Input after rising Chemo PSA and Zytiga liver #'s

Hola from Mexico. Finished my six sessions of chemo three weeks ago. I was diagnosed April 2018. Did Lupron and Zytiga and my liver numbers went crazy. Took a while to come down. MO put me on chemo and my PSA number slowly increased. I am enjoying a break except for Lupron until May 6 when I fly back to Seattle to have blood work and meet with MO to decide on next treatment. He mentioned possibly Provenge or Xtandi depending on my PSA numbers. Here are my liver and PSA numbers from Sept to January. Any input or suggestions much appreciated.....Saludos!

ALT

Jan. 23, 2019

11

U/L

Jan. 2, 2019

17

U/L

Dec. 12, 2018

22

U/L

Nov. 21, 2018

32

U/L

Oct. 31, 2018

42

U/L

Oct. 10, 2018

59

U/L

Oct. 3, 2018

73

U/L

Sep. 5, 2018

166

U/L

PSA

Jan. 23, 2019

0.55

ng/mL

Jan. 2, 2019

0.39

ng/mL

Dec. 12, 2018

0.30

ng/mL

Nov. 21, 2018

0.29

ng/mL

Oct. 31, 2018

0.30

ng/mL

Oct. 10, 2018

0.20

ng/mL

Oct. 3, 2018

0.15

ng/mL

Sep. 5, 2018

0.15

ng/mL

[GoBucks]

Zytiga helped me get to zero PSA. When my liver #'s went crazy I stopped for 7 weeks. Then restarted at 1/2 dose. When that held went up to 3/4 dose. My MO said he has some patients taking 1 zytiga with food. So there are ways for zytiga to work in lower doses.

[Trengle]

I started Zytiga in Jan 18 at 1,000 and liver did not like that. Took a 6 week break then started back on Zytiga at 750 and the liver has been great with PSA falling to 14 from 159. Five days ago I went back to 1,000 and will see my MO in a month. Zytiga will work at lower doses if managed correctly.

[Hidden]

Thanks for the replies and I will talk to my MO in March about that since I was getting good response from Zytiga.

Also, I realize my cut and paste from my portal is a little hard to follow but I was wondering if anyone had input on the increasing PSA. Thank you!

[NPfisherman in reply to Hidden]

I take it you have had the Pharmacist look at the meds you were taking with zytiga and you always took it at least 2 hours after a meal or more than 1 hour before....My team advised me to give it some extra time before taking food ( I take mine before eating)...and I stopped a supplement for sleep which contained Valerian root and phenobarbital...That got my LFT's back to normal--a retry of Zytiga as several posters suggested should be in order.... getting as much out of these drugs for as long as we can before moving on buys time.... of course, hold the alcohol also...best of luck...

Fish

[Hidden in reply to NPfisherman]

I took it two plus hours after dinner since I knew I would not be eating after that. Was only taking 5 mg of prednisone once a day with it and no alcohol for over two years. When I started getting the high liver enzyme numbers (which are not all shown since I was at a different hospital at that time) I started on my own taking milk thistle and still do. Bummer is it was working and Janssen was paying for it for a year.

Does Xtandi work similarly without impacting the liver?

I'm very interested to see my PSA results on March 6th after watching it slowly rise during chemo. I will definitely discuss reintroducing Zytiga.

[NPfisherman in reply to Hidden]

Rather than move on, I would re-challenge Zytiga--some have taken 250 mg with food here and others take 750 mg on empty stomach and do well... Sadly, we only have so many drugs for now, but the horizon looks sunny--numerous drugs under trial and in development.... I have not taken Xtandi and hope I won't need to for a long time...Hope to squeeze several years out of Zytiga... keep fighting, brother

Fish

[pakb]

When my husband's liver numbers went up with chemo we started European milk thistle and lowered chemo dose a bit. Liver numbers went back to normal. When he started Zytiga liver numbers elevated and we did European milk thistle and dandelion tea. Liver numbers back to normal and didn't lower Zytiga amt. Just thoughts.

I can't see where it gas your PSA numbers? Do see PSA listed once- but not sure the number with it? And only see it once so not sure what it started at or ended up at to compare?

[Hidden in reply to pakb]

If you go to the very bottom of the long list of numbers and work up it will show the chronological progression on the PSA. After that it shows my liver enzymes numbers.

On my PSA it seems my doubling time if very short.

Sorry, it is confusing. I cut and paste from my portal. Just follow the months up from the bottom. Thank you!

[pakb in reply to Hidden]

Ok- now I see. So you went from .15 in Sept to .55 in Jan? Sometimes I read on here that docs wait until PSA gets to 1.75-2 before doing new scans. Maybe if you rechallenge Zytiga try early morning then wait an hour to eat. Agree with a lot of advice above keep us posted!

[Hidden in reply to pakb]

Updated PSA.....it was 2.19 two weeks ago and 4.07 yesterday. Seems like a big jump from .15 in October.

[pakb in reply to Hidden]

What did your MO say?

[Hidden in reply to pakb]

Agreed it was not good and put me on a trial.

[pakb in reply to Hidden]

Keep us posted!

[Cynthgob in reply to Hidden]

Which trial?

[NWLiving]

Hi! We are also with the cabazitaxel/xtandi trial at SCCA.

[Hidden in reply to NWLiving]

Good luck to both of us! Really wishing you well.

[NWLiving]

8knots- sounds faster than our old sailboat.