Advanced prostate cancer: My father is... - Advanced Prostate...

Advanced Prostate Cancer

21,012 members26,186 posts

Advanced prostate cancer

Ankitsharma021290 profile image

My father is diagnosed with prostate cancer with PSA 168 .Cancer has spread over to the spinal and 4th rib due to which they are not able to walk..while starting the treatment dr.started by giving harmonthrepy (firmagon/degarelix)with bone cancer injection Zoldria. I just want to know...whether this cancer is slow or fast.......i want to know that i have a time of months or years for him.any suggestions?

Written by
Ankitsharma021290 profile image
Ankitsharma021290
To view profiles and participate in discussions please or .
Read more about...
107 Replies
ctarleton profile image
ctarleton

Every man is different. Some men here had starting PSAs in the hundreds or even the thousands, and are still alive several years later, with very much lower PSAs and relieved symptoms. Hopefully, his cancer may also respond very well to the drugs that lower his testosterone, and also to the drug to help keep his bones stronger.

Ankitsharma021290 profile image
Ankitsharma021290 in reply to ctarleton

ctarleton Thanks for your response....hope his body will respond nice to the drugs

ctarleton profile image
ctarleton in reply to Ankitsharma021290

See also:

translate.google.com/transl...

Ankitsharma021290 profile image
Ankitsharma021290 in reply to ctarleton

ctarleton ...Gleason report came....6 specimens taken.....section from the follwoing cores show features of prostatic Adenocarcinoma.

1) Right Base- gleason score 4+5=9 involving 50% of core area.

perineural invasion not seen.

The following cores are tumor free.

2)Right midline

3)Right Apex

4) Left base

5) Left midline

6)Left apex shows basal cell hyperplasia.

Ankitsharma021290 profile image
Ankitsharma021290 in reply to ctarleton

Hi....today while following up my dr....dr. changed my ADT+docetexal to ADT+Zytiga ....i dont know why...but i think ....my father were getting better...and PSA down to 168 to 39 in just 20 days.....

Myhubby58 profile image
Myhubby58 in reply to ctarleton

Omg this is same thing my hubby is going thru,his psa is 41.85and now he is starting to get a shot today for his bones.

Ankitsharma021290 profile image
Ankitsharma021290 in reply to Myhubby58

What is the gleason score and is this metastatic

Myhubby58 profile image
Myhubby58 in reply to Ankitsharma021290

Yes it is metesis to the bone and lymph nodes and Saturday he started on the zytiga and his blood pressure shot up outrageous and then on yesterday he had his first infusion of something and now he is being admitted into the hospital tonight because of flu like symptoms and very high fever,vomiting dizziness fatigue and very bad headache.dr thinks he may have a blood clot in his lungs..I’m praying...

Myhubby58 profile image
Myhubby58 in reply to Myhubby58

His Psa is 50.0 and Gleason is 9

Ankitsharma021290 profile image
Ankitsharma021290 in reply to ctarleton

Hi All,

A quick update on the treatment..

Doctor suggested to do orchiectomy and this has been processed on 21 dec 2019.

Till than the condition is not good .he is recovering from the operation side effect.

Had done PSA test today,

DatePSA Value

29-03-2019 PSA 167.006

17-04-2019 PSA 39.07

18-05-2019 PSA 0.80

19-06-2019 PSA 0.16

17-08-2019 PSA 0.104

18-10-2019 PSA 0.16

4/1/2020 PSA 0.19

The PSA is still increasing a slightly ....

Also , this 1 year is going to pass on but still the PSA is not undetectable.

should we take a serious note on it or its normal.

ctarleton profile image
ctarleton in reply to Ankitsharma021290

Those recent PSA numbers are still low. His doctor may want to keep watching the trend of PSA test results. It might be many more months before needing to get new scans or to change to a new treatment.

Ankitsharma021290 profile image
Ankitsharma021290 in reply to ctarleton

Hi All,

A quick update on the treatment..

Doctor suggested to do orchiectomy and this has been processed on 21 dec 2019.

Till than the condition is not good .he is recovering from the operation side effect.

Had done PSA test today,

DatePSA Value

29-03-2019 PSA 167.006

17-04-2019 PSA 39.07

18-05-2019 PSA 0.80

19-06-2019 PSA 0.16

17-08-2019 PSA 0.104

18-10-2019 PSA 0.16

04-01-2020 PSA 0.19

16-03-2020 PSA 0.26

29-05-2020 PSA 0.56

The PSA is still increasing a slightly ....

Also , this is more than 1 year as of now but still the PSA is not undetectable.

AS its a lockdown here , we are continuing the tablets but whats about the increases in PSA levels...

should we take a serious note on it or its normal.

GP24 profile image
GP24

It will be years. The Gleason score will tell how aggressive the cancer is, you did not mention that.

If he cannot walk he will loose muscle mass and become weak. This needs to be avoided! Hopefully he can walk again after firmagon started working.

Ankitsharma021290 profile image
Ankitsharma021290 in reply to GP24

Hi GP24.....Today updated PSA is 39 ...which is donw from the starting 168.....the gleason score is not yet received to me.....will share soon....about walking...he has some improvement ...he is standing up from his own but cannt still walk so asily and properly..hope after a time....he may walk ....

Ankitsharma021290 profile image
Ankitsharma021290 in reply to GP24

Hi....today while following up my dr....dr. changed my ADT+docetexal to ADT+Zytiga ....i dont know why...but i think ....my father were getting better...and PSA down to 168 to 39 in just 20 days.....

GP24 profile image
GP24 in reply to Ankitsharma021290

If you start with ADT the PSA value will go down, this is what happened. The currently available information from several trials is that ADT+Docetaxel works as well as ADT+Zytiga. But Docetaxel has usually more side effects than Zytiga.

Ankitsharma021290 profile image
Ankitsharma021290 in reply to GP24

Hi GP24.....Good morning ..Hope you are doing well.

after adding ADT to zytiga +prednisone ....my father is feeling little bit discomfort with feeling highly weighted and little pain in stomach...is this the common side effects of zytiga or is it something which is should worried about....

Ankitsharma021290 profile image
Ankitsharma021290 in reply to GP24

Gleason report came....6 specimens taken.....section from the follwoing cores show features of prostatic Adenocarcinoma.

1) Right Base- gleason score 4+5=9 involving 50% of core area.

perineural invasion not seen.

The following cores are tumor free.

2)Right midline

3)Right Apex

4) Left base

5) Left midline

6)Left apex shows basal cell hyperplasia.

GP24 profile image
GP24 in reply to Ankitsharma021290

They often take 12 probes. Its a Gleason 9, an aggressive Tumor. But this will not change the current therapy.

Ankitsharma021290 profile image
Ankitsharma021290 in reply to GP24

Can the gleason score tell us the survival time?

GP24 profile image
GP24 in reply to Ankitsharma021290

You cannot tell me your exact survival time and I cannot tell you the one of your dad. All I know is that he will probably live longer than your doctor expects.

Because your dad has a lot of bone mets I did expect a Gleason 9. I would not intensify treatment because the side effects of that will cause a poor quality of life. And he only has a limited time to live. ADT+Zytiga currently is the best treatment which can go on for years.

Ankitsharma021290 profile image
Ankitsharma021290 in reply to GP24

Also one question....the tumor is only in right base...all 5 other section are tumor free...than how it has metastasized to bone while leaving that area.

GP24 profile image
GP24 in reply to Ankitsharma021290

The tumor is only in the right base because there were just 6 specimens taken. Prostate cancer is always multifocal and thus there would be more cancer found if more specimens were made.

A Gleason 9 spreads tumor cells into the blood stream to seed metastases, it began with that probably years before the diagnosis.

Ankitsharma021290 profile image
Ankitsharma021290 in reply to GP24

Thanks GP24 fro your information

Ankitsharma021290 profile image
Ankitsharma021290 in reply to Ankitsharma021290

GP24 hi...good morning...hope you are doing well....after the 1st injection of firmagon 240 mg+docetaxal..my father was feeling good and his psa was down to 168 to 39 and ALK.pohsphate was down to 851 to 92 which was in range...but now after 2nd injection with zytiga ..my father is feeling some side effect of that like pain in stomach and joint with fatigue....and yesterday his alk phosphate is rised again to 851 which makes me in tension as PSA will also rise as per my thinking....is my thinking right....is ALK phosphate directly proportional to PSA...would PSA will also rise ?

GP24 profile image
GP24 in reply to Ankitsharma021290

Does your father get firmagon, docetaxel and zytiga combined?

ALKP is an indicator for bone mets while the PSA value is caused by all PCa cells, e.g. in the prostate. So they are not directly proportional.

Ankitsharma021290 profile image
Ankitsharma021290 in reply to GP24

No..right now....firmagon and zytiga is going on....but ALKP is varying too much...at first it was 851 and second it was 92 and third it is 851 again...are this not varying too much...or this normal.

GP24 profile image
GP24 in reply to Ankitsharma021290

You can just observe the ALKP now. Labs do make mistakes sometimes. The fatigue could be a side effect of Zytiga or Docetaxel.

Ankitsharma021290 profile image
Ankitsharma021290 in reply to GP24

GP24 An update...

PSA result dated 27/03/2019 -168

PSA result dated 17/04/2019 -39

PSA result dated 08/05/2019 -2.33

Is it a good sign??

He is getting very weak for that what can we do..

GP24 profile image
GP24 in reply to Ankitsharma021290

It is good sign, it shows that the treatment works as it should.

What can you do against weakness? Read this article:

urotoday.com/center-of-exce...

Ankitsharma021290 profile image
Ankitsharma021290 in reply to GP24

GP24 ...seriously thank you for your support in my bad time.

Ankitsharma021290 profile image
Ankitsharma021290 in reply to Ankitsharma021290

Hi GP24 good morning..hope you are dong good.

My father PSA is now down to 0.80 to 0.16 this month....is the treatement going in a right way or this treatment will be continued to year and year....or this would be stopped after a time...Could you please suggest...is chemo or surgery needed ?

Ankitsharma021290 profile image
Ankitsharma021290 in reply to Ankitsharma021290

Hi.... I just got a call from home... That my father has very badly stomach pain with loose motion and vomiting ..... I had told my family to take them to hospital right nw.... M 300 km away from him..... Very much tension.

Ankitsharma021290 profile image
Ankitsharma021290 in reply to GP24

Hi GP...PSA is still constent at 0.16 ..and dr. said me for operate the prostate.

After the operation , my father would not required firmagon ,he said.

Please let me know the side effect of this....and the reason of that...is dr thinking that the firmagon is not working now and stopped to work so they are now thinking to operate...please let me now

GP24 profile image
GP24 in reply to Ankitsharma021290

It is very difficult to answer these question from here. It can be that your father may get complications urinating without operation because the cancer grows in the prostate. What I do not understand is why this is done at a PSA of 0.16, which is very low. The side effect of the operation is often incontinence.

I see no reason to stop Firmagon. It may be that your father will get a different drug now which can be given every three or six months only and not every month as Firmagon.

Ankitsharma021290 profile image
Ankitsharma021290 in reply to GP24

Thanks for your reply GP24... I dont understand the same and that is why i'm asking this... .. Is removing prostate beneficial for 4th stage cancer🦀 Or harmony therepy was good

GP24 profile image
GP24 in reply to Ankitsharma021290

An acute urinary retention can be life threatening, therefore surgery to avoid that can be beneficial. This kind of surgery is often done in very advanced prostate cancer. Maybe the doctor wants to do it now and not later in an emergency situation.

Removing the prostate and thus a lot of tumor tissue can be beneficial too, even in stage 4 cancer. This was tested in this trial: clinicaltrials.gov/ct2/show... There are no results of this trial yet.

Ankitsharma021290 profile image
Ankitsharma021290 in reply to GP24

I asked the dr.... He said " There is same either prostate operation Or firmagon.. Both has same result... But operation may be quite beneficial cost wise and monthly,firmagon can be avoied after that.... So can be escaped from firmagon side effect.

Also he mentioned, cancer is in advance stage so cannt be depend upon firmagon.... So he is doing that

GP24 profile image
GP24 in reply to Ankitsharma021290

I think he does not mean prostate surgery, he means orchiectomy, surgery to remove the testes. This way the testes cannot produce testosterone. It has the same effect as firmagon or similar drugs.

If your father is so advanced that he needs to take firmagon all the time this makes good sense.

Ankitsharma021290 profile image
Ankitsharma021290 in reply to GP24

Yes, you are absolutely right in saying ,this would be a testes surgery...but the option to do operation over on firmagon doesnt understand.

Ankitsharma021290 profile image
Ankitsharma021290 in reply to Ankitsharma021290

Also, want to understand that what the difference between zytiga and firmagon ,,i think both are harmon therepy which stop production of testosterone..is any of these chemotherepy?

Also if i understand it normally, the cancer may be stopped in prostate but what about the cancer outside the prostate like ribs, spine.

GP24 profile image
GP24 in reply to Ankitsharma021290

Prostate cancer needs testosterone to grow. Without testosterone it will stop growing, this causes a decrease in the PSA value, or even shrink a bit. Firmagon stops the testes to produce the testosterone in the body. However, if you remove the testes with surgery, there are no testes any more to produce testosterone and you do not need drugs for that any more, e.g. Firmagon. However, you can stop taking Firmagon but you cannot put the testes back in. But your father will always need a low testosterone so you may remove the testes.

After maybe two years, prostate cancer becomes resistant to testosterone suppression. No matter if done by surgery or firmagon. It can grow with very little testosterone then. Abiraterone is then used to lower the testosterone even more and the cancer stops growing again. Again for about two years perhaps. Then you would have a Chemo, e.g. with Docetaxel.

Suppressing testosterone stops the cancer both in the prostate but also in metastases, e.g. in the bone. It is the same cancer which needs testosterone to grow.

Ankitsharma021290 profile image
Ankitsharma021290 in reply to GP24

Hi All,

A quick update on the treatment..

Doctor suggested to do orchiectomy and this has been processed on 21 dec 2019.

Till than the condition is not good .he is recovering from the operation side effect.

Had done PSA test today,

DatePSA Value

29-03-2019 PSA 167.006

17-04-2019 PSA 39.07

18-05-2019 PSA 0.80

19-06-2019 PSA 0.16

17-08-2019 PSA 0.104

18-10-2019 PSA 0.16

4/1/2020 PSA 0.19

The PSA is still increasing a slightly ....

Also , this 1 year is going to pass on but still the PSA is not undetectable.

should we take a serious note on it or its normal.

GP24 profile image
GP24 in reply to Ankitsharma021290

As long as the PSA value is not getting over 2.0 ng/ml the orchiectomy plus Zytiga is working. He should continue with Zytiga!

He has aggressive cancer and started with 167, so you cannot expect the PSA value to get to undetectable. I think it does not matter for him if it is 0.19 or undetectable, this will not change his prognosis - whatever this may be, I cannot look into the future.

Ankitsharma021290 profile image
Ankitsharma021290 in reply to GP24

Hi GP24 ...should be follow Free PSA or PSA.....this time the clinic has done two test ...free psa as well as psa...Free PSA value is 0.04 and PSA value is 0.22...from starting till down we had done only PSA.

GP24 profile image
GP24 in reply to Ankitsharma021290

If the PSA value is 0.22 I see no reason to monitor the free PSA also. The ratio of PSA and free PSA can have diagnostic value but in case of your father this is not needed.

Ankitsharma021290 profile image
Ankitsharma021290 in reply to GP24

Hi All,

A quick update on the treatment..

Doctor suggested to do orchiectomy and this has been processed on 21 dec 2019.

Till than the condition is not good .he is recovering from the operation side effect.

Had done PSA test today,

DatePSA Value

29-03-2019 PSA 167.006

17-04-2019 PSA 39.07

18-05-2019 PSA 0.80

19-06-2019 PSA 0.16

17-08-2019 PSA 0.104

18-10-2019 PSA 0.16

04-01-2020 PSA 0.19

16-03-2020 PSA 0.26

29-05-2020 PSA 0.56

The PSA is still increasing a slightly ....

Also , this is more than 1 year as of now but still the PSA is not undetectable.

AS its a lockdown here , we are continuing the tablets but whats about the increases in PSA levels...

should we take a serious note on it or its normal.

GP24 profile image
GP24 in reply to Ankitsharma021290

As I said: He has aggressive cancer and started with 167, so you cannot expect the PSA value to get to undetectable. So do not ask why it is not getting undetectable, it will never be.

A value of 0.56 is still low considering the bone metastases he has. Currently all you should do is just to continue with the current treatment for maybe the rest of this year.

Ankitsharma021290 profile image
Ankitsharma021290 in reply to GP24

Hi... Today pet CT was done again after 1 yr... And cancer is extensive old as well somenew part... Docter classified it as MCSPC to MCRPC... And now they are planning for chemo or target therepy (lu177) .

Don't know whts going on... His blood/iron is low... Blood is 8.2 ... As cancer is in bones and its stopping to reproducing of blood... In very tension.. What will happen next

Cheerr profile image
Cheerr in reply to Ankitsharma021290

Hi Ankit the numbers seem low and good.

How did the orchidectomy go? Any side effects?

Ankitsharma021290 profile image
Ankitsharma021290 in reply to Cheerr

Hi Cheerr....Good morning....The orchidectomy went ok..it results in weight loss and some issues...it took around 1 month to recover the side effects...still he is recovering the weight...the weight loss was arround 80 kg to 72 after orchidectomy...which is now at 76.

Ankitsharma021290 profile image
Ankitsharma021290 in reply to Ankitsharma021290

Hi All,

A quick update on the treatment..

Doctor suggested to do orchiectomy and this has been processed on 21 dec 2019.

Till than the condition is not good .he is recovering from the operation side effect.

Had done PSA test today,

DatePSA Value

29-03-2019 PSA 167.006

17-04-2019 PSA 39.07

18-05-2019 PSA 0.80

19-06-2019 PSA 0.16

17-08-2019 PSA 0.104

18-10-2019 PSA 0.16

04-01-2020 PSA 0.19

16-03-2020 PSA 0.26

29-05-2020 PSA 0.56

The PSA is still increasing a slightly ....

Also , this is more than 1 year as of now but still the PSA is not undetectable.

AS its a lockdown here , we are continuing the tablets but whats about the increases in PSA levels...

should we take a serious note on it or its normal.

Ankitsharma021290 profile image
Ankitsharma021290 in reply to GP24

Update:

16-03-2020 PSA 0.26

29-05-2020 PSA 0.56

20-07-2020 PSA 0.96

Dr. aksed him to do PET ct psma again and asked him to cone with the report after 20 days... as his hemoglobin is going low...its 8.2 right now.

NPfisherman profile image
NPfisherman

Several thoughts here...since he has pain, if his kidneys are functioning normally, you could consider adding Celebrex to Zoldria--survival benefit--see below:

cancernetwork.com/asco-geni...

Celebrex may help with the pain as well....

My other thought is that a RO could consider doing stereotactic radiation to his spine lesion to prevent spinal fracture, and may do the one on his rib as well,which would also help with the pain significantly ...

Fish

Ankitsharma021290 profile image
Ankitsharma021290 in reply to NPfisherman

Hi NPfisherman....Dr suggest that only 1 radiation is required at D11 spine ....and it has done ...but after radiation we are not able to see much improvement in walking...even his diabetes has increased a lot after this...fasting value of diabetes is 176 yesterday.

NPfisherman profile image
NPfisherman in reply to Ankitsharma021290

Is it stereotactic radiation--SABR---3 sessions ...if so....that is good....the Celebrex works with Zoldria (Zoledronic acid) to enhance survival....see the study I listed....I believe it increased OS by 22%...the rib lesion he has may be addressed with thermal ablation possibly--getting on the ADT first for 8 weeks prior to radiation is important as there seems to be synergy with ADT first and then radiation....Good luck

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

Fish

Ankitsharma021290 profile image
Ankitsharma021290 in reply to NPfisherman

NPfisherman hi thanks or the info....but one information....after radiation my father's diabetes has gone up...180 (fasting) from earlier 130 fasting...

NPfisherman profile image
NPfisherman in reply to Ankitsharma021290

I did a search and Firmagon did not seem to raise blood sugars, so I am wondering if he has changed his eating /diet any? The other thing that makes blood sugars go up in diabetes is infections, and Firmagon has a side effect of increased urinary tract infections....Has he had any UTI's in the past? Burning/ discomfort with urination? If so, see his MD...

reference.medscape.com/drug...

Lastly, stress can effect your blood sugars and being diagnosed with prostate cancer creates stress...

diabetes.org/living-with-di...

Some stress management may be in order...meditation, a 20 minute nature walk has been shown to reduce stress...

Hope this helps.....Best of luck.....

Don Pescado

NPfisherman profile image
NPfisherman in reply to Ankitsharma021290

It is not unusual for blood sugars to go up post treatment with radiation--see below:

macmillan.org.uk/informatio...

It should drop back down if it is radiation related....I offered some oother ideas in another post...Good luck to Dad...

Don Pescado

Ankitsharma021290 profile image
Ankitsharma021290 in reply to NPfisherman

Hi....today while following up my dr....dr. changed my ADT+docetexal to ADT+Zytiga ....i dont know why...but i think ....my father were getting better...and PSA down to 168 to 39 in just 20 days.....

NPfisherman profile image
NPfisherman in reply to Ankitsharma021290

With Zytiga, he will be put on prednisone which can really increase blood sugars. He may need a referral to an endocrinologist to manage his blood sugar better. Glad to hear his PSA is down. Another indicator of improvement may be his ALP (alkaline phosphatase) may be down also. With 2 lesions, he is oligometastatic. Stereotactic radiation for his spinal met is a good idea to reduce the likelihood of a compression fracture at T11. Zytiga is a great choice post docetaxol. Wishing him continued good luck and health...

Fish

Ankitsharma021290 profile image
Ankitsharma021290 in reply to NPfisherman

Hi .....Good morning ..Hope you are doing well.

after adding ADT to zytiga +prednisone ....my father is feeling little bit discomfort with feeling highly weighted and little pain in stomach...is this the common side effects of zytiga or is it something which is should worried about....Also one thing....i did research that with zytiga predinisone should be given twice a daily...but dr. asked me to give only one tablet per day.....is anything wrong i should talk with dr..

NPfisherman profile image
NPfisherman in reply to Ankitsharma021290

Unless your Dad is castrate resistant then one tablet is given of prednisone...if he has castrate resistance, then 2 tablets of prednisone are given.....There are side effects to Zytiga.....fatigue, light headed or dizzy...my stomach got used to taking it on an empty stomach but the first week or two, it was rumbling....Hope this helps....Good luck...

Don Pescado

Ankitsharma021290 profile image
Ankitsharma021290 in reply to NPfisherman

Gleason report came....6 specimens taken.....section from the follwoing cores show features of prostatic Adenocarcinoma.

1) Right Base- gleason score 4+5=9 involving 50% of core area.

perineural invasion not seen.

The following cores are tumor free.

2)Right midline

3)Right Apex

4) Left base

5) Left midline

6)Left apex shows basal cell hyperplasia.

NPfisherman profile image
NPfisherman in reply to Ankitsharma021290

He is a Gleason 9--aggressive cancer, but many have lived many years as a Gleason 9...So he is on Zytiga now with a current PSA of 39...It should go much lower....as I replied to you earlier, consider getting on Celebrex for the pain and to add to his Zoldria...decreasing inflammation helps.. Get Dad up and walking again...start with a 1/2 mile if needed... and work up...good luck...

You are a good daughter and do not forget to do something good for yourself...being a caregiver is stressful....you need a break from time to time...

All the best to both of you....

Fish

Ankitsharma021290 profile image
Ankitsharma021290 in reply to NPfisherman

Thanks.... But dr. Stopped zoldria... He is doing daily exercise for moving the leg

NPfisherman profile image
NPfisherman in reply to Ankitsharma021290

It is for bone strengthening and hypercalcemia....any idea why stopped?

Fish

Ankitsharma021290 profile image
Ankitsharma021290 in reply to NPfisherman

I know.... After getting first zoldria he can stand up now due to that only... But why Dr. has stopped that no idea..... I will ask him on next followup date...

NPfisherman profile image
NPfisherman in reply to Ankitsharma021290

Ok...hope he gets to feeling better...

Fish

Ankitsharma021290 profile image
Ankitsharma021290 in reply to NPfisherman

NPfisherman Hi.....hope you are doing well....after the 1st injection of firmagon 240 mg+docetaxal..my father was feeling good and his psa was down to 168 to 39 and ALK.pohsphate was down to 851 to 92 which was in range...but now after 2nd injection with zytiga ..my father is feeling some side effect of that like pain in stomach and joint with fatigue....and yesterday his alk phosphate is rised again to 851 which makes me in tension as PSA will also rise as per my thinking....is my thinking right....is ALK phosphate directly proportional to PSA...would PSA will also rise ?

NPfisherman profile image
NPfisherman in reply to Ankitsharma021290

Not necessarily...ALP is made up of 2 components--bone and liver--it could be that his liver is having some issues with zytiga--(stomach pain)--were his liver enzymes---alt, ast or ggt elevated also? The other possibility is that it could be bone related and that could be due to bone involvement--either reformation or destruction. I can not say what his PSA will be based on ALP. You will have to do the PSA test and see. Be sure to take zytiga and prednisone as prescribed. Hoping all goes well for him. Good luck.

All the best,

Fish

Ankitsharma021290 profile image
Ankitsharma021290 in reply to NPfisherman

Yes he is getting stomach pain...fatigue with zytiga... However, AST and ALT value are increased from the previous one but it's inline and fair value.. It's around 24.3 and 23.9 which should be <35....... Will it be any problem... Also it may be because he has cancer in 4rib also... Will it be any big problem... However we have appointment with Dr. On 9th may and we will discuss the same with him.... Thanks for your information

Ankitsharma021290 profile image
Ankitsharma021290 in reply to NPfisherman

NPfisherman An update...

PSA result dated 27/03/2019 -168

PSA result dated 17/04/2019 -39

PSA result dated 08/05/2019 -2.33

Is it a good sign??

He is getting very weak for that what can we do..

NPfisherman profile image
NPfisherman in reply to Ankitsharma021290

Hi Ankitsharma021290...It is a very good sign----the drop from 168 to 2.33 in a few months post docetaxol and on zytiga....great....Now, let's attack his other issues....1)fatigue....if he feels it shortly after taking zytiga, then he may benefit to taking it in the evening--a few hours before bed--especially if he is not sleeping well. 2) He has bone pain--I have some too on zytiga. Check with his team to see what type of medication they advise.... I use Bengay or Biofreeze on areas that hurt and that helps...3) He has stomach pain.... Does he have upset stomach?--heartburn? --in which case, he may benefit from Ranitidine(Zantac) but not to be given less than 12 hours from Zytiga--there is a drug to drug interaction--It is a CYP3A4 inhibitor--raises the level of zytiga--I take it myself...

.

Zytiga info:

accessdata.fda.gov/drugsatf...

List of CYP3A4 drugs that can interact with zytiga:

en.wikipedia.org/wiki/CYP3A4

Is he eating ok? If not, get some drink supplements like Boost or Ensure for him to drink between meals and when he doesn't eat...To fight the fatigue, I walk daily...

Hope this helps...

Fish

Ankitsharma021290 profile image
Ankitsharma021290 in reply to NPfisherman

Thanks for you reply...

he takes zytiga with one 5mg tablet of prednisone in morning 5 o clock...and his full day goes with slightly fatigue/stomach pain/bone pain..mostly pain at in morning 7-11 am after that slightly cover up...but he is not able to take a good sleep in night due to that....

Ankitsharma021290 profile image
Ankitsharma021290 in reply to Ankitsharma021290

Hi NPfisherman good morning..hope you are dong good.

My father PSA is now down to 0.80 to 0.16 this month....is the treatement going in a right way or this treatment will be continued to year and year....or this would be stopped after a time...Could you please suggest...is chemo or surgery needed ?

NPfisherman profile image
NPfisherman in reply to Ankitsharma021290

Call me Fish or NP (saves typing)....His stomach pain could be due to taking prednisone with Zytiga.....Zytiga is taken on an empty stomach, but not prednisone. Prednisone should be taken with food or it can cause stomach pain or worse, an ulcer of the stomach lining. He is going in the right direction... 0.16 now, right??..Keep it up and congratulations.... Best of luck to you and Dad....Hope he is in less pain and eating better...

Fish

NPfisherman profile image
NPfisherman in reply to Ankitsharma021290

It will be continued year to year...he is still dropping....PCa activity is diminished / nonexistent when PSA is low...Good luck....

Fish

NPfisherman profile image
NPfisherman in reply to Ankitsharma021290

Final thought....he must feel 1000X better.....to fall from a PSA of 168 to one of 0.16 is a change of 1050%--see below:

.16 x 1050=168

You are a good daughter....If you have any questions, just post again and I shall reply...

All the best,

Fish

Ankitsharma021290 profile image
Ankitsharma021290 in reply to NPfisherman

Hi.... I just got a call from home... That my father has very badly stomach pain with loose motion and vomiting ..... I had told my family to take them to hospital right nw.... M 300 km away from him..... Very much tension.

NPfisherman profile image
NPfisherman in reply to Ankitsharma021290

I am sorry to hear this....As stated previously, he should not take prednisone on an empty stomach....always with food....I take my Zytiga at 9:30 am and wait for about 1 1/2 hrs--and take food and then prednisone at 11:00am...Good that he went to the hospital...His last PSA was 0.16--hopefully, it has fallen further...Prayers for your father...Hope it is nothing too serious....Best of luck....

Fish

Ankitsharma021290 profile image
Ankitsharma021290 in reply to NPfisherman

Hi NP... Thanks.... However he is taking zytiga at 6 o clock morning and taking predesolone at 12:30 after lunch... Hope it fine.... But still don't knw the reason why that hard pain happened...

NPfisherman profile image
NPfisherman in reply to Ankitsharma021290

Hard to say....he is at the hospital and they will determine the cause...Hope his PSA is still dropping...he has had good success on Zytiga so far...

Best of luck...

NP

Ankitsharma021290 profile image
Ankitsharma021290 in reply to NPfisherman

Hi NPfisherman today PSA result came from this month.... There is a increase in PSA from 0.16 to 0.21......however we have dr. Follow up date on 22 aug.... Is it very bad news of incremental of PSA.... Should we show him to dr. tommorow itself.... Or wait for the time and should show him on his date 22 aug.... If it not a big issue.... As you know... His health was not so good 4-5 days before... Now he is ok and having a little loose motion...however, all the kft lft cbc report looks to be normal in range...

NPfisherman profile image
NPfisherman in reply to Ankitsharma021290

I would wait...as for the incremental increase, if his PSA was done while sick, then it is possible that threw off his PSA number.... I would do a retest when I see the MD.... as for the loose stool, he should have a stool test for WBC's, as well as a test for Clostridium difficile if he has been on antibiotics....that would rule out an infectious process for the loose stool and leave it as a digestive process....any new meds beyond the zytiga and prednisone?? Wishing you and Dad all the best....Good luck...

NP

Ankitsharma021290 profile image
Ankitsharma021290 in reply to NPfisherman

Thanks np

Ankitsharma021290 profile image
Ankitsharma021290 in reply to Ankitsharma021290

Hi NP...PSA is still constent at 0.16 ..and dr. said me for operate the prostate.

After the operation , my father would not required firmagon ,he said.

Please let me know the side effect of this....and the reason of that...is dr thinking that the firmagon is not working now and stopped to work so they are now thinking to operate...please let me now

Ankitsharma021290 profile image
Ankitsharma021290 in reply to NPfisherman

Hi All,

A quick update on the treatment..

Doctor suggested to do orchiectomy and this has been processed on 21 dec 2019.

Till than the condition is not good .he is recovering from the operation side effect.

Had done PSA test today,

DatePSA Value

29-03-2019 PSA 167.006

17-04-2019 PSA 39.07

18-05-2019 PSA 0.80

19-06-2019 PSA 0.16

17-08-2019 PSA 0.104

18-10-2019 PSA 0.16

4/1/2020 PSA 0.19

The PSA is still increasing a slightly ....

Also , this 1 year is going to pass on but still the PSA is not undetectable.

should we take a serious note on it or its normal.

Ankitsharma021290 profile image
Ankitsharma021290 in reply to NPfisherman

Hi... Today pet CT was done again after 1 yr... And cancer is extensive old as well somenew part... Docter classified it as MCSPC to MCRPC... And now they are planning for chemo or target therepy (lu177) .

Don't know whts going on... His blood/iron is low... Blood is 8.2 ... As cancer is in bones and its stopping to reproducing of blood... In very tension.. What will happen next

Ankitsharma021290 profile image
Ankitsharma021290 in reply to NPfisherman

Hi @NP ...should be follow Free PSA or PSA.....this time the clinic has done two test ...free psa as well as psa...Free PSA value is 0.04 and PSA value is 0.22...from starting till down we had done only PSA.

Ankitsharma021290 profile image
Ankitsharma021290 in reply to NPfisherman

Hi All,

A quick update on the treatment..

Doctor suggested to do orchiectomy and this has been processed on 21 dec 2019.

Till than the condition is not good .he is recovering from the operation side effect.

Had done PSA test today,

DatePSA Value

29-03-2019 PSA 167.006

17-04-2019 PSA 39.07

18-05-2019 PSA 0.80

19-06-2019 PSA 0.16

17-08-2019 PSA 0.104

18-10-2019 PSA 0.16

04-01-2020 PSA 0.19

16-03-2020 PSA 0.26

29-05-2020 PSA 0.56

The PSA is still increasing a slightly ....

Also , this is more than 1 year as of now but still the PSA is not undetectable.

AS its a lockdown here , we are continuing the tablets but whats about the increases in PSA levels...

should we take a serious note on it or its normal.

j-o-h-n profile image
j-o-h-n

Namaste, I assume you're in India, is that correct? Would you be kind enough to tell us your father's age? Generally it is believed that Prostate Cancer (Pca) is a slow growing disease but it is difficult to generalize. Hopefully your father will be around for a very long time. Keep us in the loop of what is going on with your father.Thank you.

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 04/17/2019 7:17 PM DST

Ankitsharma021290 profile image
Ankitsharma021290 in reply to j-o-h-n

Hi john.....my father age is 60 year ...he has no issue rather than the pain in the back hip...which is now in control with the tablet...he cannt walk fully now but little improvement we can see ..he may stand up now...

j-o-h-n profile image
j-o-h-n in reply to Ankitsharma021290

Thank you for your reply. It's good to see that your father sees some improvement, and hopefully he sees total improvement in the near future.

Keep posting here for help and information. Keep us up to date with what's going on there.

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 04/18/2019 12:05 PM DST

Ankitsharma021290 profile image
Ankitsharma021290 in reply to j-o-h-n

Hi John ...Sorry for not replying completely...yeas i'm from INDIA

Ankitsharma021290 profile image
Ankitsharma021290 in reply to j-o-h-n

Hi....today while following up my dr....dr. changed my ADT+docetexal to ADT+Zytiga ....i dont know why...but i think ....my father were getting better...and PSA down to 168 to 39 in just 20 days.....

j-o-h-n profile image
j-o-h-n in reply to Ankitsharma021290

Good News...Keep getting better....

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 04/25/2019 4:44 PM DST

Myhubby58 profile image
Myhubby58

We are in a small town,Augusta Georgia..Not Dr here that know about the medications y’all are mentioning.Hubby has been on Casodex and lupron,Xtandi and lupron and now zytiga and lupron..alone with prednisone and a an infusion for his bones..

Hi... What's the age of ur hubby..... How much cancer has spread...... What is the gleason score......

Myhubby58 profile image
Myhubby58 in reply to Ankitsharma021290

My hubby is 58

Myhubby58 profile image
Myhubby58 in reply to Myhubby58

His Gleason is 9 50.0 psa

Cheerr profile image
Cheerr

Hi Ankit,

In which hospital / city is your father being treated currently?

The decline in PSA is a good sign. Hope he is doing better now. Wishing him success in all treatments.

Hi cheerr... Treatment is going in Aiims new delhi india, the psa was down to 168 to 0.16 till last month... This month he got sick and psa has been slightly increase to 0.16 to 0.21... However, dr said this is due to sickness.... Hoping for the best

Hi all... Hope you are doing well.... My father is now walking and improving day by day.. However he is not 100% normal walking. . But soon he will be.... My only question is.... Is radiation not required on this case... Only zytiga +firmagon is given to them on monthly basis... Till now 6 shot has been given... Radiation has been given in starting one time... Is that not required now.

AlmostnoHope profile image
AlmostnoHope

Two of my friends had PSA over 100 and brought it down with PCSPES and moderate ADT (Bicalutimide)

Ankitsharma021290 profile image
Ankitsharma021290 in reply to AlmostnoHope

Thanks for your reply....however, my father's PSA is 0.16 now with firmagon and dr. is planning for his prostate operation

AlmostnoHope profile image
AlmostnoHope in reply to Ankitsharma021290

Sorry to hear. I wish him well.

You may also like...

Advanced Metastatic Prostate Cancer

with advanced metastatic (gleason 9) prostate cancer. The cancer spread to the nearby bladder and...

Advanced prostate cancer

ELIGARD injections every six months and Xgeva injections monthly to strengthen my bones. While I...

Radiation for Advance Prostate Cancer?

metastatic PC. My GS was 8-9 for all 12 cores. Cancer spread to lymph nodes, I also have lesions in...

Advanced prostate cancer

anyone living this now.My father is 70 and was recently diagnosed with prostate cancer and there...

Friend with advanced Prostate cancer

Good friend with advanced prostate cancer has failed ADT. Cancer spread to bones and is being...