66yo male, diagnosed Nov 2016 with stage 4 aPC and three mets to bone. PSA 80 at time. On Lupron and with Xtandi after Lupron lost effectiveness and then Lupron/Casodex did also. Current PSA is 1.21 after two months of Lupron/Xtandi.
Just wondering if anyone has experiences AFIB with the Xtandi. Just started over the last two weeks. Saw oncologist yesterday and she immediately ordered ECG/EKG which I got just minutes. Waiting results but we are pretty sure that I am experiencing it.
If so, what treatment should I suggest to doc? She listens well.
Also, had colonoscopy about 2 years ago. One pre cancerous pylop removed. She suggests having another one to be sure nothing new. is there. A retired document suggested not doing an invasive procedure at this time. Said that better to do that at first to see what if anything is there before doing a colonoscopy.
Thoughts on that.
Thank you for any suggestions or thoughts.
Pat
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Atrial fibrillation does not kill the patients but it can cause strokes depending on the duration of the episodes. The longer the episodes the higher the risk, particularly if they last more than 24 hours.
During episodes the patient has palpitation and the heart rate is elevated over 90 . It could reach very high values and compromise the cardiac output causing hypotension and potentially shock.
One approach depending in many factors, is the " pill in the pocket". Once the patient has the symptoms of AF, he/she takes flecainide and waits up to 5 hours. If the symptoms persists the patient goes to the emergency room and they could use chemical or electrical cardioversion to take the heart back to sinus rhythm.
To reduce the risk of stroke , patients could be anticoagulated with the new oral anticoagulants, xarelto, pradaxa, eliquis etc. There is a score called the CHADS score that is use to determine if the patient should be anticoagulated.
Patients could be also treated with flecainide, propafenone, amiodarone, sotalol etc, or offered ablation of the aberrant electrical foci around the pulmonary veins which are causing the episodes of AF.
If your polyp was large the colonoscopy could be repeated after 2 or 3 years:
Thank you. Obviously it is a concern. Glad my docs are on it. Hopefully something shows up on the EKG. (When the Doc checked me in her office, all was fine.)
The Afib comes and goes. Only started after being on Xtandi about 3 months. Does not last long in duration, just a few minutes generally. About an hour ago, had one with pulse about 120, then stopped. Know when I am having one because it feels a bit like heartburn.
The polyp was large. But was hoping that there was an Imaging process that was non-evasive that could be used in place of running the scope up into the colon to begin.
Anyway, I presume it would be a good idea to get the AFIB under control before the colonoscopy is done.
I agree, you need to be seen by an electrophysiologist (cardiologist specialized in arrhythmias). They could do a 15 days monitoring of your heart rhythm and determining the burden of your AF. Many episodes could be asymptomatic.
Have had good health except for this and the PC. Have the PC under control with the Xtandi, just might have to change meds now because of it if we cannot figure it out. Don't want to because it is working, but why take the risk.
Should I reduce exercise while this is going on? Only exercise is walking 1 mile per day, twice a day.
I believe there is something called a virtual colonoscopy using oral contrast with an MRI. If something is seen then the regular colonoscopy will be needed to remove it. I've had 6 of the regular since 1994. The prep is the worst part. I don't know if the same prep is used for the virtual colonoscopy.
The first colonoscopy I had in 1994 I was awake and was watching the monitor. Then they "inflated" the colon and I began protesting loudly. It was unpleasant for all involved. The next time they took me to the operating room and had an anesthesiologist give me "conscious sedation". Since then, colonoscopy has become more popular and they have dedicated endoscopy suites where they make you comfortable. Last time I had "2 for 1" (scoped from the top down and the bottom up).
They've changed the prep liquid a couple of times. The first was very salty. Now not quite as bad. Good luck on your afib.
My first was in 2017. Drink was lemon flavored. They put me totally under, but stopped it about 10 seconds too early and felt it coming out. Double ouch.
If it's any help, I'm not a doctor of course, but just so you know my husband's experience. He had arrhythmia long before PC. He's been taking blood thinners for many years because of this. Precisely he was put on only Xtandi because it was less hard on his heart, also he takes sotolol and Enalapril maleate in very small doses. Before Xtandi he was taking Firmagon but it stopped working. He has an ECG done every month (i convinced onco with that) to check the QTC since the PC meds can prolong it.
I agree you should go to a cardiologist that specializes in arrhythmias. My husband has lived with it for at least 20 years. His Pc was diagnosed three years ago.
Thank you Juan! That is just what I wanted to hear! Now I know what approach to take over the coming months as we sort this problem out.
Docs say I should have many many years of life left. Our agreement is that PCP doc will keep regular health issues at bay, Urologist will keep that part of me working, Oncologist works on the PC, and I keep myself exercised and healthy as I can. Both physically and mentally.
Excellent team work all the way around.
I've dealt with a-fib for many years prior to prostate cancer diagnosis. I take rythmol (propafenone) for it. One thing that I've found is that vit D3 aggravates the condition. I've had fewer episodes since stopping vit D3.
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