practiceupdate.com/journals...
This meta analysis should end the discussion posed often here about using “one drug at a time to extend overall survival”. Most of the key drugs that were once used only when castrate resistance sets in, have been shown to extend life when added early while still castrate sensitive.
Schwah
Immunotherapies have not been shown to be better. I don't know if PSMA-based therapies are better at the castration-sensitive stage. ADT is always continued after castration resistance, of course.
Why “Of course”? Why the favoring of ADT after castrate resistance. shows that it is no longer working. Seems just a legacy bias as the SOC against which all other treatments must be compared or added. What am I missing here?
You have imagined that it is a "legacy bias" because you don't understand the actual reasons why castration resistance occurs. There are about 5 different mechanisms responsible for castration resistance. One of them is "upgrading of the androgen receptor (AR)," which means that the AR multiplies on the surface of the prostate cancer cell. In this state, even the smallest amount of testosterone can activate it. It becomes more vital than ever to restrict the production of testosterone because the cancer becomes exquisitely sensitive to testosterone. Some of the newer anti-androgens, like apalutamide, are thought to prevent upgrading of the AR. It is possible that castration can be stopped as long as it is working, but that has to be shown in clinical trials. Even if that is the case, eventually it stops working and ADT must be continued.
Thank you for clarifying reminders of perspective. Still opens a host of further considerations (why combined androgen blockade not more effective; why not go to Abiraterone after LHRH failure; etc ). But the gentleman will suspend the remainder of time to T_A. Thx!
Casodex is a comparatively mild antiandrogen; it adds to castration, but not a whole lot - abiraterone, apalutamide, and enzalutamide are much more effective. Abiraterone and enzalutamide are already approved for use at castration resistance.
That's a good news. Thanks for this info. They included all other Lutamides but did not include humble "bicalutamine" (casodex) . My favorite med as it brought down my PSA from 830 to 248 in just 15 days in first 2 weeks of diagnosis before Lupron was prescribed.
My add ons are also over a dozen natural foods and supplements.
I'd love to know what natural foods and supplements you are using. I'm trying to go that route also for my husband.
I see it as a war going on inside our bodies and the right course of action is to collect all our weapons and strategy to subdue our adversary and keep him down as long as we can.
(1) Food: Research in different parts of the world have confirmed that plant based food
slow or stop progression of PCA. Plant based food is consumed in China and India at higher amounts and according to textbook written by Harward med school faculty ,
the prevalence of PCA is lowest in India, China and Asian nations.
I am 100 % vegetarian..only thing besides plant based diet I eat home made fat free yogurt. More green leaves you eat, better for you. Specially..Moringa leaves, Spinach,
Limited amount of Neem Leaves (7 leaves a day) , Everyday, one of the three..Cabbage, Cauliflower or Brocolli. Lentils are great source of Vitamins,minerals and micronutrient besides protein. A full glass of sodium free Tomato soup daily.
of course, green tea at least two times a day
Keeping our immune system is our first priority because good immunity kills all kinds of cancer cells.
(2) Physical activity: IMO Walking and dancing are best exercise along with some
light weight lifting ( Based on your capacity and physical condition) Be careful in this area.
(3) Meditation/Relaxation/ Warm Baths: Warm bath in tub causes widening of blood vessels and increase circulation. Relaxation and deep breathing increase Oxygen level in blood which cancer cells can't stand.
(4) Anti inflammatory supplements : The best person on forum with extensive knowledge about this topic is Nalakrats. What I take are : Curcumin, Ginger, Garlic, Red Yeast Rice, Berberine, Dan Shen (Chinese root powder) , black pepper, hot red chillies, jalapeno green chillies, etc. I always prefer natural form in diet .
(5) I do not use refines sugar at all. Use Stevi or Monk Fruit sugar substitute
(6) Preffered Fruits: Pomegranade, Papayas, Pine apples, Blue berries, Guavas. Fruits should not be consumed in large quantity as we need to keep our body weight in normal range.
Disclosure: Please note that I am reporting and not suggesting or prescribing anything.
Do your due diligence before deciding )
Thank you so much for your quick responce. I was happy to see many of the things you are using are the ones I have incorporated into his diet. Although he is stage 4 with mets, he claims he hasn't felt this good in years! It really gives me some hope that dietary changes can indeed make a difference (dispite his Doctor telling us he can eat whatever he wants).
Isn,t it amazing. My wife keeps telling me you look better than ever...I feel good energy level and mostly joyful. When I walk 5 miles..I feel great excitement afterwards. I believe food we eat and our life style matters a lot.
I used Lupron and Eligard (the generic) for 6 1/2 years. I had stage 4 PCa and stage 4 bone cancer. I also had 72 radiations over eleven years. At this time I no longer have cancer, so for me one agent worked just fine.
Jim- What an amazing response and what a battler you are. I don’t know anything about bone cancer , but haven’t heard of anyone beating stage 4 PC before.Am I correct in understanding your bone cancer was a different cancer from your PC? Or, was the cancer in your bones really PC that metastasized into the bones. Either way, it’s Remarkable.
Yes, the cancer cells in my prostate got into my blood steam and attached to my hip bones. It is common for everyone with PCa to have pieces of cancer cells leave the prostate and these cells are not healthy. They often die in the blood stream, because they are not fully formed and healthy. Also, sometimes your T-cells will kill them off, so staying healthy helps cure PCa. The circulating cancer cells attach to bone or go into the lymph nodes. Medications can kill them in the lymph nodes or they attach to the bone tissue. Some may go anywhere in the body. The cells on the bone sit there for months, then sink into the bone, where they are stuck (like in a coffin). Prostate cells require testosterone to replicate, so without Testosterone they eventually die off. Thanks for asking.
Jim- I appreciate your response- but my question was whether you had bone cancer OR prostate cancer in the bone. Those are 2 different things. I have PC mets in several bones and a lymph node- but I don't have bone cancer.
My Oncologist referred to my metastatic bone cancer as "bone cancer stage 4". I did not get cancer in my lymph nodes. I understand that there are other causes of bone cancer than prostate metastases. In adolescents it is common for osteoblasts (cells inside the bone) that break down the bone in the arms and legs of young children called Osteosarcoma. Usually if someone knows you have PCa and you tell them you have bone cancer they assume it is from metastases.
Got it- thx.
Has anyone ever switched to a half a dose of Zytiga. My husband had horrible side effects from the Zytiga and had to stop taking it. He was taking the full 1000. Has anyone tried taking 500 on an empty stomach? I know the study is out there for the 250 with food.
Yes..I am taking only 250 mg of Zytiga with a cup of yogurt. My PSA keep going down..currently at 0.6.
I started on 1000mg, stopped it with elevated ast/alt, when that was resolved I returned to 750 mg and it elevated my liver enzymes. Then reduced it to 500 mg and been on it for about 8 mo's. Taken at least 1 hr before breakfast. I'm undetectable. All done under MO direction. Bob
Thanks. My husbands liver enzymes where way up also. He started taking Milk Thistle as I read that was suppose to help support the liver. Last test all his enzymes back to normal and that was before he stopped the Zytiga. We see the oncologist again on Wednesday. See what the next step is. I hope you stay undetectable for years to come.
I take 250 mg of zytiga in the morning with my low-fat breakfast. And I don't take any prednisone. Instead I take 50 mg of eplerenone to control the mineralocorticoids excess production. Which is what prednisone does, but prednisone is bad for you because it weakens your bones and it weakens your immune system. And you don't have to take my word for it, just look up study for zytiga with low-dose 250 mg. The results are my zytiga low dose caused my PSA to drop twice as fast as it ever did with the high-dose. And I don't have to worry about the side effects of the prednisone which are very bad. In fact the study says most people don't have to take anything with the zytiga. Zytiga was first approved in 1994, with no Prednisone prescribed because it wasn't necessary for most people because they wouldn't have excessive mineral corticoids which is what the prednisone was prescribed for. And that's how the formulary was created with the new zytiga patent.
I am on the 1000 regimen of Zytiga and am curious about the 250 with food intake. Can you or someone else refer me to the study you are referring to in support of the 250 with food ?
Please talk to your doctor about this before switching.
Thanks very much for sending the link.
Here's an article that reports the study results for low-dose 250 mg of Zytiga with low fat meal. ascopost.com/News/58735
Thx. I read this the other day and found it to be interesting. My insurance charges me less than $5 for a month supply, otherwise I would go to the lower dose. It needs further study and outcomes were very similar, so I will follow my MO's lead for now, although I will ask her about the lower dose again- as I did at our last appointment 3 months ago.
I dropped Zytiga after 4 months because of high BP, and continued on Lupron only, PSA continuing to drop from 0.03 to <0.01 four months later. I probably won’t restart Zytiga with 9 more months of ADT to go.
Combination therapies were/are a standard of Snuffy Myers protocol. He was prescribing them years ago, once again proof of how far ahead of the curve he was.
Ed
Rezvilutamide: new anti-androgen is better than Casodex added to ADT for newly diagnosed high-met HSPC. But is field too crowded?
Enzalutamide/Xtandi monotherapy as ADT with fewer side effects than Lupron
Prostate cancer adt treatment and rso oil combination Pluvicto+Xtandi Delays Progression Better than Xtandi-alone in mCRPC
Anyone have Physical Therapy for joint and bone pain do to ADT?
