From reading the different postings I understand that Zytigia ( abiraterone) with prednisone is being prescribed upfront for high risk men with hormone sensitive non metastatic PCA. There are also many postings about the side effects of ADT and Zytigia when each is administered separately. Lupron and other agonists have one set of side effects, Zytigia another and prednisone another. Thus taking all three simultaneously can result in a large amount of side effects, some of which require the addition of other medicines to counter the side effects. My question relates to the inability to know whether ADT or Zytigia has unknowingly failed . Assuming a treatment period of 36 months, ADT could have failed at 12 months with progession controlled by Zytigia , and the patent needlessly suffered the ADT side effects for 24 months. Since chemo ttreatments last 4 months, a chemo failure with a ADT failure at 12 months would be known and Zytigia could be administered to test whether the cancer was androgen sensitive. Is everyone saying that they are convinced that Upfront Zytigia is so potentially curative that the risk of needlessly suffering ADT side effects is worth it?
Chemo or Abiratone Upfront - Advanced Prostate...
Chemo or Abiratone Upfront
There are several faulty assumptions, but I'll try to unpack them:
• Zytiga is NOT given for high risk PC, only for metastatic PC
• Lupron (or other GnRH agonists and antagonist) is ALWAYS continued even after castration resistance sets in. The cancer becomes super-sensitive to even the smallest amount of androgen, so it is critical to reduce testosterone as low as possible.
• Prednisone is only given as a replacement dose because Zytiga blocks cortisol production. It PREVENTS side effects.
• There are certainly side effects to Zytiga and chemo.
• Zytiga does not test whether the cancer is androgen sensitive. It blocks adrenal and intratumor synthesis of androgens in spite of one's status as castration resistant or GnRH sensitive. It stops working when the cancer evolves a workaround.
I thought some oncologists were using Abiraterone in non metastatic patients.healio.com/hematology-oncol...
I ( mistakenly ? ) thought that historically, when PSA progressed while on ADT the cancer was deemed hormone resistant and a second line of hormone therapy like Zytigia which seeks to shut down adrenal androgen production/ synthesis was introduced , but it was brought forward first in metastatic and now in certain non metastatic Patients( see above).
If I understand you correctly, and I may not, you would not suggest using Abiraterone in non metastatic men. But if a metastatic man failed ADT , you might suggest adding Abiraterone and continuing ADT to reduce/ eliminate any testosterone even though the principal PCA fuel would no longer be coming from the main sources of testosterone production but from the adrenal gland/ synthesis or PCA tumor production of androgens. If I am correct in my understanding , would you stop ADT and Zytigia if the cancer further progressed or would you recommend continuing that protocol indefinitely for some residual benefit. I have heard the term ADT for life. Is that want you are referring to? That once the cancer is metastatic you ride hormonal therapies to the end notwithstanding progressions?
Finally, You say that Prednisone is used to defeat Zytigia side effects which is true. But prednisone has its own set of side effects, which for some can be more debilitating than the Zytigia side effects.
Thanks for all your insights and knowledge and the generosity with which you share them.
Abiraterone is not approved for non-metastatic PC. The reference you cited does NOT say it is for non-metastatic. It (plus GnRH) was originally approved for metastatic castration-resistant PC, then, a couple of years ago, it was approved for metastatic hormone sensitive PC. Enzalutamide and apalutamide (+GnRH) were approved last year for non-metastatic castration resistant PC. You never stop a GnRH agonist/antagonist.
Prednisone in replacement doses does NOT carry side effects for most men.
You really know your shit. Bless you for being here....
Good Luck, Good Health and Good Humor.
j-o-h-n Sunday 01/13/2019 12:38 AM EST
Where do I begin. With a shovel or rubber boots? I too thank Tall_Allen for being such a shit expert. A lot of it on this site - including my own. And like a fly, I come back every day to witness the triumphs and the tragedies. I must buzz of now, as the sun has come out, and I need my vitamin D.
Recruiting is underway for Phase II clinical trials for men who have bone-metastatic PCa to see if apalutamide and abiraterone (Zytiga) works as well as it has been shown for men for non-metastatic PCa. Be aware that you must have a rising PSA (castration-resistant) to be admitted to these trials (I know this...I do not (yet) have a rising PSA so I was turned down).
Well....I've been on Lupron/Zytiga-Prednisone for a year and a half. My skin is paper thin, meaning easy bleeding under skin, easy cuts/tears. I did some reading and it looks like Prednisone is the culprit, (when one goes off Prednisone the skin does thicken). It's really not a big deal, except when I have to fix the car or build something. I wear a long sleeve shirt when I go the the gym.
Best,
Craigv
Excess prednisone is catabolic (breaks down tissue) and may be the culprit. If so, talk to your oncologist about slowly cutting back and see what happens. Don't cut back on your own - that could be dangerous. And closely monitor for low potassium, high BP and edema.
But the lack of anabolic steroids (that builds up tissue) like testosterone may be contributing as well. Estrogen seems to increase skin thickness - it can be taken transdermally (to reduce blood clots) together with tamoxifen (to prevent breast tenderness and enlargement). It also relieves hot flashes and suppresses androgens. There are clinical trials underway in the UK for its use against prostate cancer.
According to my dr at md Anderson my pc is not metastatic. I asked the question specifically. It is in the nerve bundle,which I thought meant metastatic. They say no. My only treatment to date is Zytiga and lupron with radiation coming in February. I believe they are using the results from the stampede trial. Hope it works. It has shrunk the tumor and psa is 0:00.
How are you getting Zytiga without any metastases? Just curious. None of the STAMPEDE trials showed a survival benefit for men who are not metastatic - perhaps they will with longer follow-up, but it is not currently approved for that. Maybe it's better to not look a gift horse in the mouth.
I wonder that too for my dad. He had Provenge treatment 2 years ago and how do we know it’s working or isn’t working when we combine all three medications? My dad is so sick of taking his Zytigia I notice that he’s not taking them religiously like he was, I have to get on him about it. But back to your question and reasoning I wonder what’s working when combining them all together great point?
Olivia, when I underwent a six month chemo-ADT trial over fourteen years ago, some in the cohort stopped taking the additional oral chemo because they it made them sick. Bad choice as they are no longer around. Show this to your dad and encourage him to take his medication.
GD
Not what you're looking for?
You may also like...
Upfront Docetaxel or upfront Zytiga
Tips for cheaper Abiratone costs
Chemo (Docetaxel) with Prednisone
Zytiga resistance and Chemo
First Week Following First Chemo
Husband doesn’t want more chemo 
Chemo Progress Update
