Prednisone

[Nutters85]

In your opinions... If you have failed Zytiga are there any benefits to continue Prednisone? Maybe for energy or to combat fatigue.. I am on Xtandi and it is bringing my PSA back down (thankful), but man am I tired!!

[Tall_Allen]

The prednisone was only there to replace the cortisol that Zytiga takes away, but Xtandi doesn't affect it. You have to taper off it because it depresses your natural production.

[Nutters85 in reply to Tall_Allen]

Thank you Tall for the reply

[pjoshea13]

While Prednisone is a necessary add-on to Zytiga, it has been used as monotherapy. e.g. [1] (2006):

"To evaluate the PSA response rate to prednisone in asymptomatic patients with hormone refractory prostate cancer (HRPC)." i.e. CRPC.

"Forty-nine patients met the inclusion criteria. There was a 22.4% response rate to prednisone as defined by a 50% PSA decline. An additional 16.3% of patients had a PSA decline of < 50%. Ninety percent of patients had no documented side effects. PSA responders were more likely to have bony metastases (9/11 versus 17/38, p = 0.03) and lived longer (24.7 versus 15.4 months median survival ...). The median duration of response in the PSA responders was 4.3 months (0.89-30). Of all PSA responders, 27% had a time to progression greater than 1 year and 45% did not require chemotherapy for the duration of the study."

[2] (2015):

"Dexamethasone may be the most efficacious corticosteroid for use as monotherapy in castration-resistant prostate cancer."

"Corticosteroids have been used in the therapy for castration-resistant prostate cancer (CRPC) for decades, both as monotherapy and in combination with additional agents. In this article the authors report the results of a phase II trial of dexamethasone versus prednisolone as monotherapy for CRPC. The study suggests improved PSA and radiographic response rates as well as improved time to PSA progression for dexamethasone over prednisolone therapy; however the differences only trend toward statistical significance. Nonetheless, in light of these data, when treating patients with corticosteroid monotherapy for CRPC it may be prudent to consider using daily dexamethasone over prednisone/prednisolone."

-Patrick

[1] ncbi.nlm.nih.gov/pubmed/171...

[2] ncbi.nlm.nih.gov/pmc/articl...

[Nutters85 in reply to pjoshea13]

Thank you Patrick

[Nutters85 in reply to pjoshea13]

Patrick,

Do Dexamethasone and Enzalutamide play well together?

[pjoshea13 in reply to Nutters85]

See my response to ITCandy. -P

[ITCandy in reply to pjoshea13]

How about Dexamethasone and Prednisone taken together. Any harm or benefit in doing so?

[pjoshea13 in reply to ITCandy]

Here's an interesting paper. Interesting author mix: Oliver Sartor (Tulane) & Johann de Bono / Chris Parker (Royal Marsden).

(2014) "Recent reports and discussions of preclinical prostate cancer models have emphasized the possibility that enzalutamide resistance may be mediated by glucocorticoid receptors (GR).1,2 In both in vitro and xenograft animal studies, it is possible to show that the GR is up-regulated in prostate cancer cell lines and that dexamethasone reverses enzalutamide induced growth inhibition. "

"Taken together, although there are multiple potential interactions between glucocorticoids and prostate cancer, the story may be quite complex and context dependent. Studies of the benefits and potential harms of various glucocorticoids are warranted in prostate cancer patients.

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

The topic of the benefit of a corticosteroid switch came up recently:

"The aim of this retrospective study is to evaluate the activity and safety of a steroidal switch from prednisone to dexamethasone in patients with advanced, heavily pre-treated, castration-resistant prostate cancer (CRPC) who progressed on abiraterone acetate. Treatment consisted of oral daily abiraterone plus dexamethasone (0.5 mg once daily) administered until disease progression or unacceptable toxicity. Thirty-six patients were evaluated: all men underwent a prior treatment with enzalutamide. A PSA decrease ≥50% was observed in 11% of patients; median progression-free survival was 10.8 weeks (95% CI: 9.2-16), and median survival was 17.6 weeks (95% CI: 15.8-28.8). Better efficacy and survival were observed in the subgroup of patients treated with abiraterone acetate prior for a period >3 months; treatment was well tolerated, and no grade 3-4 toxicities were observed. Our findings did not suggest the use of steroid switch in all CRPC who were heavily pre-treated. However, the switch could be an option for patients who responded well to prior abiraterone acetate treatment."

ncbi.nlm.nih.gov/pubmed/303...

Is there value in taking two together, or alternating? Beats me,

-Patrick

[monte1111]

After chemo was prescribed prednisone with Xtandi. Questioned MO and told was for fatigue and was used with Xtandi as well as Zytiga. Have noted a few people taking pred. with Xtandi. 99%, including all the heavy hitters recommend against pred. Got MO to agree to cut to 1 5mg a day instead of 2. Did notice yawning and etc. in afternoon. Did start back on 2 a day a couple of days ago and did notice fatigue difference. So, what to do? Will cut back to 1 per day again, and suggest to MO to wean completely off next time I see her. Would rather be fatigued than look like the hunch back of Notre Dame. Dexamethasone? Been there, done that, don't want it.

[Nutters85 in reply to monte1111]

Yes Monte I have been trying to grin and bear it. I have lost 25lbs, which I needed to do, over the last 2 months since stopping prednisone but am literally falling down tired by the end of the workday. It is nice to start not looking like the Hunchback too!

[j-o-h-n in reply to monte1111]

Question: How does a hunch back sleep?

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 03/01/2019 9:30 PM EST

[monte1111 in reply to j-o-h-n]

By closing their eyes.

[j-o-h-n in reply to monte1111]

Geez can't get one by you....

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 03/02/2019 12:20 PM EST

[monte1111 in reply to j-o-h-n]

I google it.

[j-o-h-n in reply to monte1111]

hahahahahahahahahahahahahaahahahahahaha 10 on the gigglemeter.

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 03/02/2019 12:25 PM EST

[RonnyBaby]

Although slightly off topic, fatigue is a common complaint with virtually all the treatments.

The advice I keep hearing is exercise, some exercise, more exercise - believe it or not. I know from experience, after 2 years of being a PCa patient (I'm post treatment now) that fatigue continues but decreases over time. I feel at my best (for days) after exercise. AND it gets me out of the house and the four walls.

Start slowly if you haven't done much of it, but DO IT - you will feel better - guaranteed.

[Nutters85 in reply to RonnyBaby]

Yes Ronny I agree. I do feel better when I exert myself mowing the lawn, trimming and blowing. It takes a good 3 hrs. Florida takes winters off so the grass keeps growing. 🌴😎