Problems with Zytiga / Prednisone - Advanced Prostate...

Advanced Prostate Cancer

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Problems with Zytiga / Prednisone

bluephi profile image
45 Replies

Hi All,

I was put on Zytiga and Prednisone by my oncologist about six weeks ago after being on ADT and casodex. My onc said that adding Zytiga would extend life. Before starting with the Zytiga and being on adt plus casodex, my PSA was .2 and T was 290. With Zytiga and Prednisone added after six weeks psa was undetectable 0.01 and T was <10. These are great results and onc was pleased. The problem is that being on prednisone (10 mg. ) a day made my glucose level go through the roof. I was hospitalized with a blood glucose level of 925 and A1c tests showed that I am now a certified diabetic taking insulin for this condition. Does any one know if there is any way to take Zytiga without prednisone or should I be looking at other meds to continue the results I have had? I was dx in in Oct. 18 with psa of 1340. Gleason 9

45 Replies
Tall_Allen profile image
Tall_Allen

Talk to your oncologist about reducing prednisone to 5 mg/day:

pcnrv.blogspot.com/2019/06/...

bluephi profile image
bluephi in reply to Tall_Allen

Thanks...I will do that. So you don't think that taking prednisone at a reduced dose will be a problem.

Tall_Allen profile image
Tall_Allen in reply to bluephi

As it says in the article, it's very individual. You have to monitor closely and work with your oncologist on it.

bluephi profile image
bluephi in reply to Tall_Allen

Thanks

Fairwind profile image
Fairwind in reply to bluephi

There is another steroid that can be used, Dexamethasone, instead of prednisone. I would ask about that..When on pred, few guys need more than 5mg.. Or maybe switch to Xtandi which requires no steroid medication..

bluephi profile image
bluephi in reply to Fairwind

Thank you...I have an appointment next week with my oncologist and I will mention that.

efsculpt profile image
efsculpt in reply to Fairwind

I just read an study comparing Prednizone 10mg, Prednizone 5 mg, Dexamethasone 0.5 mg, all with Zytiga and Lupron. Patients that switched to Dexamethasone did better than Prednizone (10mg P did better than 5mg P).

theoncologist.alphamedpress...

ncbi.nlm.nih.gov/pubmed/300...

Best Regards,

Craig

bluephi profile image
bluephi in reply to efsculpt

Thanks...what are the side effects of Dexamethasone?

efsculpt profile image
efsculpt in reply to bluephi

Ah. There you have me. I haven't checked on side effects, yet. I just found the study.

I see my MO, and go off all drugs ( starting intermittent) tomorrow. I'll ask him about side effects, along with, "When can I get drunk?".

Regards,

Craig

bluephi profile image
bluephi in reply to efsculpt

Lol.....thanks

GeorgeGlass profile image
GeorgeGlass in reply to efsculpt

what does "did better" mean? tolerating, or longer remission?

bluephi profile image
bluephi in reply to GeorgeGlass

Tolerated.....it was bringing psa down

Victorq1 profile image
Victorq1 in reply to Tall_Allen

I agree Tall..Allen

worth trying

Is anybody in our groups replacing Prednisone ,

beside lowering the dose??

I am Chemist and it is known that larger

dose of Prednisone may affect Calcium in bones.

Any comment?

Tall_Allen profile image
Tall_Allen in reply to Victorq1

Here's what I know:

prostatecancer.news/2019/06...

BMD declined by 2% among those taking 0.5 mg dexamethasone/day. But there is tremendous individual variation. The only way to know is to make small adjustments until symptoms subside.

tango65 profile image
tango65

Talk with your oncologist about using zytiga with inspra (eplenerone) and a very low dose of prednisone (2.5 mg or less). Inspra is an aldosterone receptor blocker. Aldosterone is elevated when taken zytiga . This increase in aldosterone is the cause of sodium and water retention (edema and hypertension), and hypokalemia (low potassium). If aldosterone is blocked these symptoms may not appear and the amount of prednisone could be reduced.

bluephi profile image
bluephi in reply to tango65

Thanks. I have never heard of those meds, but will talk to onc about them

tango65 profile image
tango65 in reply to bluephi

Inspra has been used for about 20 years to treat hypertension or other pathologies associated with increased aldosterone (heart failure, adrenal tumors etc). It substitutes a very old drug called spironolactone (inspra has less undesirable side effects). It is the correct treatment for the excess of mineralocorticosteroids caused by zytiga since it blocks aldosterone.

bluephi profile image
bluephi in reply to tango65

Thanks...I will take up with my onc

Magnus1964 profile image
Magnus1964

What ADT were you taking with casodex? Casodex is an ADT drug.

bluephi profile image
bluephi in reply to Magnus1964

Lupron...since Oct. 24, 2018

Magnus1964 profile image
Magnus1964 in reply to bluephi

Did you have a rising PSA on casodex and Lupron, what were the numbers?

bluephi profile image
bluephi in reply to Magnus1964

No....actually Lupron and casodex took 2nd from psa of 1340 down to .2. T 290. In the six weeks I was on Zytiga psa went to .1 and T <10.

Magnus1964 profile image
Magnus1964 in reply to bluephi

I am not sure why your Onc took you off Casadex and Lupron. They seemed to working just fine. Maybe Zytiga could take PSA lower but not the best move. Casadex and Lupron might have been effective for years.

bluephi profile image
bluephi in reply to Magnus1964

You are reading my mind. That's exactly what I was thinking. Casodex and Lupron did a good job. Since my problem with Zytiga and Prednisone, I have been back on Casodex and will see how i do. I told my onc I am a little gun shy in going back on Zytiga at this point.

kaptank profile image
kaptank in reply to bluephi

If it is working, casodex (bicalutamide) has few side effects. But. Bical when it fails becomes an agonist ie it promotes growth of the cancer. Thus, important to closely monitor and stop when PSA starts to rise.

LearnAll profile image
LearnAll

I am taking only 5 mg Prednisone a day.( I was prescribed 10 mg a day) So far , BP and BS both are WNL.

bluephi profile image
bluephi in reply to LearnAll

Thanks...

Drphil1938 profile image
Drphil1938

I am a diabetic and on lupron, zytiga and 10mg of predisone, my sugar runs 100 to 120 each morning fasting. I also take a Januvia pill each morning to help control the sugar. The predisone doesn't seem to have an effect on the daily reading. My diet each day will cause a sugar spike, to much desert, or carbs can be a real diabetic problem. Ask about taking Januvia, it is a pill no needle which is plus.

softwaremom00 profile image
softwaremom00

My husband took Zytiga without prednisone. He weaned himself off. It was because our oncologist had talked about some of his patients doing that and being fine. My husband was tired a lot. He did this for 5 or 6 months. I tried everything to pep him up.(cordyceps, ginseng..etc) Some of his doctors had him take a test to determine if his body was making the proper chemicals.. the test determined that Zytiga was doing what it should.. shutting down his adrenal glands. They said he needed to be on something. He talked with a endocrinologist who put him on hydrocortisone they said it is similar to prednisone but it is supposed to be closer to what your body makes. He has a lot more pep now.

I guess the point is consider asking for a consult for an Endocrinologist to see if there is something other than Zytiga to help you.. there might be.

Sending you hugs and prayers!

Softwaremom

bluephi profile image
bluephi in reply to softwaremom00

Thank you so much. I have an appointment with an endocrinologist next month. I will certainly be asking that and any other substitute for prednisone.

JamesAtlanta profile image
JamesAtlanta

As mentioned previously, ask about 5mg of dexamethasone. That’s what I take - fewer side effects for me than prednisone.

Hope this helps! Hang in there - you have had great results from Zytiga!

Best wishes,

James

bluephi profile image
bluephi in reply to JamesAtlanta

Thank you....I would like to continue with Zytiga and will talk to Inc about this med.

MMMayhem profile image
MMMayhem

I was type 2 before i started ADT. Began insulin approx a month before starting on Lupron. The prednisone also caused problems but those glucose numbers are really high, especially if they wre normal before. I assume you're talking long acting insulin like Lantus solostar? How many units? My reaction to prednisone seemed to be raising my fasting glucose by roughly 100. The endocrinologist they had me see also recommended hydrocortisone but the oncologist went with dexamethasone. Good luck, hope one of those works for you.

bluephi profile image
bluephi in reply to MMMayhem

Thank you. I see a endocrinologist next month and will see what they say

lincolnj8 profile image
lincolnj8

My sugar rose and hit 190. Your 925 number is very dangerous. My Mo wasn't concerned about my rising sugar number. It was a gradual rise. He was so happy with all the other bloodwork numbers. My General Practitioner doctor is the one who put me on the sugar pill. I feel your pain. Hang in there. This is a daily fight. All the little side effects take a lot to get used to. It changes our lifestyles. The zytiga and prednisone are a home run for many of us.

bluephi profile image
bluephi in reply to lincolnj8

Yes...you are right about Zytiga being a home run. I will be seeking ways. To continue it with my Inc.

Mathes72 profile image
Mathes72

I had the same set up only prednisone of 5 mg had no problem

bluephi profile image
bluephi in reply to Mathes72

Thanks. Many others have mentioned that as well.

I'm on a therapeutic keto diet (less than 20 carbs a day). If I am good and eat to the plan, plus exercise, my blood sugar is between 60 and 80 in the morning on a 10 hour fast. It's tough to maintain, but I am mostly successful at it.

bluephi profile image
bluephi in reply to

Thanks ...keep it up

Oh, also on zytiga and prednisone. I am going to look into hydrocortisone though!

bluephi profile image
bluephi in reply to

Thanks....Me too

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

There's a wealth of knowledge in this group. I commend you all.

youtube.com/watch?v=trZlvpL...

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 07/09/2019 7:47 PM DST

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

Thanks for posting the marches, j-o-h-n. They were a great soundtrack for watching the All-Star game.

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

You're welcome indeed. To me All-Star games are like kissing your sister (anyway mine had a bit of a mustache).

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 07/09/2019 11:44 PM DST

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