If just Lupron is keeping your PSA at <.1 looks like you are better off not adding Zytiga or Xtandi...if Lupron fails to control PSA Lupron + Chemo might be the way to go. With the drugs that target the androgen receptors look what can happen when they fail and force the cancer to adapt. Looks like there is no free ride and the so called OS extension might not hold up longer term. Xtandi and Zytiga are great drugs but why take them if Lupron is working by itself. This is just one of many published studies that show what can happen when the AR receptors are targeted.
The problem with abiraterone and enzalutamide is cross resistance. Use one and the other will be less effective as a future treatment. I think the first step in the "dance of the androgens" should be bicalutamide. It buys time and doesn't close off future options.
This is a presentation by Charles Snuffy Myers in 2016, titled Path to durable remission in prostate cancer:what do we know and what do we need to know". I thought it touched on the issue of treatment induced mutations in a reasonably considered way.
Guys you are reinventing the wheel. Studies were done that concluded in 2017 that were exactly on point. They compared Early use of Zytega with lupron for newly diagnosed stage 4 PC patients vs lupron alone and then watched how many people lived and how many died. Over 40% more of those that used both were alive at about 5 years. Most oncologists that worked in the Prostate field saw this as a huge breakthroughs ending the old ways of using lupton until it failed and then starting Zytega. Guys this is undisputed by those in the know.
I’m one of the 1900 on this regime. Currently at 7 years. It’s worked remarkably well for me and a great many others, but does not suit all. PSA @ dx was 571, currently immeasurable. It would appear that as it cuts off two pathways of testosterone, it delays mutation to CRPC.
I have avoided Lupron for 14 years. At 56, I figured that I would be CRPC before age 60. Now at age 70, I suspect that I would have been long dead.
When the new drugs came out, I wondered if the right combo might delay CRPC significantly - enough to satisfy someone aged 56? The problem is, the more you cut off the androgen receptor axis escape routes, the more likely that you will induce a CRPC form that is extremely difficult to manage.
In fact, Johann de Bono worried about this in a video discussion. Basically, he said that as wonderful as the new drugs are, doctors are ill-prepared for drug-resistance.
His depression can and should be treated. Many Cancer facilities have Quality of Life centers that offer counseling and evaluation ...often for no cost. See what help is available and take advantage of all of it. I see a Counselor once a month and it really helps to have an outside of family person to talk to.
I found that increasing testosterone via androstenedione (which was otc back then but illegal now) & controlling estradiol with chrysin (plus bioperine for bioavailability) stabilized my PSA. My integrative doc ultimately prescribed AndroDerm & Arimidex.
After some years, PSA reverted to its 3-6 months doubling time & I began using the supplement you mention - 3 months on (no T) / 3 months off (with T). Late this year, on a whim, I switched to BAT: I inject T on the first of the month & use the supplement on days 8-31.
I must say that I like the 3 month cycles better. 3 months castrate is quite bearable & 3 months high T is wonderful. It actually takes me a week to feel the full benefit of T - the BAT cycle is too fast.
Throughout the 3 month cycles, my PSA doubling time has been 3 months during the 3rd month of T. Scary, but I have had better control (no CRPC) than I think I would have had with Lupron.
I had my radical prostatectomy in October of 2002. I had radiation in 2003. My PSA stayed below 4 until 2012. At that time I went to MD Anderson in Houston and had a bunch of tests run. There were no Mets but they told me that I should start Lupron immediately and possibly look at a test of zytiga. I went back to my Mo and he suggested I start a regime of casodex daily. I take 50 mgs of casodex every day and now my PSA is at 1.5. my doctors at the Mayo Clinic here in Scottsdale are saying that I should also go on Lupron. When I hear about someone like you who is in the same position as me I am always curious and try to reach out to them. What do you think?
Well, I never thought I could avoid Lupron forever - I always expected to be forced to use it sooner or later, & more sooner than later.
Recognize that my 3 month cycles do involve 3 months of castration every 6 months. I figured that intermittent ADT fails within a few cyles because the castrate period is generally too long, e.g. 12 months. I hoped that the cells wouldn't become too resistant after 3 months & that high-normal testosterone [T] would turn back the clock.
I could have opted for monthly cycles - I think it's worth trying.
Nothing magical about his procedure. It seems designed for study convenience - full-time Lupron & a once a month injection of T cypioniate. The key is rapid T cycling & you could design your own protocol with that in mind.
I started reading about castrate resistance and DES is way superior to Lupron in this regard...DES can prevent castrate resistance while Lupron promotes it. I think a good protocol would be: DES - Indomethacin - Xtandi - Apigenin. This protocol might be safer than cycling with T...there are some papers out there that suggest BAT promotes metastasis to the Liver. That is scary because it is almost 100% fatal.
The case for switching to Lupron (in 1985) from DES (after about 40 years) was mostly related to high-dose DES & blood clots. IMO
Clots don't worry me since I use nattokinase & monitor D-dimer. & I know a number of men who have safely used low-dose DES for quite a while without getting CRPC.
I am going to try DES - Xtandi - Indomethacin - Apigenin....the idea being to control the cancer and at the sane time block some pathways to castrate resistance
IMO the only reason you have had such good results is because your are doing DES+T and not Lupron+T...virtually no one in the BAT trials has gotten anything close to what you have achieved...the results are short term..even reversing resistance to Xtandi was 4 months then progressively shorter...you should be pushing up grass and would be had you not taken your treatment into your own hands..you know the story about DES and why it was replaced by that poison Lupron
In my 22 year journey i have been on HT three times. 1) Eight months in 1996, 2) Eighteen months in 2013, 14, 15. 3) Eighteen months and continuing in 2017, 18. My last visit with MO in November 2018 PSA increased from .07 to .09. MO suspects cancer is morphing to Neuroendocrine PCa. No blood work yet to confirm. Presently taking Eligard and Erleada. Next blood work scheduled for May 2019. I don't want to wait 6 months so I am going to ask for script to get a 3 month blood work. In the last few years I feared when or if my PCa would morph to Neurocrine PCa.
At my last Duke appointment with my MO I asked what is the best thing to do to delay the development of MRPC as long as possible. I have been on Lupron for 8 months and my PSA is undetectable. He said the thing to do is to keep the PSA as low as possible, which it is. Therefore he does not recommend adding other drugs at this time. Hopefully I am getting the right information as far as current knowledge is concerned.
Crap. Take home message: If the cancer don't kill you first, the drugs you take to kill the cancer will kill you. Did read both links. The first one and Thirdly paragraph was way depressing, Snuffy Myers link was way long and didn't understand a lot of it but apparently we are all lost in a cornfield. I need to go outside and get some sun after this week of very depressing weather. But also need to do some online x-mas shopping. Was in a retail store the other day and in the old days would have yelled "hey, can we get some more cashiers down here". But I no longer have any balls and just shuffled along like the children in the Pink Floyd hey teacher leave those kids alone video. (had to look up Pink Floyd! damned lupron). Yes sir, prostate cancer is a brick wall. I hope we can tear it down.
Hey monte give cash screw the presents. Avoid the traffic, problem parking, selecting gifts, waiting on lines to pay etc. cause most of the presents will be returned for refunds anyway. Pink Floyd? I'm so old I knew him as Red. Forget about tearing down walls just pretend you're an illegal alien and climb over.
This post sounds kinda relevant to me I think. So I haven't read all the replies, but I think it is related to how aggressive the cancer is to start with. Initially Diagnosed, PSA over 10,000. mets in 5 places already. On hormone therapy permanent since start and started three and half months of chemo 2 months from diagnosis. A little break in October/November but by end of November highly recommended zytiga. When the cancer is so aggressive, there is little to lose fro starting new treatment. We don't have the luxury to wait. Scans showed cancer progression, so what would I be waiting for being off treatment? Maybe if PSA is low their is all these decisions. But my stage of stage 4 needs aggressive treatment
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Xtandi or Zytiga?
Lupron injection with xtandi
Next steps after Xtandi and Zytiga 
Zytiga is slowlyletting us down
Xtandi added with Lupron 
