We were given the possibility to begin with firmagon + Zytiga from beginning of treatment (plus radiation to prostate, pelvis + mets), Gleason 9 T3b N1 M1, PSA 28.
Because of atherosclerosis (70% blockage) not sure of adding Zytiga now, also if research shows advantage. In addition I have the impression that after Zytiga cancer gets very hard to treat.
Does Zytiga affect atherosclerosis?
I have never heard either of these things. Zytiga may make the cancer more susceptible to X-rays, not less (at least in theory). He can take a statin if he's concerned about atherosclerosis.
He is already on statins. But ADT can make plaque more unstable and also increase atherosclerosis (at least lupron, not sure for zytiga). and normally adding of ADT drugs also adds the odds for cardiovascular risk (at least what I've read).
Well, you have to weigh the benefit of therapy against the increase in CV risk. Perhaps visit with a cardiologist.
onclive.com/conference-cove...
That suggests a risk in men with afib or myocardial infarction, not atherosclerosis.
yes, I really don't know for atherosclerosis, will try to find out. Cardiologist is more worried about putting stents before treatment, than on drug side effects...
what about beginning Zytiga some months after degarelix, so we could do a heart check and also know better of side effects of single drugs, would the advantage of early Zytiga be lost?
Good question
but the underlying mechanism of an MI is caused by the complete blockage of a coronary artery caused by a rupture of an atherosclerotic plaque. So it could cause a rupture, not sure...
But the risk is only in men with pre-existing MI — not in men with atherosclerosis.
For getting an advantage with Zytiga how near to ADT begin should it be given. Together, 3 months?
No one has yet done a trial of Abiraterone neoadjuvant to RT. In STAMPEDE (without RT) it was started within a couple of months.
My MD Anderson oncologist says for me (stage 4 mPCa hormone sensitive with one bone met in pelvis, G8, all 12 segments positive in prostate biopsy, but no noticeable symptoms from the cancer) with a history of CVD (bad family history, one LAD stent for 90% blockage, one silent heart attack) that for my volume of cancer (low metastatic volume) I am best served by ADT alone followed by either RP or IMRT cause the toxicity of additng Zytiga/prednisone outweighs the advantages.
Thanks! I had the same ratio.
What do u mean by same ratio?
same thinking. But would the fact of having a stent protect you from side effects? what did your MD tell you about Zytiga, what could it do as toxicity: make plaque unstable, more atherosclerosis, or more afib or infarction risk?
Another good question. I need to discuss that with him next visit to MDA early April prior to scheduled IMRT. What he communicated was via messaging so no in depth discussion. He did say that adding Zytiga would have to be done soon after start of ADT to get the benefits. However, I am a conundrum in that regards because my local urologist, now referred to by me as fu##head, who did the original biopsy and initial diagnosis, screwed up big time and said he gave me a 6 month Eligard injection but after much wailing and knashing if teeth and consulting with MDA turned out to be a one month injection so from late July 2018 my PSA started going down but 3 months later was higher than it ever was!
This article may be much of what you have already researched but I'll go ahead and share a link it just in case...
yes, I know, but there they look at the difference between mortality of patients with or without CVD (and mortality without is already very high!).
it is really a difficult choice, reading the stampede I see that ADT + Zytiga in comparison to ADT alone did show more CVD problems, but more in terms of high blood pressure and dysrhythmia, and no difference in infarction. nejm.org/doi/full/10.1056/N...
Look at table 2.
BUT probably they did not have any problems before ADT and the ADT was an agonist.
Re: atherosclerosis... I've had PC since 1996 when at age 43 I weighed 250 and had 50% blockages in 3 coronary arteries. My tenth doctor's diet eliminated all forms of high Omega-6 fat (corn oil, all other vegetable oils, non-grass-fed meats and dairy ( because we feed our animals corn)). I switched to Olive and other fruit oils, read every ingredients list to avoid any Trace of vegetable oils, but made no other significant changes in diet nor exercise. Within a year or so I lost 100 lbs., the heart blockages disappeared, my PSA ranged from 0.01 to over 300, and I'm still here and active. Sure beats surgery or worse.
Holy chit, you weigh 150 pounds now?... is that a Roger? Over...
Good Luck, Good Health and Good Humor.
j-o-h-n Sunday 03/17/2019 1:16 PM DST
Yup, and had to get all new skinny clothes on top of still being alive. So no complaints. Well except for no more steak and cheese, and getting rid of my smoker. Thanks and best to you and yours, and of course to Dr. Snuffy Myers and his diet for saving my life!
I’ve made my decision to add Zytiga to my ADT and IMRT therapy. This will be after 7 months of ADT.
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