PSA went from 1340 to 2.4 in 2 months on Lupron and Casodex 50 mg

[bluephi]

Hi my name is Jim.I was diagnosed with prostate cancer and some lymph involvement In September 2018. My psa was 1340. My urologist put me on daily Casodex 50mg for two weeks before starting Lupron. I had my first Lupron injection on October 24, 2018. The first time I had my psa checked after starting this regimen was on December 20, 2018. My MO called me on Christmas Eve to deliver the news. My psa was down to 2.4 in such a short time. I will be seeing my MO on January 18, 2019. On my first visit with my MO, he suggested Zytiga instead of Casodex. In light of this drastic change in psa in less than 2 months on Casodex, my question to you all is should I stay on Casodex or switch to Zytiga as my MO suggested?

[GP24]

I guess nobody can tell for sure. Here is a video presentation advocating sequencial use of these drugs:

eau-bb-01.s3.amazonaws.com/...

I always ask myself, what do you do when the combination of Lupron and Zytiga does not help anymore? Apart from the side effects Zytiga has now.

[bluephi in reply to GP24]

Thanks GP24. I took a look at the video, however I didn't understand much of it.

[PGDuan in reply to GP24]

Thanks- interesting analysis.

[GP24 in reply to GP24]

I agree that the video is difficult to understand. You better read all the mentioned studies too.

You write "some lymph involvement". This could be a few affected lymph nodes in the pelvis, but these will not generate a PSA value of 1.340. You should have a bone scan to see if there are bone mets.

The NCCN guidelines recommend LHRH agonist(e.g. Lupron) + antiandrogen(Casodex) or Lupron + Zytiga as alternatives, among other alternatives. So if you would choose to continue with Lupron+Casodex this would meet the guideline recommendations.

The recommendation for ADT+Zytiga is based on the Latitude trial:

nejm.org/doi/full/10.1056/n...

This trial included patients with a Gleason score of ≥8, the presence of ≥3 bone lesions, or the presence of measurable visceral metastasis. So if you have no bone mets, which I doubt, this trial would not make recommendations in your case. This does not rule out that Zytiga will provide benefit in your case.

[bluephi in reply to GP24]

Thanks GP24.....I did have a bone scan in Oct. Nothing in the bones. I had a pelvic scan also and that indicated lymph node involvement. I am pleased to hear about the NCCN guidelines. Will see my medical team next month

[GP24 in reply to bluephi]

Then you are not M1 and Zytiga can be used but is not required. If you had a CT, they probably would not have seen the affected lymph nodes. Then you would be a very-high risk case and the treatment recommendation would be this:

nccn.org/patients/guideline...

Since affected lymph nodes are visible you are regional case and your treatment is described two pages further in this booklet. However, I would still try to get surgery or radiation. Here is a brand new study which recommends that:

mdedge.com/oncologypractice...

But continue with ADT after surgery or radiation! Most patients who did this lived for over 10 years in this trial:

ncbi.nlm.nih.gov/pmc/articl...

or a later report here: "The 10-year estimate for disease-free survival was 72% for both arms."

ncbi.nlm.nih.gov/pubmed/296...

[bluephi in reply to GP24]

Thanjs,...no bone mets

[Break60 in reply to GP24]

Very interesting. Thanks. My major takeaway was that with low volume disease , no advantage of Abiraterone or Docetaxel over ADT, and with high volume disease, use of either Docetaxel or Abiraterone is based on patient preference/comorbidities.

[elvismlv123 in reply to GP24]

These drugs are temporary to get the PSA very, very low. You cant take them more than 13 months. But you can retreat later when and if PSA rises. This way they will work for a very long time. Restraint in their use is what is important to prevent CRPC.

dominick

[bluephi in reply to elvismlv123]

Thanks again for the info

[Tall_Allen]

Zytiga has proven survival benefit in men with metastatic hormone-sensitive PC - more than you could hope for from Casodex.

[bluephi in reply to Tall_Allen]

Thanks tall_allen. Would it be better to wait to start Zytiga since psa has dropped so dramaticaly.

[Tall_Allen in reply to bluephi]

No. Start ASAP to build on that wonderful response. It is more effective if used earlier.

[bluephi in reply to Tall_Allen]

Thank you. I will discuss starting with mo next month.

[Shooter1 in reply to bluephi]

Started Xdtadi early( during chemo). Pushed hard and got PSA down to 0.140 range before side effects forced me to stop chemo. only to find that Xtandi side effects were the problem. See my other posts if interested in details. Hit it hard and early fore best results..

[bluephi in reply to Shooter1]

Thank you..,iwill

[Hirsch in reply to bluephi]

zytiga with prednisone is the standard of care..

[arete1105 in reply to Tall_Allen]

TA- question- Is Zytiga stronger than casodax for ADT? And is Zytiga the last defense before chemo? Is Zytiga only recommended for advanced pCa?

[Tall_Allen in reply to arete1105]

Yes, Zytiga is "stronger" than Casodex. The two drugs work differently and it is entirely possible to take them both along with a GnRH agonist/antagonist. Zytiga prevents adrenal and intra-tumoral synthesis of androgens. Casodex blocks the androgen receptor from being activated by androgens. Xtandi is a more powerful androgen blocker than Casodex. Zytiga is only a approved for metastatic PCa, hormone sensitive or castration-resistant.

[Monkeymamma]

I am not capable of offering a suggestion on the medication, but I wanted to tell you how happy I am to see your great results! To continued good health and happiness in 2019.

[bluephi in reply to Monkeymamma]

Thank you...it was a great Christmas gift

[Hidden in reply to bluephi]

And many more brother..

[bluephi]

Thank you Nalakrats. I will be talking to my MO and asking what the best course is for me. I am tolerating Casodex an Lupton well. Not so sure how I will react on Zytiga. Any thoughts?

[Tall_Allen]

This from the man who prescribes all manner of possibly unsafe and ineffective drugs to patients!! At least I have reliable data to back up everything I write, and I am telling him what the standard of care is - which you seem to be ignorant of. I just ignore your posts and I suggest that those interested in living longer do the same. When I want your opinion, I'll tell you what it should be.

[charlesmeyers1964 in reply to Tall_Allen]

guys remember its opinions some men work differently then others i wished i had a good oncologist then what i got from cancer n.w his specialty is breasts for women but i guess breasts are just like a prostrate heeeeee

[PGDuan]

Hi, Good to see your huge drop in PSA. Our situations may be different but my research and discussion with Stanford and UCSF docs led me to start Zytiga (+ Lupron + adjuvant RT) right away in hopes of long term remission...or better.

Recent studies seemed to confirm (again for my situation) that earlier multi-modal is better. In short, going aggressively with all guns firing. Adding the Zytiga after a month of Lupron was noticeable but not too bad.

My case was PSA 11, GS 4+3 post-RALP T2cN0M0 and then identification of “missed” positive lymph nodes after persistent PSA 4.5.

Best of luck and may your PSA keep dropping like a stone.

[bluephi in reply to PGDuan]

Thanks PGDuan. Don t know what RALP is. At this point I think a second opinion is warranted. Happy Near Year!

[PGDuan in reply to bluephi]

Sorry - robotic surgery that removed the prostate. (RALP=Robotic assisted laparoscopic prostatectomy.).

Just 6 short months ago I knew nothing about any of this!

[Essex488 in reply to PGDuan]

Where did you have the RALP?

[PGDuan in reply to Essex488]

When this started there wasn’t any sign of spread. The biopsy was Gleason 4+3 and PSA was 10.8, and the CT and bone scan and PSMA/PET were all clear. (Initially post-surgery all was good too with negative margins, vessels, and 0/15 lymph nodes). After my first PSA test post -surgery we realized something was missed and an Axumin scan identified 2-3 avid lymph nodes, that were also confirmed on 2nd reading of the PSMA/PET.

In my case, hard to say where I fall in the risk spectrum. High risk given lymph node and persistent PSA? Or intermediate risk given the moderate diagnosis, clear post-pathology, and consideration that the PSA may be coming only from the missed pelvic lymph nodes.

[PGDuan in reply to PGDuan]

Sorry - to your original question I had the RALP at Stanford with Dr. Chung.

[bluephi]

Thanks Nalakrats...You certainly have given me another perspective. I like the idea of seeking another opinion.

[Tall_Allen]

He asked me if I thought Zytiga would be a better idea than Casodex. Since he can get an extra 18 months of life by adding Zytiga now (vs 4 months if he waits) I told him that he should take his MOs advice by starting Zytiga now.

I will leave crystal balls and voodoo to you, I will focus on what we know now. What we know now is this:

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

"If it ain't broke don't fix it?" I know you don't value studies like those discussed in my blog - you only value what works for mice in a lab. What STAMPEDE and LATITUDE taught the REST OF US is that in HUMANS early use of Zytiga - at the stage the OP is in today - extends life.

[Hazard in reply to Tall_Allen]

It's well accepted that a high functioning teams need diversity in thinking not just follow the leader. I get value out of reading posts by both Tall Allen and Nalakrats can we please continue to share different POV in a constructive manner rather than making it a pissing contest.

[Tall_Allen in reply to Hazard]

Hazard, conflict is constructive. It should enable you to make a smarter choice when you understand the assumptions underlying each position. I respect the authority of medicine. If you do, listen to what I'm saying; if you don't, listen to Nalakrats and his ilk.

[Ahk1 in reply to Tall_Allen]

I agree with Allen. He always have science based suggestions

[gusgold in reply to Hazard]

Nalakrats told me to drink a bottle of Gator Blood ( Birm) + MCP and now I have 3 months to live...I am going to hunt Nalakrats down in Florida...below is a pic of Nalakrats anybody spotting him let me know

Gus

1.bp.blogspot.com/-07OfKL1f...

[Hidden in reply to gusgold]

Hey ! That’s not the pic that he showed us?

[bluephi in reply to gusgold]

Lol

[Break60 in reply to gusgold]

😂

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

Hey that's the spitting image of my ex-wife...

Good Luck, Good HEALTH and Good Humor.

j-o-h-n Tuesday 01/01/2019 2:32 PM EST

[rococo in reply to gusgold]

A little levity appreciated. We know that cutting edge science today started out speculative and some guys will take the gamble with an educated risk. Rocco

[Hirsch in reply to Tall_Allen]

agree with you Allen..its the standard of care

[AlanMeyer]

Hello bluephi,

Congratulations on your excellent response to Lupron and Casodex. It is my understanding that PSA is a good predictor of longevity for PCa patients. The lower the PSA goes with treatment, the more effective the treatment is and the longer a man lives.

I'm not an expert on any of this but I've read Tall_Allen's and other reports on the subject and, as Allen explains, the clinical trials have demonstrated that hitting the cancer hard, before it has a chance to mutate further and become resistant to some of the drugs, produces a longer lasting response to therapy and a longer life than trying a weaker set of drugs until they fail and then switching to a stronger set. This is especially true for men with aggressive disease - which you have as your Gleason 9 and high PSA show.

So I think your MO is offering you a good treatment. I think if I were you I'd try it, though I might also ask his opinion about Xtandi or docetaxel (chemotherapy) as alternatives to Zytiga. All of them are proven cancer killers.

Best of luck.

Alan

[Balsam01 in reply to AlanMeyer]

I guess I missed where his Gleason score was 9 but if it is, is genomic testing warranted? As a Gleason 9, BRCA 2, I'd would like to know.

[bluephi in reply to Balsam01]

My gleason was 8 (4+4)

[AlanMeyer in reply to bluephi]

Sorry for the confusion. I guess I remembered the huge PSA and in my mind the number 9 popped up.

Alan

[kaptank]

Its important to note that zytiga (abiraterone) and xtandi (enzalutamide) confer cross resistance. If you go resistant to one, you will likely end up resistant to the other as well.

[Hidden]

Welcome to the club! Great results.. hope that things keep going in the right direction.. Others more knowledgeable than I shall answer the drug question.. for now ,you’re improving.. Salud!

[bluephi in reply to Hidden]

Thank you. Yes I have already receive some good advice from others in this group. I am also hopeful that I will continue to improve. Happy New Year

[Hidden in reply to bluephi]

Can not give up hope..

[bluephi in reply to Hidden]

Never....not in my nature

[Hidden in reply to bluephi]

We will roll until the wheeels fall off this old jalopy... Happy New Years...

[EricE]

All the best to you. Good numbers. Happy New Year. You are in a good club with good people. Listen to what they have to offer. Your course will be yours to choose. Good luck. I'm pulling for you.

[bluephi in reply to EricE]

Thank you Eric E. As a newbie I already feel like I am among friends and thankful that I have found you all. I have gotten some good advice and questions that I can take to my medical team. Happy New Year

[Hidden in reply to bluephi]

We all start off the same.. In fear and ignorant.. it won’t take you long to catch on to the niceties of APC and all of those confounded medical terms and abbreviations .. You’ ll know as much as anyone by this time next year... You’re going to be around a long time.... no guarantees for any of us..but find love and enjoyment whenever we can.. Peace..

[Nicnatno]

Jim, what a way to start 2019 and with a bang. As many have said and I will echo it, I believe you have to hit that "sucka" very hard to extend survival. I did it with chemo with great success. Others hit it hard with zytiga and/or xtandi with great results. Get yourself educated and listen to your doctor. You have the final decision. Keep us posted.

Nick

[bluephi in reply to Nicnatno]

Thanks...I appreciate that

[charlesmeyers1964]

u are lucky. with a psa that high could have meant it had spread all over your body and it came down to such a low number stay on it for sure. my psa hit 60 and i was worried after 10 years finally got zytiga now and will stay on it till i can't. got my 2nd shot but this time its good for 6 months

charlie

[michael00]

My situation is similar. Lipron plus casodex dropped psa from 1200 to 113. Took out casodex and psa shot back up to over 900. Now 3 months on zytiga has brought psa down to 2.2 with no side affect other than hot flashes. So apparently, for me at least, zytiga is doing its job.

[bluephi in reply to michael00]

This is great....so happy for you

[Hidden in reply to michael00]

Let it work! Great news...

[redbank]

Similar situation here ,Gleason 9-10 PSA was at 1300 and change , After RP had Chemo with Taxotere and now on Lupron every 3 months and Casodex daily 50 mg Have spread to lungs and PSA holding at .05 since July of 18. Oh yeah Tall Allen and Nalakrats KNOCK it OFF or I'll turn this bus around !!!!

[WXYZ123 in reply to redbank]

Really!! Keep that banter to yourselves! And Happy New Year! Hope we all win this fight!

[EricE in reply to redbank]

Indeed. We have our new friend to think about and angry disagreements can fog the issue. Thank you all for your advice but let's try to all stay on the same team, if only for the holiday.

[larry_dammit]

Great results 😀. My oncologist put me on casodex for 2 weeks prior to chemo, it stabilized and dropped the PSA for me. PSA at <0.05 for the last 25 months. Been on Xtandi since chemo it’s similar to Zytiga. Good luck with your battle

[bluephi in reply to larry_dammit]

Thank you

[elainea53]

I always feel if it ain’t broke don’t fix it

[bluephi in reply to elainea53]

Thanks elaibea53...I say that all the time about everything

[Break60]

I would ask about radiation to prostate bed and all pelvic lymph nodes as well.

[bluephi in reply to Break60]

👌...thanks

[monte1111]

A pissing contest. What a great way to start the New Year. I just get tired of changing my underwear all the time. I know nothing. Think most here would suggest following MO advice and get on Zytiga train. Easy way for me to figure out acronyms or how to spell acronym is open new tab and google it. Close tab and you are back. You can also close your eyes, click your heals three times, and wish you were anywhere but here. Good luck Mr. bluephi.

[j-o-h-n]

Hello Jim, Greeting!!! You have just entered the wonderful world of WrestleMania. Sit back, relax and enjoy the show..

Please contribute to MaleCare online to "malecare.org/donate" (Good Cause).

Happy New Year.

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 01/01/2019 2:50 PM EST

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

Thanks j-o-h-n

[joancarles]

My PSA was 1350. With Zytiga I managed, in 12 months, to go down to 0.17. In the last four months it has started to rise: 0.19. 0.26. 0.45 and 0.73. Praying for him to stop a little and be able to spend more time in Zytiga.

[elvismlv123]

i dont know about zytiga but you should be taking 3x50mg of casodex at the same time each day plus 5mg of finasteride daily. You should take this regimen for 13 months.

Your PSA will drop to .005 You will get hot flashes,low libido and some small issues like minor fatigue. There is substantiation for doing this. Go to Compassionate Oncology.com.

I did this 14 years ago and it works.

Dominick

[bluephi in reply to elvismlv123]

Hi elvismlv123

Thanks for you reply, I interested to know you situation

1. Gleason score

2. Psa

3. Testosterone level

[elvismlv123]

Hi,

My PSA is 3.4.

My Testosterone is 250.

My Gleason score was 3+4

My PCa cells are diploidal not aneuploidal.

My prostate is small.

My libido is low,

I have ED.

My PSA at Dx was 4.7, 14 yrs ago. I did 18 months of 3xADT at which point my PSA dropped to .005. My PSA has risen very slowly for 14 years. But I still have a prostate and normal prostate cells that produce PSA and since I am older my PSA is allowed to rise a bit beyond 4.0. But that may be only for undxed men. I have no symptoms that might indicate crazy stuff.My doc is focused not on PCa but other potential issues like the heart.

[bluephi in reply to elvismlv123]

Thanks....God bless and may you continue to stay well

[bluephi]

Interesting....I will check this out. Thanks

[tnvans]

Hi Jim, My name is Thijs. Diagnosed with prostate cancer spreading into ribs on lower spine. One year ago at diagnosis..psa 1470, started casodex 50 on daily basis and decapeptyl shots monthly. Radically changed my diet and worked hard to get more exercise. PSA then at 0.8. Ten months in my psa started to rise into the 330 range, but scans and mri's showed condition as static. Urologist said to stop Casodex. Stopped Casodex about 7 weeks ago with side effects being occasional hot flashes that have now dissipated. And had stopped monthly shots and went to 6 month periods in Feb. Recent psa tests show lowering of count by 50 points and my only change was stopping Casodex and trying to eat more veg less meat, no sugars etc. Saw my oncologist yesterday and she asked if I was on some other treatment? Maybe not for everyone but I do take laetrile type supplements (apricot pit seeds from Germany and capsules of the same B17 ). High doses of vitamin C and some other minor vitamins and minerals. Just keep an eye on psa numbers with the Casodex and Lupron. Hope things go well.

[bluephi]

Thanks for replying Thijs. Casodex ADT got me down to psa .8. Added Zytiga a month ago and psa now .2 and testosterone less than 10. I need to get on that diet you are on. Eating more fruit and veggies and definitely cutting down on sugar. Good luck to you.