I have doubts from PA that Zytiga is working

SO is on Lupron , Zytiga and Xgeva. The Zytiga (1000 MG) with Xygeva were both added 4 months after Lupron. (initial PSA was 947 in October 2018) Here are the PSA numbers when Zytiga started:

2/12/19- PSA 21.55

3/19/19- PSA 18.66

5/7/19- PSA 11.63

MO told him to stop Zytiga for one week from 5/7/19 to 5/14/19 (AST and ALT high) then restart at regular dosage of 1000 mg

6/4/19 - PSA 14.95

Physician Assistant (MO was delayed so SO saw PA instead) said zytiga is working and that due to the fact he stopped zytiga for one week PSA went up a bit. Physician assistant also stated that his PSA for the week he stopped probably was over 14.95.

I can't believe that stopping a week would cause the PSA to go up quickly. I would have expected his PSA today would be less than 11.63.

Does anyone think Zytiga is still working for him?

His liver enzymes are all back to normal.

Thanks all.

Added note- please contribute to male care...such a valuable site ...I did last week.

[Tall_Allen]

I'd wait for a clear upward trend, then have a bone scan/CT. Try switching to dexamethasone.

[Hidden in reply to Tall_Allen]

Good advice here IMO. The bottom line: Is there progression? PSA is one indication, but you need imaging to really know whether it's working or not. There's no rush at this point, you can wait to get more clarity on the trend. I'd do the Dexamethasone first as TA suggested as per the postive SWITCH trial results. See what happens with that. If/when it keeps going up, do the imaging.

[cathyfongus61 in reply to Tall_Allen]

PSA usually is closely connceted with prostatitis, and antibiotics produce drug resistance and you've got to change the medicine from time to time, and it seems you can't get a complete cure by it, that's how the psa remaining high. However there're natural therapies available to avoid the drug resistance, for instance herbal treatment of diuretic and anti-inflammatory pill, and there could probably be others. Don't give up, there's still great hope of ultimate recovery.

[cesanon]

In my uninformed opinion, all that makes sense to me.

[Hidden]

Isn't liver enzymes related to zytiga? His liver enzymes are fine. Is dexamethasone to protect the adrenal gland similar to prednisone?

[Magnus1964]

I don't understand why his MO told him to stop zytiga for a week? He needs to question his MO on this.

[Hidden in reply to Magnus1964]

His MO stopped his Zytiga for one week because his AST and ALT was almost 4 times than the high normal range of AST and ALT. By the way, this was from the lab testing results of his own GP. His MO only likes to see him every 3 months for the Lupron and Xgeva injection.

No bone scan was done prior to taking Zytiga so no base line.

[Magnus1964 in reply to Hidden]

He could reduce the dosage. Stopping altogether runs the risk of becoming resistant to the zytiga.

[JazzMan42 in reply to Magnus1964]

After my enzymes started climbing, my MO dropped my Zytiga dose to 750mg and my prednisone to 5mg. Soon after, enzymes went back to normal range ( now ALT 28, AST 25), and PSA keeps dropping (now down to 0.69). That's my experience - perhaps this would work for HPpurple.

[j-o-h-n]

75 years ago today those brave men saved our freedom, now don't let it dwindle away from us.

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 06/06/2019 5:33 PM DST