruceSF

Thank you Bruce....I will bring that up with my MO.....thanks so much....

Traditional ADT shots shutdown testosterone from the testes. Zytiga shuts off other sources that also produce lesser amounts. This includes the adrenal gland which is why you have to take prednisone to compensate for the lack of cortisol production. Talk to your MO for advice on when to start.

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