PSA jumped 71.points in month😳

I have posted before about my husbands numbers! Stage 4 adv prostrate cancer! On Lupron and Zytiga with Predisone! Just had full body scan and Ct no significant changes! Small right pleural effusion! Oncologist thinking Predisone so cut dose in half! Last PSA amonth ago 98. Labs done at visit I just got results couple days ago PSA jumped 169.67😳 Oncologist talked about not changing HT treatments yet never knowing side effects! I just wanted to know if anyone has had a jump like this and why! I know PSA is not only meter for determining whats going on! Husband working no new complaints🙏🏻

[Tall_Allen]

1)Discuss switching from prednisone to dexamethasone for some extra time from Zytiga

2)Discuss getting a scan to see if there is progression.

3)After 1 & 2, try docetaxel and Provenge next

[Hidden in reply to Tall_Allen]

Discussion had about switching to dexamethasone! Dr said no! Just had full body scan and Ct . No new activity showing!

[Schwah in reply to Hidden]

Tall Allen' susually quite kind and understanding. As always his advise (in matters PC anyway) is always sound. Why won’t your dr switch you go Dex? Sometimes as a patient (or as their surrogate)you need to be firm and fight for yourself. Don’t just take what they say. As hard as it is, question your expert. Show him articles indicating that switching to Dex can extend zytega’s usefulness. Make him provide a logical reasoned answer.

Schwah

[tango65]

If zytiga has failed , the cancer is castration resistant. The most effective next treatment could be chemotherapy. Alternating an anti androgen with chemo could be more effective than using another anti androgen. (zytiga - enzalutamide could be less effective than zytiga-chemo-enzalutamide). Besides chemo sometimes may re sensitize the cancer to zytiga/abiraterone. He could do provenge since the cancer is castration resistant and it could be an advantage in using it earlier in the disease process.

Another possibility are the clinical trials with modified niclosamie which could resensitize the cancer to zytiga/abiraterone!!!!

clinicaltrials.gov/ct2/resu...

Bets of luck!!!!

[HopingForTheBest1 in reply to tango65]

I failed on Zytiga/Prednisone after 6 months. To determine my next step, I had genetic testing. Was found to be BRCA2+ and, based on precision medicine protocol, was put on Olaparib (PARP inhibitor). My PSA has been undetectable for the past year. Have not had chemo as a next treatment, so far.

[gcman in reply to HopingForTheBest1]

Hi Hoping - I did Parp at initial diagnosis of BCCA2 thru clinical trial, which was good for 9 months, just started standard treatment of ADT w/Zytiga. Thinking radiation this summer, have you thought about that?

[HopingForTheBest1 in reply to gcman]

I haven't. Don't think radiation is a viable option for me as I have several bone mets. I have done Provenge last March. Also on Eligard and Xgeva with quarterly shots.

Sorry to hear PARP only lasted 9 months for you.

[podsart in reply to HopingForTheBest1]

Any side effects PARP inhibitor?

[gcman in reply to podsart]

30% Fatigue & noticeable constipation.

[podsart in reply to gcman]

Thanks

[HopingForTheBest1 in reply to podsart]

Side effects not bad. Much less than having chemo, which I have not had personally. Some daily fatigue and slight anemia.

[podsart in reply to HopingForTheBest1]

Thanks

[jfoesq in reply to tango65]

Tango- Has it been scientifically established that after Lupron and Zytiga failure, chemo is next step. I may be on the verge of that after 7+ years and at my last visit , I thought MO was thinking about apalutimide next. Appreciate your thoughts.

[Hidden in reply to jfoesq]

Here's an article on the subject:

onclive.com/conference-cove...

[jfoesq in reply to Hidden]

My understanding of this article is very different from yours. As I understand it, docetaxel was the CHOICE of 50% of those he had failed Zytiga. I don’t see anything indicating it was the best choice

[Hidden in reply to jfoesq]

I'm not sure there is a specific article on which treatment is best. You could do a search for that and see.

From what I can see from the treatments that remain after CRPC and after failure of second-line ADT agents like Zytiga and Xtandi, chemotherapy seems to be the best option if you are fit enough.

Going from one second-line ADT drug to another is not very effective for most due to the cross-resistance. LU-177 and other PSMA ligand-based treatments are promising, but not much trial data yet to suggest they are any better than chemo, not to mention they are not yet approved in the US outside trials.

[jfoesq in reply to Hidden]

Thx for response. I wasn't familiar with the "cross resistance" issue and will discuss with my MO. I am 61 yrs and healthy so no reason I can't do chemo, but Apalutimide was floated as the next treatment for me when Zytiga fails.

[Hidden in reply to jfoesq]

Don't let anyone scare you about the side effects of chemotherapy, they are tolerable for most. It was no worse than a bad cold for me and I've survived many of those. Chemo was WAY better than flu or the Norovirus I had last year.

You only have to commit to one cycle at a time and you can decide to stop at any time. If it doesn't work or the side effects are not tolerable you can stop. The risk for most is about a week of feeling crappy and that could easily be offset by slowing down or stopping progression. Knowing it was working helped me feel better. Those who have pain symptoms can also see an improvement with that as well.

[jfoesq in reply to Hidden]

I have no fears of chemo. I have had 7 surgeries including getting infected from one that went undiagnosed while in a cast with swelling for 5 weeks. I am pretty sure I have been through much worse. I am just trying to find out what is the best way to attack the cancer. Thx.

[tango65 in reply to jfoesq]

There are not data that I know about apalutamide following a zytiga failure.

There are some data suggesting an advantage in doing docetaxel after failure of one anti androgen:

ncbi.nlm.nih.gov/pubmed/302...

This other article is about chemo with cabazitaxel vs other anti androgens in patients pretreated with docetaxel and one anti androgen:

nejm.org/doi/full/10.1056/N...

The AR-V7 splice variant of the androgen receptor makes abiraterone and enzalutamide less efficient. These AR-V7 splice variants have been found in patients treated with abiraterone or enzalutamide.

nejm.org/doi/pdf/10.1056/NE...

Perhaps this is one of the mechanisms why an anti androgen given after failure of other anti androgen may be less effective. If one believes that apalutamide is similar to enzalutamide, perhaps before treatment with apalutamide after failure of abiraterone one could consider to study if the AR-V7 splice variant it is expressed by the cancer.

[jfoesq in reply to tango65]

Thx., Tango. I will read the articles you have attached.

[tango65 in reply to jfoesq]

The are no definitive data indicating what is the best sequence of treatment using anti androgens and chemo. Now we have the new anti androgens apalutamide and darolutamide. Data are more scarce with these new drugs.

Apalutamide is considered by some oncologists to be similar to enzalutamide ( Dr. Michael Morris personal communication), it is possible that AR-V7 variant will also affect apalutamide. It is known that this variant could be present when abiraterone fails. If it is possible to study if this variant is present in the cancer could be something to discuss to do before starting apalutamide.

You could also consider the trials of modified niclosamide which could resensitize the cancer to abiraterone or enzalutamide:

clinicaltrials.gov/ct2/resu...

health.ucdavis.edu/synthesi...

ncbi.nlm.nih.gov/pubmed/270...

Best of luck!!!

[Hidden in reply to tango65]

I think if you are considering switching from Zytiga to another secondary ADT agent such as Apalutamide I would have a Circulating Tumor Cell liquid biospy to look for AR-V7 along with treatable mutations. If your are AR-V7 positive, you won't benefit from another anti-androgen treatment. However, Docetaxel ot Cabitaxel chemotherapy should still be effective.

[jfoesq in reply to tango65]

Thx, Tango. Very interesting

[tango65 in reply to jfoesq]

Best of luck!!

[Hidden]

I encourage you not to be afraid of chemotherapy. Many of us here have been through it and the side effects are not bad for the possibility getting 6 months or more of holding back the cancer. There are two chemotherapy drugs available: first-line Doctaxel and second-line Cabazitaxel. These are proven treatments that will often work when secondary ADT like Zytiga and Xtandi fail.

Hoping for the best.

[Kevinski65]

Woman tend to use exclamation points more than men. Especially when they feel emotional about a subject!!!!!!!!!!!

[Kevinski65]

Try zyflamend it's a supplement. It might help.

[Sxrxrnr1]

Before going into chemo be aware that it has no positive effects at all for a substantial number of patients. Therefore one might go thru often very serious side effects,,some life threatening or permanent,,,to no cancer fighting benefits at all.

I do recall reading somewhere that the average overall survival benefit for those who might derive any, is about 4 months. Just about the time to undergo normal 6 infusions of the chemo,,,cabazitaxal or Taxotere

Have this conversation with your MO and do your research.

The advice to look into niclosimide,,,or possibly Indomethicin, I would do first. These along with other agents are being studied to reset 2nd generation drug resistance,,,as in Zytiga, Extandi, Erleada or Nubeqa.

There is a slim chance that any of the 2nd generation anti-androgens may still work even having failed Zytiga. Likely about 20;percent chance.

Ask your MO about Keytruda. Has worked quite well for a lucky few.

[Kevinski65 in reply to Sxrxrnr1]

What would be the dose on niclosamine? The doses for dogs is small.

[Sxrxrnr1 in reply to Kevinski65]

I do not know dosage, brand name of medication or cost. Trial of niclosimide with Xtandi is currently in progress at UC Davis in Calyfornua.

I cannot imagine why it would take very long to determine safety or efficacy.

Perhaps there are members that have participated in this trial and can answer these questions.

As an aside, I did apply to volunteer for this trial over one year ago and was not accepted.

Currently I am taking Indomethicin with my current 2nd generation AR inhibitor anti-androgen as I had failed standalone Xtandi after 15 months. Obtain niclosimide in USA is very difficult and what you might find, quality of sources is very uncertain.

I believe I am getting a good result. Do not wish to go in more detail until have more experience and just how well I am doing.

If anyone in our forum has participated in UC Davis trial, please respond with your experience.

If we can lick this resistance issue to these AR inhibitor drugs, this could be a home run. Other reset drugs are currently being studied.

I have submitted to an AR-V7 test and have been deemed negative,,,however as noted did eventually fail Xtandi.

[Kevinski65 in reply to Sxrxrnr1]

As a dog tape worm dewormer it's the same drug. I had no trouble ordering it. To get a therapeutic level you'd have to order a lot. It seemed kinda scary a project to go alone and I'm not recommending it. I never took the amount I ordered because I'm doing ok on lupron and xtandi.

[Vindog29]

I actually thank you for this as it made me more aware that I too put exclamation marks and capitals way too often. I'm 66 years old and if something touches me when I read or hear it I know to learn from it, no offense ever taken. That is offen the problem with social media and the internet your kind voice (I know you have one) couldnt shine thru

[Schwah]

Well if the service you intended was to get a devastated woman to exit our site, you succeeded. She closed her account.

Schwah

[j-o-h-n]

So the cat is out of the bag.... you're Bella9... I wonder why people post as Hidden?...

Are you guys using the same lab for testing? BTW where are you located and where is your partner being treated? (Doctor's name(s))? All info voluntary but it helps us help you and helps us too. Thank you....

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 03/01/2020 10:33 PM EST

[Hidden]

How is he feeling. Much pain?

[Hidden]

Dear friend . Please don’t take offense from others comments . Stay with us asking questions please ?. The tide rises and falls with the psa . It horrifying with a jump like that. Ouch ! The darned PSA .. I welcome you here .... Scott 🌵

[j-o-h-n]

To gregg57,

Thank you for your detailed explanation. I was in IT for many years and when something (someone) was deleted in a system, it was gone forever. So I'm surprised to see that "deleted and hidden" are the same here, but I didn't design "the system" so I'll just have to be aware of that idiosyncrasy of "the system."

p.s. I've been playing "Hidden" for years by avoiding my ex-wife.....

BTW I am not defending "stupid trivial shit"in posts even though most of my posts are...

I deal with my Pca with humor, otherwise I'd be fucking crazy by now.

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 03/02/2020 4:31 PM EST

[407ca]

Totally agree. An apology is warranted.

[407ca]

Nobody is "new" to the internet these days.

[Sxrxrnr1]

Sxrxrnr1in reply to Kevinski65

A few seconds ago

I do not know dosage, brand name of medication or cost. Trial of niclosimide with Xtandi is currently in progress at UC Davis in Calyfornua.

I cannot imagine why it would take very long to determine safety or efficacy.

Perhaps there are members that have participated in this trial and can answer these questions.

As an aside, I did apply to volunteer for this trial over one year ago and was not accepted.

Currently I am taking Indomethicin with my current 2nd generation AR inhibitor anti-androgen as I had failed standalone Xtandi after 15 months. Obtaining niclosimide in USA is very difficult and what you might find, quality of sources is very uncertain.

I believe I am getting a good result. Do not wish to go in more detail until have more experience and just how well I am doing.

If anyone in our forum has participated in UC Davis trial, please respond with your experience.

If we can lick this resistance issue to these AR inhibitor drugs, this could be a home run. Other reset drugs are currently being studied.

I have submitted to an AR-V7 test and have been deemed negative,,,however as noted did eventually fail Xtandi.

Here is one of many references utilizing Niclosimide as a reset drug.

urotoday.com/conference-hig...

[Kevinski65]

I've obtained niclosamine as a dog dewormer. I haven't taken it yet because I'm in a clinical trial on xtandi and lupron. 8.5 years out.