OK....on Casodex, PSA has gone from 7+ to almost 9 now ove 11 during a 5 week period. My profile details his journey, including prostatectomy 2009, radiation 2010, chemo 2016, Lupron started at same time till now, added Casodex 5 weeks ago. Doc suggesting Zytiga with Prednisone.
Joe wants to check with the Cleveland Clinic.
I've come to trust your experiences. What do you recommend, Village?
I can't imagine why his doctor gave him Casodex rather than a more effective hormonal therapy (Zytiga or Xtandi).
Hi Tall_Allen: Not sure why, either, but Joe was instructed today to call and have the Zytiga delivered.....
I'm investigating relugolix, rucaparib and olaparib , as I've just read about their approval and efficacy.....
But it looks like Zytiga to start...
Relugolix is not approved- probably won't be available until mid-2021. The PARP inhibitors are only useful if he is BRCA+
How far are you from Detroit or Ann Arbor? Karmanos cancer center in Detroit has an excellent prostate cancer oncologist, Dr. Heath. The cancer center at Michigan Medicine in Ann Arbor has several oncologists that specialize in prostate cancer, Dr. Caram and Dr. Smith. After reading your profile it seems to me that it's time for Zytiga.
Thanks so much for your reply. I'm not sure why he wants Cleveland Clinic, so I'll suggest the options you mentioned for his consideration.
The next step from the oncologist here is Zytiga with Prednisone
Casodex was a bad choice. Now that it has been shown to be ineffective it's time to move on. Zytiga is a good plan. But also have him tested for genetic i.e. BRAC 1 OR 2. He may be eligible for a PARP inhibitor.
Thank you, Magnus1964: I like what I’ve been reading so far about the PARP inhibitors. Hadn’t read yet about the need to be tested.
Might a PARP come before or instead of Zytiga? Should I push for the test first in case he is eligible?
His PSA is rising fast and genetic testing could take some time especially during this COVID fiasco. I would recommend he start Zytiga first to try to slow things down.
That’s just the kind of guidance I was hoping for. Thank you very much.
Good luck with the zytiga. Keep us informed.
It is time for the second-line anti-androgens like abiraterone and Xtandi.
I agree with the others who are suggesting second-line ADT Zytiga.
I don't think it was a mistake to try Casodex, you just have to make sure to get off it quickly if your PSA starts rising because it can eventually feed the cancer. Sure, other drugs are more effective, but I doubt you lost anything by trying it.
In general, you would go to second-line ADT if you have at least 6 months to a year success on primary ADT (Lupron), otherwise look at going back to chemo. Sounds like he's been on Lupron for several years so that would favor going to Zytiga. I've been on it for 2 years and have an undetectable PSA.
Awesome! Thank you, gregg57. That’s great to hear. Happy it’s working so well for you!
Sound advice.🤙🏽
Let him check the Cleveland clinic. Why not? A second option never hurt anyone.. I commend you both on long hard fought journey ... It seems that we can’t ever stop swinging the ax . I think that he will get that PSA down again .🙏
Tapeworm medication
PSA 209 originally 42 months ago now undetectable still
PSMA PET Results post-Chemo and what to do next?
8 years since dx, doing well ...
Hormone therapy with the lutamides and keepin your testosterone intact
