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Advanced Prostate Cancer
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How long does Lupron + Zytiga take to be effective?

Newly diagnosed with metastasis to distant lymph nodes (peritoneal) but no bone. Prostate Biopsy showed adenocarcinoma in 12 of 15 samples, all GS 4+4, except two 4+5. Prostate is 102 g. I’m 70.

My question has to do with when Lupron and or Zytiga become effective.

Started Lupron 35 days ago and zytiga 15 days ago. My PSA before starting treatment was 8.4. Lab now reports PSA of 4.2. I keep reading about people with fractional PSA’s, but mine sure isn’t.

Is it too soon for these to take affect? Or is this implying I’m castrate resistant?

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You have to wait. Have you talked to a brachytherapist about brachy boost therapy?

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Yah, and the radiation oncologist said, affected nodes are too close to aorta. But thanks for answering

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Someone in my support group just had all his para-aortic lymph nodes treated with IMRT, with an SBRT boost to the detected node. Similar to this:

redjournal.org/article/S036...

Perhaps send that link to your RO and ask for his comments. Mack Roach is a big name in radiation oncology.

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Is a brachy boost any use for a metastatic prostate cancer patient ?? Just curious.

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If all the metastases are in the pelvic lymph nodes (Stage N1), then whole pelvic external beam plus a brachytherapy boost to the prostate plus long-term ADT may cure it. If the metastases are distant (Stage M1), then brachy boost probably won't be curative, but may slow progression if there are 3 or fewer metastases.

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Thanks, Tall_Allen.

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Mack Roach is the "Mac Daddy" of Radiation Oncology @ UCSF.

I consulted him on radiation to inguinal lymph nodes. His approach was spot on.

If you haven't do so already you should get a GA-68 PET MR.

In my opinion Weill Cornell has the best team for metastatic PCa.

Trials are ongoing at UCSF, UCLA, MSK, Weill Cornell and John Hopkins 4 GA-68 PET MR.

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Thanks, I’ll look into it. But that article referred to just one node. Scan showed cancer in a dozen+ of my retro peritoneal nodes, all the way up to the area of the aorta.

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My friend had the entire chain of para-aortic lymph nodes treated with IMRT (50 Gy in 5 weeks). Because he only had one node on Axumin PET scan, he also got an SBRT boost dose (25 Gy in 5 treatments) to that one - you may not be able to get the SBRT boost, although they can probably give a little more IMRT to the biggest lymph nodes. Because his PSA had started rising, he qualified for Provenge at the same time he had the SBRT boost. He is also taking Lupron + Zytiga for the next 2 years.

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Your PSA has fallen by half in 35/15 days on Lupron/Zytiga respectively. Remember there is a temporary boost in testosterone levels when starting Lupron. In my experience it lasts about 2 weeks, so you've probably had falling T levels for about 2 weeks. Having your PSA fall by half in 2 weeks is a good response. Hopefully it will continue to fall as rapidly. Good luck!

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While the PSA value gets lower you cannot be resistant.

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My PSA at diagnosis on 13th January, 2018 was 16.53

After radiation (38 fractions) & Casodex & Eligard, PSA fell to 2.3 on 2nd August, 2018.

Then rose rapidly to 8.6 by 13th October, 2018 and I was considered castrate resistant.

Asked to start docetaxel and PSA fell a bit to 5.6 ( so was I castrate resistant or not ?) and then jumped to 16.3 by end, Feb, 2019.

So, I think I am castrate resistant. What do you say ?? Thank you for a reply.

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I agree with you doctor that you are castrate resistant. While you are resistant, you can reduce the PSA value with various treatments, e.g. docetaxel or Zytiga. You remain resistant though.

An exception would be if you debulk your tumor volume with e.g. radiation and after that Eligard alone will keep the PSA value low. Then you killed enough resistant cells so you are hormone-sensitive again.

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Thank you very much, GP24. I much appreciate the time and trouble you take to reply to everyone, especially myself. Thanks again, much obliged.

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I have taken 38 fractions of radiation to the prostate. Did not seem to help much. The mets in the prostate are still very much there.

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I expect the Lu177 therapy will work for you. If you are very lucky, you get the same response as this patient:

ncbi.nlm.nih.gov/pubmed/269...

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Thank you, GP24. I hope my situation turns out to be somewhat similar :-)

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According to the statistics, a long slow decline to a nadir of <2 is best. As long as it keeps going down you are doing well.

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How distant of lymph nodes we talkin' ??.. there are options especially if not too distant...give it some time, brother...in the meantime, fight on...gain knowledge..good luck

Fish

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Too distant- lymph nodes too close to my aorta for RT. But I appreciate your comments.

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I started Casodex for three weeks, PSA dropped from 33 to 21, then concurrently added 3/4 dose of Zytiga for two weeks, and PSA dropped to 4.5, total drop of 86%. Testing again this week after two more weeks. Probably adding Lupron this week if PSA > 1.0. I’m Stg 3b N1 M0, Gl 7 (3+4).

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Helpful, thanks. I’m stage 4: T2c N1 M1a. Yuck, but a lot of life left in me.

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Man oh Man..... You got a lot of life left in you. Unless you're 99 years old and stupping your next door neighbor's wife.... Hang in there Bro..... Think positive and laugh your ass off....

Good luck, Good Health and Good Humor.

j-o-h-n Tuesday 05/07/2019 5:30 PM DST

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According to one study, a PSA drop of more than 50% in the early weeks of Zytiga treatment is an indicator that Zytiga is working. Do you have your before-and-after Zytiga ALP (alkaline phosphatase) levels? Apparently if there's an ALP bounce up right away followed by a drop, this is also shows a good response. (Others here can comment on the quality of this study.)

malecare.org/is-alkaline-ph...

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If it's dropped its working. We are all in the same boat here but all Cancers are not the same and we all respond different to treatments. My suggestion is to stay the course and wait for the next blood work. My stats are very similar to yours and Zytiga has kept my PSA at 0.1 for 14 months now. Never give up never surrender. Leo

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When my dad first started Zytiga, his oncologist said to wait at least three months. If the overall trend is downwards, then Zytiga is working. After the three months, there will be occasional upward spikes, but you have to look at the overall trend, which you want to be downwards. So far it is working for you, and that is a wonderful sign!

Arthur

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Sounds like a good response! Agree with all here. It is going in the right direction. My husband has been on Zytiga + lupron for a year. PSA has gone from about 25 to about 9 in that time.

He was diagnosed 7 mos prior to starting Zytiga with PSA >677. He did lupron and Docetaxel before Zytiga which got him to 25.

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Mine dropped from 571 to immeasurable within twelve (12) weeks where it’s stayed for the last 7.5 years. That’s a good target to achieve, but highly unusual from what I’ve seen.

I’ve taken to posting pictures of my test results on some sites as it was so dramatic, some have questioned my integrity.

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IN my case, my PSA took about 10 months to bottom out. I took Casodex to fight the 'flair' prior to RT treatment and ADT (Eligard) for a total of 16 months. I've been at my nadir (>0.02) for a year. I was also node positive at Dx, but mine was confined to the pelvic floor area.

In summary, it takes time to bottom out.

Hopefully, your trend to a lower value continues.

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I’ve now heard enough that I am satisfied with my progress rather than scared. This is a fantastic place for us miserables. Thanks all for sharing.

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