Advice-as with many here PC metastatic gleason 9 psa last blood test 0.21

[Dondodoc]

Recently heart rate 120/140 told by onc stop abiraterone. Angiogram result heart not bad for 76 year old started by cardiologist on digoxin and Apixaban rate now normal - see you in 12 months. In meanwhile joint pains stopped since stopping abiraterone after 3 weeks! Telecom today from onc, appraised angiogram results have blood test to check vitals we will then restart abiraterone. Do I ? Or say sod it I feel better without abiraterone?? Any comments fellow sufferers?

[Tall_Allen]

You have to balance feeling better with living longer. If you resume abiraterone, make sure you take enough prednisone with it to keep your BP normal.

[Dondodoc in reply to Tall_Allen]

Thanks TA I tend to follow all of your informative comments. I was just thinking of continuing an aberaterone holiday holiday perhaps?

[tango65]

Difficult to say what to do since there is info suggesting that abiraterone may be associated with cardiac arrhythmias .

You said you have atrial fibrillation. AF is not usually associated with lethal events (different from ventricular arrhythmias) The major complications are brain infarctions (some of these infarction could be lethal). The infarction are produced by emboli coming from the left atrium if the atrial fibrillation last 24-48 hours or more. The apixaban (an oral anticoagulant) reduces the incidence of these complications. The other possible complication is to develop a very high heart rate with a drop in blood pressure and syncope. If you do not have heart failure, I believe your Dr prescribed digoxin to try to reduce your heart rate.

Perhaps you should consider to have a consultation with other cardiologist, since digoxin is not used in atrial arrhythmias anymore, they use beta blockers, mainly metoprolol..

Since you are taking apixaban which reduce the incidence of strokes in atrial fibrillation, and your cancer is a Gleason 9, you should discuss continuing the abiraterone and monitoring very close the potassium (K) levels, since hypopotassemia, a complication of insufficient prednisone when taking abiraterone, could facilitate episodes of atrial fibrillation. Insufficient prednisone when taking abiraterone could also increase the blood pressure and the blood volume which could dilate the left atrium and could trigger atrial fibrillation .

You could discuss taking drugs to control the AF, mainly flecainide, or propafenone. These drugs could be taken everyday or use when having an episode of AF (pill in the pocket concept). Using the Kardia you could determine if there is AF and medicate with these drugs and reduce the duration of the episode. This way you could control the AF and concentrate in treating adequately your Gleason 9 cancer.

Best of luck on this journey!!

[Hidden in reply to tango65]

Propafenone (AKA rythmol) worked well for my a-fib, once I got past the side effect of feeling a nasty taste in my mouth. That lasted for several months. I recently got a-fib ablation surgery. No more propafenone for me.

[tango65 in reply to Hidden]

I know, but ablation is an invasive procedure with its risks. The efficacy of ablation was studied in the CABANA RC trial. Thirty percent of the patients who got ablation relapsed after 6 months and 50 % around 3 years (see figure 6)

sci-hub.tw/https://jamanetw...

"CONCLUSIONS AND RELEVANCE Among patients with AF, the strategy of catheter ablation,

compared with medical therapy, did not significantly reduce the primary composite endpoint of death, disabling stroke, serious bleeding, or cardiac arrest. However, the estimated treatment effect of catheter ablation was affected by lower-than-expected event rates and treatment crossovers, which should be considered in interpreting the results of the trial."

[Hidden in reply to tango65]

I just passed the six month post surgery interval. Not an a-fib episode to be seen. I had been on meds for probably 30 years. The meds were failing as evidenced by increased number of episodes. I suppose one other factor that prompted me to pursue the surgery was the mention of a-fib as a serious risk factor for covid death. On those rare occasions I got the flu or a serious cold my a-fib occurences spiked.

[tango65 in reply to Hidden]

I agree it was a very good decision to have the ablation if the drugs were failing. Hopefully, it is end of AF for you.

Best of luck on this journey.!!

[GoBucks]

I only take 3 pills a day because my liver acted up. I went from 4 to zero for about 7 weeks until my liver was normal. Then started 2 pills a day. Liver still ok so I went to 3 a day. I believe 2 a day would work but since I am at <0.01 why look for trouble? Others take 1 a day with food. You don't have to take 4. Discuss lower dose with your Doc. 1/2 the regular dose might be the sweet spot. Be your own clinical trial. Good luck.