Zytiga

[Lisaron628]

My husband has been on Zytiga only since April and his PSA has begun to climb the last three blood draws. Started at a leveled out 0.4 and then went to 0.5 and 0.6 each month consecutively. Now in this last month the current PSA went up to 0.8.

It is creeping up. Does this mean it's not working any longer or is there something else they can do or add in? I have read to change from prednisone to another steroid and I have also read to change to Xtandi?

Our oncologist is waiting until it gets to 1.0 and says it's back to Dana Farber for us...Is it too soon to assume it has stopped working?

[Tall_Allen]

Yes, it is too soon. His PSA is still very low. You gain nothing by stopping while it is still working so well. Wait for radiographic progression.

[Lisaron628 in reply to Tall_Allen]

That's what I am thinking also but we are a bit on alert and scared so hubby asked for a sooner appt with the oncologist. Mostly for confirmation that all is still ok. I am thinking a scan will help him to feel better?

[depotdoug in reply to Tall_Allen]

At what do you stress the need for radiographic scans? I’m confused myself as to discern when to scan and when not. Trigger point for just an effect I e CT scan is?

[Tall_Allen in reply to depotdoug]

Wait for PSA to steadily increase over 2. That's the benchmark used in most studies.

[depotdoug in reply to Tall_Allen]

Well that's pro news and con news I think. In my body case: 1st Lupron Depot Sept 10; subsequent PSA & T labs Dec 10th 90days post showed PSA 1.100ng/mL and T-levels non-detectable. Ok, I'm 0.900 below minimum scan requirement norms.

Next up are my 45 days into Lupron#2 inj + Abiraterone (only 250mg) tabs Lab Tests(PSA and T-levels + liver and lymphocytes).

We shall see in 3 weeks what my 1.100ng/mL PSA drops to or stays at or goes up to...

Tall_Allen I shall see if I qualify to ask or insist on CT or Nuclear Body/bone scan. Probably not. Thxs...

[Longterm101 in reply to Tall_Allen]

TA

What is the the minimum PSA to possibly see it on a scan ?

[Tall_Allen in reply to Longterm101]

The idea is to confirm that biochemical relapse is a clinical relapse. Most studies use 2.0 for such cases.

[Longterm101 in reply to Tall_Allen]

And which scan would you recommend ?

PSMA if I can get one?

[Tall_Allen in reply to Longterm101]

To document clinical progression, I think it's a good idea to use whatever scan you had before - probably a bone scan/CT. Else how would you know if there has been progression or if you just detected what was always there.

[depotdoug in reply to Tall_Allen]

Next I’ve got to comprehend difference between biochemical and clinical relapse Tall_Allen. I should know 1st one🧐though. That’s me.

[Tall_Allen in reply to depotdoug]

Biochemical (PSA) relapse means that there is suspicion based on some arbitrary cutoff that true, clinical, relapse has occurred. Clinical relapse is diagnosed by radiology, biopsy, or symptoms rather than just a biomarker.

[depotdoug in reply to Tall_Allen]

Kind of sounds like one depends on the other and vice versa. I’d like to try Clinical relapse. I’m still anticipating my 1st 2019 now it will be 1st 2020 CT scan Abdomen/Pelvis and NM total body bone scan. That I was deprived of by my MO in September....

[Tall_Allen in reply to depotdoug]

No - not vice versa - biochemical failure, upon investigation, may turn out to be a clinical failure.

[Magnus1964]

I Don't know your husbands age or general health but it does sound like he is ready for a switch to casodex or xtandi.

[Lisaron628 in reply to Magnus1964]

He has already had Casodex prior to the Zytiga. He also has had 6 doses of Taxotere.

He is a 72 year old - diagnosed in 2012. Mets in 2017 to spine and then in 2019 spread to many bones and mild lymph involvement. He also has a crushed vertabra that can't have the glue product injected into it due to not having any room to insert it into.

Just feeling helpless and want to try to help in any way I can.

[Hidden in reply to Lisaron628]

It's not working any more when there is radiographic progression, not just a rise in PSA. He can also switch steriods to Dexamethasone. That might slow the PSA increase or make it go back down (see SWITCH trial results).

Once it has been determined that there is progression, the best direction to go in general is chemo, then back to another anti-androgen such as Xtandi.

[tom67inMA in reply to Hidden]

For my own education, if a scan shows one hot spot, is it an option to zap it with radiation and kill off the one castrate resistant tumor?

[Hidden in reply to Lisaron628]

Another thing he can do if he hasn't already is molecular profiling. He might have a variant that has a targeted treatment available.

[HopingForTheBest1 in reply to Hidden]

Totally agree. I had genetic testing when Zytiga/Predisone failed after just 6 months. PSA went from 0.12 to 0.5 in just 3 months, which was enough of an acceleration to warrant changing treatment. Was found to be BRCA2+ via genetic testing, and was switched to a PARP inhibitor Olaparib. PSA undetectable for almost 1 year now.

[Lisaron628 in reply to HopingForTheBest1]

He did have genetic testing done and he is negative on all the genes that would be an issue.

[Hidden in reply to HopingForTheBest1]

That's great that a PARP inhibitor is working for a year now. How have the side effects been?

[HopingForTheBest1 in reply to Hidden]

I am now on Eliquis, a blood thinner, as a result of a recent partial blood clot in my left thigh that probably developed from the med.

[Vindog29]

My husband was 72 when zytiga stopped after few months, chemo didnt work either. Gene mapping showed rare mutation, received Keytruda for MSH2. Now undetectable PSA. I agree gene mapping important in my opinion.

[Lisaron628 in reply to Vindog29]

MSH2?

Unfortunately, he did have the gene testing done and there is nothing about the results that help.

[Annie1373]

I hope it doesn’t escalate sharply.would I ask the metastasis locations?

[Lisaron628 in reply to Annie1373]

L4 vertebrae, hips, both femurs, shoulders, ribs, pelvis

[Longterm101]

How long was he undetectable for his PSA started to climb?

[Lisaron628 in reply to Longterm101]

Never was undetectable. Went down to 0.4 within 10 days of starting Abiraterone

[Longterm101]

Thx keep us posted