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
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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..
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).
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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