Follow up on Zytiga 4 1/2 weeks later

My dearest S.O. (82 years young) saw the MO yesterday. Zytiga and Prednisone was added to his Lupron and Xgeva on February 14, 2019. 1000 mg Zytiga and twice a day 5 mg of Prednisone per day.

Here is his PSA since the beginning of his treatment:

10/4/18 - 947.50

11/6/18 - 267.60

11/20/18- 90.4

1/8/19 - 21.43

1/29/19 - 20.36

2/12/19 - 21.55

3/19/19 - 18.66

Since February 14, 2019 to March 18, 2019 , his PSA dropped from 21.55 to 18.66. MO said Zytiga is working and he should stay with the treatment plan. Any thoughts or should the plan be more aggressive?

How well is it working? Does anyone think PSA will go down a lot further by May 7th?

MO also changed his twice per day 5mg of Prednisone to once per day? Does anyone know why and if this is a good idea?

(His kidney and liver functions are all normal except for Potassium which is a tad above normal)

His next appointment is May 7th for the Lupron 3 month shot and blood work.

[Magnus1964]

I am wondering if radiation would be the best option at this time? It would be chance to really send his PSA way down.

[Hidden in reply to Magnus1964]

MO has never mentioned radiation to him.

[Magnus1964 in reply to Hidden]

He/she is an oncologist. Some have difficulty thinking outside of their medical specialty.

[Hidden in reply to Magnus1964]

His MO is Dr. Pinski from USC Norris Cancer. He has a consultation with Dr. Lam in Marina Del Ray in mid April. Same office as Dr. Scholz. S.O. has no pain whatsoever. In fact, he is looking good with also a change in his diet to fruits and vegetables, no meat products.

[Magnus1964 in reply to Hidden]

They are all oncologists. I may have to bring this up at his next appointment.

[Tall_Allen in reply to Hidden]

Radiation is inappropriate for men with multiple bone mets.

[Hidden in reply to Tall_Allen]

He has many bone Mets on his body .

[Mkeman in reply to Magnus1964]

I have similar routine... MO said to save radiation until I need it for pain relief from the Mets.

[NPfisherman]

Agree with Magnus's idea, I put out info on SABR-COMET-10 trial... there were several replies and some information about stereotactic radiation in the post---

healthunlocked.com/advanced...

It is an option to consider... Good luck meeting with the RO...

All the best,

Fish

[michael00]

May 2018 my psa was 1230. Have had two 6 month lupron shots. Started zytiga sept.2018. By feb 2019 psa was down to .82 and it brought alkaline phosphatase from 782 to 121. I'm happy so far with only this treatment.

[whatsinaname in reply to michael00]

Good for you, michael100.

I am hoping to get some remission with Abiraterone, which I started approx 12 days back. Will test my PSA, CBC, RFT, KFT, etc, etc tomorrow for the first time after starting Abiraterone. My last PSA had more than doubled to 11.7 after completing 6 cycles of pure poison (docetaxel)

All the very best to you, michael100 !!!

[Lisa0627 in reply to michael00]

Can I ask the dosage that you are taking of zytiga ? My Dad’s got lowered from 4 to 3 tabs nightly since his BIllirubin was rising along with his alkaline phosphates. He started zytiga on January 31.

Thank you !

[michael00 in reply to Lisa0627]

Taking 1000mg daily. 2 500mg pills every morning. Sorry for delay in responding

[Tall_Allen]

The reason he is getting a lower dose of prednisone, is because his potassium is a tad above normal. Everyone needs a slightly different replacement dose.

The Zytiga has stabilized his PSA at a lower level, so there is no need to make changes. They will want another bone scan eventually to confirm that. There are lots of medicines available for him when it stops working.

[elvismlv123]

Hi, Ive been at this since 2004 but I do not have advanced PCa.

Is your dad castrate resistant meaning at some point someone said hormones do not work.If so my friends take a low dose DES.

Prednisone is a steroid not meant for long term use. He cut it back to protect your Dads body. With the latest readings it appears the PSA is being maintained at a certain level.

Thats good and I dont see it dropping further. It needs to go lower.

People are also using Metformin. .if a drug works it drops the PSA down like crazy.

It was working in the beginning very well but now its not so good

[elvismlv123]

But I never had a high PSA in the first place so hormone treatment made it undetectable.

After 15 years my PSA is about 3. It started out at 4.7.

[dadzone43]

Another thought on the prednisone. Normal body physiology for the adrenal hormones is a burst once a day in the early morning hours. Single-dosing of prednisone is closer to his body's rhythms. That may be his MO's thinking. We often focus on the PSA when it his _total well-being_ that is the goal. If he has pain-free bone metastatic disease, that seems to me to be a good balance.

[monte1111 in reply to dadzone43]

You seem to have specific knowledge of prednisone. My MO prescribed 2 5mg even though I was on Xtandi. (When questioned she said for fatigue.) I did get her to go down to 1 5mg and in April will suggest suspending it all together. (Been taking it for 2 years now.) Knowledgeable persons here wonder why I'm taking it at all (same as me). If I'm only taking one, and there is a morning burst of the adrenals, should I take the 1 dose in the evening? Exactly opposite of what I'm doing? I understand if you do not want to respond. Thanks. Monte

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

Shit, Why wouldn't anyone want to respond? You're a nice guy battling this dreadful disease. If I knew how to respond to your issue(s), I would. You could take that to the bank.

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 03/21/2019 7:39 PM DST

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

Thanks. You have already been responding to my many psychiatric issues just splendidly. The bank has been very reluctant to accept my carrot deposits.

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

They will if they're 14 18 or 24....

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 03/21/2019 10:59 PM DST

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

Especially, if they are 24

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

Yep @ $1,312.80 per troy ounce.✔

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 03/22/2019 12:08 PM DST

[dadzone43]

Take it in the morning to supplement what your body may be producing. I say "may" because when we take external adrenal steroids like prednisone, it tends to suppress natural production. Like others I am not sure why prednisone gets thrown into the mix. It tends to reduce the body's immunity mechanism. Hope that helps.

[monte1111]

Thanks much to dadzone43. Time to tell doctor wean me off this, I don't want to do this anymore. Still think I was an experiment. Enjoy, everyone.