Observation after zytiga fail??

[Vsahay]

Hello everyone.This is my first post here.My dad was diagnosed with metastatic prostate cancer in 2013.The cancer was in his pelvis ,ribs and vertebre.However, there was no visceral disease.He was fine after orchiectomy till 2017 when psa began to rise.bicalutamide was of no help.started zytiga in june 2018.Psa began to rise in june 19.Now it is 28 from 12(in june 19).

Doctor satrted a monthly dose of zoledronic acid and wants him to continue with zytiga and prednisone until bone pain begins.Is not offering any scans to assess radiological progession.Is continuing with zytiga until symptoms ok for now?Is any any chance of disease becoming visceral.what should be our next steps?

No prior chemo and never wish to go for the same.☺

Any advices would be of much help.

[LearnAll]

It takes time for Zytiga to work. What is his latest PSA ? What is his Alk phosphatage ?

If both are decreasing, you should wait and let zytiga do its job.

If he has not had visceral mets..for so many years the greater chance is that he will not have visceral mets.

[Vsahay in reply to LearnAll]

Psaa is on rise

12 in june

And 26 in nov (latest) and hence i m in fear of visceral metastasis but the doc is not showing any concern in this respect and wants him to continue zytiga.

Alkaline phosphate is within limit and still decreasing.

[Vsahay in reply to Vsahay]

He had good psa respone to zytiga for a year and then it began to rise since june

[LearnAll in reply to Vsahay]

You can ask your doctor to swich from Prednisone to Dexamethasone as it makes Zytiga work again if Zytiga is losing effect.

[LearnAll]

If Alk phosphatase is steadily decreasing..I will still take Zytiga because most likely PSA will also start declining later. ALK Phos is as important marker (some say more important) than PSA in cases of bone mets. PSA and ALP should be monitored monthly in such a case.

[Vsahay in reply to LearnAll]

Thankyou so much for the valuable suggestion.😊

[LearnAll in reply to Vsahay]

Again your fear about visceral mets is logical fear. But you need to watch for (1) does he have any new symptom at all ? (2) watch the trend of PSA, ALP, Hb, Albumin and Calcium by checking EVERY MONTH to ascertain direction of illness.

[Vsahay in reply to LearnAll]

I shall make sure he undergoes these tests every month.

[LearnAll in reply to Vsahay]

you are such a lovely son...your father is fortunate. best wishes to you .

[Vsahay in reply to LearnAll]

Well I 'm his daughter 😂

[LearnAll in reply to Vsahay]

Sorry....I know daughters are all love . They have heart for their parents. Thanks for correcting me.

[GP24]

What is the plan when the bone metastases start to cause pain? The doctor should tell you that.

The usual next step would be a chemo with Docetaxel. It may be that the doctor decided against that because your father has other health problems.

A chemo with a lower dose every two weeks may cause less side effects:

"Administration of docetaxel every 2 weeks seems to be well tolerated in patients with castration-resistant advanced prostate cancer and could be a useful option when 3-weekly single-dose administration is unlikely to be tolerated."

thelancet.com/journals/lano...

[Vsahay in reply to GP24]

Doc has plans for starting chemo when dad begins to experience symptoms.But we want to keep it as last resort.Is there any effective alternative to chemo.

However the doc is of opinion that my dad's cancer will take much time to cause any problem and hence we should not be worried about it at the moment.

[GP24 in reply to Vsahay]

With a PSA value of 28 most doctors would recommend to start chemo. I would worry that the pain will not stop after the chemo and therefore do it before pain occurs. You will have to do a chemo in the future, maybe in six months, so you do not gain anything if you postpone it now.

[Hidden]

His PSA doubling time is around 6 months so he probably does have some time. I would have imaging done at some point in the 6 months, not wait until there is pain. It's clear that Zytiga is losing effectivity, but switching to Dexamethasone as was already suggested is a good idea.

Looking ahead, his best treatment available at this point is Docetaxel chemotherapy. The side effects are tolerable for most so don't be afraid of it. I can speak from experience since I had 6 cycles of it myself. As also mentioned, it can be administered in 2 week or even 1 week intervals at a lower dose.

Wishing the best for your dad.

[Vsahay in reply to Hidden]

How long did chemo work for you?

[Hidden in reply to Vsahay]

I did early chemotherapy along with ADT when I was first diagnosed to increase my overall survival odds. So it's not possible to answer that.

But I am planning on doing again when Zytiga becomes ineffective. It really wasn't that bad, otherwise I wouldn't consider it.

[Hidden]

I would make the decision when to start chemo based on imaging results and PSA, not PSA alone.

[Tall_Allen]

He can try switching from prednisone to dexamethasone to get some more use from his Zytiga. He should have a bone scan/CT to check for progression. If there is progression, he should have Docetaxel, then Xofigo (either with Provenge), then Jevtana, then Xtandi.

pcnrv.blogspot.com/2019/12/...

He should also ask his doctor for a prescription for Celebrex to take while he is taking Zometa. It will reduce any bone pain, and more importantly, the combination has been found to extend survival by 22%.

[Vsahay in reply to Tall_Allen]

Thanks for the info😊

[j-o-h-n]

Greetings Son, oops Daughter.... Here I go again. Would you please fill us in regarding your dear Dad: Age? Location? Treatment center(s), doctor's name(s). All info is voluntary but it helps us help you and helps us too. Thank you Son, oops Daughter.

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 12/13/2019 8:16 PM EST