What should I do? Or do what my MO's decision path is for me!

[depotdoug]

My office visit with my IU Health Simon Cancer MO is now history, or factual I'll say. Post 90 day Lupron#1 injection facts. 1] 1st mandatory blood labs. PSA is now 1.100ng/ml (10/17 PSA was 2.9) T-level down stuck at < 10ng/dL. 2] Yes, I'm tagged Metastatic & Stage 4 per my MO 3] 2nd 90 day Lupron inj injected 50hrs ago.

Plan forward? Yes, forward? Zytiga time. Dr A. my MO is sticking with administering Abiraterone Acetate 250mg 4tabs/day with Prednisone 10mg daily. He is stating that this is the most proven long term longer irradication method for my Metastatic Lymph node(pelvic and abdominal areas). i.e. Adrenal gland inhibitor drug targeted.

My problem is: 1] with my cardiovascular status, 8.5 years post SCA, but now extremely better, and still my AFIB prone rhythm heart.

Is 4 - 250mg Abiraterone tabs daily an avalanche ready to fall? 2] My cost for 120 tabs monthly of 250mg Abiraterone is $990.00 my cost. Insurance pays a whopping $2,100 of $3,300 monthly.

Or can I go with (1) 250mg Abiraterone tab daily. Which of these problems do I ignore or both??

Depotdoug (Doug)

[rust]

Oh crap. I read a study press release from Reuters the other day that said that if you have PCa before 50 that you will most likely die from cardiovascular disease (heart attack, stroke, hypertension related events.) . . . that because of treatment related side effects that our risk of dieing from a CV event is 10 times the general population. "Most prostate cancer patients do not die from prostate cancer itself, but from other disease." How many times have you read or been told this (uhh buthead, they die from treatment related side effects)?

I am hoping to quit further hormonal or chemical therapies (except for orchiectomy) in 12 months and let the disease progress. My father hated prednisone ans quit it around age 80. My current father in law is trying to recover after being on it for 2 years. I have also read a study recently that said that while it is effective in treatment of metastatic disease that it did not extend patient lifespan. My father had a-fib and successful treatment after several ablations at UAB. In fact towards the end of his life he was able to get off of all the heart meds. This Taxotere and ADT I began in August after being diagnosed with nodal disease has been hard on my heart, probably from edema SE. Thanks for posting brother. Rust

[depotdoug in reply to rust]

Seems like I've heard that several many times. We will die from something else before we cease living from PCa. That sounds discouraging. The mental block im having today and tonight is my Cardiovascular health, No AFIB, good pulmonary function, excellent HR control, no issues to speak of or bark about. And my Med Onc knows that point.

I did find out today from my Dr's hospitals pharmaceutical tech that the Drug Company producer of Abiraterone Acetate 250mg prescribing dose is for (4) tabs daily on an empty stomach. Wonder what erupts when 1000mg hits the bottom of my 67,5yo stomach? My point is: is it necessary to pre-load, overload the dose with 1000mg daily/month for 6 months? Or is 1-2 250mg tabs gonna take care of Adrenal gland hormone producing cancer food?

''I've got to get this out of my mind', think there was a song like that.

$3,300 per month is a lot to charge my insurance for these pills, $990.00/month I pay for 6 months or more; enough to cause a cardiac event overnight and have not even touched an Abiraterone acetate tab yet.

Phone call time Friday the 13th b4 09:00/ Think I'll start dialing at 07:45.

depotdoug

[Hidden in reply to rust]

Just ten times ? Not bad .. 😂It is surely true

[depotdoug in reply to Hidden]

10 times? Don’t comprehend. It’s been a taxing mental memory medical day and it’s Friday 13th

[Hidden in reply to depotdoug]

My mistake .Take care

[Hidden in reply to rust]

I just signed up for a-fib ablation. Been taking meds for it for over 20 years and now the current medication is failing. Should have the surgery in February.

[depotdoug in reply to Hidden]

Good decision WSOPeddie. My 1st an only Cryoablation was April 2014. It’s (mine) called PVI pulmonary vein isolation which takes care or supposed to break the electrical mid-conduction of signals in the upper Right Atria. It was 75% successful. I returned to AFIB in 2015- thru July 2016. Off an on. Had my 3rd Cardioversion July 2016. Been in NSR ever since then. I plan to keep it that way. NSR I mean. Ask me how I’m staying out of AFIB. Let’s hope my Cancer now advanced Stage 4 meds, Abiraterone acetate + 2nd Lupron shot doesn’t knock me back in AFIB..

[Hidden in reply to Hidden]

Wow!

[Hidden]

If you trust your Cardiologist and trust your Medical Oncologist, then listen to them. If no trust, then find someone new. These people know better you, than anyone else. Everyone I knew who took short cuts, especially not informing their Physicians, are in another place. Been doing this since 2004. BTW, my Cardiologist and Medical Oncologist communicated about me regularly for the first five years.

Good luck,

GD

[depotdoug]

Shall see... I’m trying to ensure make sure, make definitely damn sure that my Med Oncologist and Cardiologist and Electrophysiologist talk to each other. I mean my Cancer treatment med ONC notes on me get to my Cardio and EP doctors. A phone was made this morning... About that subject. No response to me yet!

[j-o-h-n]

"definitely damn sure that my Med Oncologist and Cardiologist and Electrophysiologist talk to each other."

That's the ticket.......

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 12/13/2019 5:32 PM EST

[depotdoug in reply to j-o-h-n]

When they are not out playing 18 on the golf of course.

[j-o-h-n in reply to depotdoug]

Or sipping tea on the 19th.....

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 12/13/2019 7:06 PM EST

[depotdoug in reply to j-o-h-n]

They probably exceed at that weight lifting 🏋️ procedure

[j-o-h-n in reply to depotdoug]

dem egos are heavy ya know....

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 12/13/2019 7:38 PM EST

[depotdoug in reply to j-o-h-n]

There’s No more Dr. Jack Kevorkian though j-o-h-n. Didn’t even know he was a pathologist.

[j-o-h-n in reply to depotdoug]

youtube.com/watch?v=Q8Tiz6I...(Not working as expected?)

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 12/13/2019 9:48 PM EST

[depotdoug]

Can anybody answer my newest post? On a separate new post .

Qty:1 250mg abiraterone without food = qty: 4 250mg abiraterone with food intake(in stomach)?

[herb1]

depotdoug: Wait, isn't it the other way: 1 250 mg AA WITH food versus 4 250 on empty stomach? In fact, that was going to be my comment-have you discussed this alternate dosage with your doc. I also am concerned that AA is supposed to have significant cardio side effects, maybe another reason to consider the 1 250 mg approach with your doc? Good luck. I'm in about the same situation at 83. I think I've decided to stop when casodex stops.

[depotdoug in reply to herb1]

Yes, your are absolutely correct. 250mg without food is = to 1,000mg without food in stomach. Why I have no idea.. my newest ONC pharmacist told me so. I’m not planning on any Cardiac rhythm eruptions herb1. I’m 67.5yo.

[tom67inMA in reply to depotdoug]

It's better absorbed with food, but absorbed more consistently without food, so 1000 mg on empty stomach is the standard dose. Probably the same heart risk either way since blood levels will be comparable.

[depotdoug in reply to tom67inMA]

I’m balancing both dosage Cardiac wise and dosage $$$ wise. If my 5 weeks from now LABS show no effects:: I.e. PSA 0.0000ng/mL and Liver and enzymes and CBC’s and AST and fill in the blood labs results exemplary. My MO would convince me to up up up my Abiraterone ready or not.

[herb1 in reply to depotdoug]

Depotdoug, go back, read your reply. You still got it wrong! Just be sure you're taking the right dose.

[herb1]

Doug, et al: Let's go back. The only or primary reason that Zytiga is dosed at 1000 mg on an empty stomach is THAT WAS HOW THE CLINICAL TRIAL WAS DONE AND consequently, that is the only dosage there is "proof" for. Recent papers have explored lower dose WITH food and seem to show OK results...but no clinical trial that I know of. Anyone, correct me if I'm wrong.

[depotdoug in reply to herb1]

Thanks Herb, I understand 100mg empty stomach is most effective shock to cancer and shuts down the adrenal glands....

My issue is

1] I need to watch, no my EP electrophysiologist and cardiologist my Heart Rhythm for irregularities. Yeh seriously.

2] My Med Onc is perfectly fine on me starting on 250mg Abiraterone on Low--Fat Breakfast meal. That's what he communicated yesterday.

3] My MO's facility huge internal hospital pharmacy pharmacist talked to me at length yesterday about that same thing. 250mg at Low-Fat Breakfast food. I'm getting my RX Fed Ex'd to me Next Tuesday 12/17.

4] IU Simon Cancer Center is one of the top accredited Oncology facilities in the USA.

5] 1000mg per day Zytiga is way too expensive right now. $990.00/month for 6 months no 12 months.

6] I do blood labs in 45 weeks after start of Abiraterone - Liver functions , CBC PSA T-levels enzymes plus others.

7] Next office visit with my MO is Feb 4th.

8] He my MO Dr A. understands as I do that we/I can Up the dosage 4 Feb.

9] I need to watch, no my EP electrophysiologist and cardiologist my Heart Rhythm for irregularities. Yeh seriously. Yes I repeated the important point.

herb1 I hope you understand.

Thank you for following me.

Doug

[Hirsch]

F y I... the recommended dosage for hspca is just 5mg prednisone. No longer 10 if that makes you feel better