Does xtandi shrink tumors on bone from metastasis?

[cmbork]

Xtandi,does it eradicate tumors on the bone?

[Tall_Allen]

It shrinks them if they are hormone sensitive.

[cmbork in reply to Tall_Allen]

Thank you Tall_Allen

[dhccpa in reply to Tall_Allen]

But they will re-emerge eventually?

[Tall_Allen in reply to dhccpa]

Of course.

[dhccpa in reply to Tall_Allen]

Well, we just have to do better then.

[LearnAll]

Any treatment which is successful does shrink bone metastases...including Xtandi. How do you know that your bone mets are shrinking....(1) your bone specific Alkaline Phosphatase keeps falling and reach normal level.(2) Scans show less and faded bone mets.

[dhccpa in reply to LearnAll]

Does such treatment make bone mets go away or just become inactive?

[LearnAll in reply to dhccpa]

It depends. There are broadly 3 types of Pca cells in tumor and mets...based on degree of androgen sensitivity. (1) fully androgen sensitive (2) Partly androgen sensitive and (3) mostly androgen resistant. Approx. 35% Pca are in first category, 50% are in second category and 15% are in third category.

If a man is super responder to ADT as he is in the first group ...ADT kills almost entire population of his cancer cells both at prostate gland as well as at bones. In this lucky man, bone mets are erased so well that they can stay erased for may many years or until the man dies of other disease.

In men who are in second category which has mixed population, both androgen sensitive and androgen resistant ...albeit in different proportions in different men. The tumor and mets do not get entirely erased and as left over cancer cells start growing again, bone mets start to appear again ...in months or years if proper therapy is continued.

In third category, cancer cells are largely androgen resistance or partially resistant. These cells are hard to kill and have tendency to come back faster. In these less fortunate men, ADT does not work well and lots of cancer cells are left alive to grow quickly causing much shorter survival.

First group tends to have longest survival (5 to 15 years or more), Second group intermediate survival (3 to 10 years) and third group shortest survival (2 yrs to 5 years)

There is no definite way to know who is in which group but Nadir PSA, Nadir Testosterone and Time to Nadir etc can give us good estimate of percentage of fully androgen sensitive cell population.

There are many other factors which play a role in survival ..such as low BMI, absent or controlled Diabetes, Low triglycerides and high HDL cholesterol, capacity of physical activity, absence of bone pain, other illnesses and so on.

Continuous ADT for long periods start changing more of androgen sensitive cancer cells to androgen resistant cells ..thereby eventually causing Castration Resistance.

[dhccpa in reply to LearnAll]

Thanks. I've been on Lupron for 22 months now. PSA rose in the spring after I had been on fenbendazole for2-3 months, then dropped back to earlier levels by August. Latest blood tests were yesterday morning but no results yet.

[LearnAll in reply to dhccpa]

Can you tell us about your Fenbendazole experience in more detail ?

[dhccpa in reply to LearnAll]

I started in mid-February, 14 1/2 months after starting Lupron. My PSA was already 0.7-0.9 from the Lupron. In May and June PSA rose to 1.3 and then 1.4. However, in August, PSA fell back to 0.8. Scans in August show visible improvement (less uptake) than PET scan in January, and earlier MRIs and CT scans.

I was taking one dose of fenben every day from February to early June, then took a 2-week break, then began doing two doses daily for half of each week and pausing for second half of week. I also take about 20 supplements off and on, most of them added from March-August.

[LearnAll in reply to dhccpa]

When a new treatment is started ...PSA can temporarily go up ..only to fall down afterwards. This "PSA bounce " is usually considered a good sign. The explanation is that the new treatment killed a large number of cancer cells quickly and their PSA got spilled in the blood...giving higher PSA reading . Do you think Fenbendazole caused this rise followed by fall of PSA ? And why did you choose to stop Fenben ?

Its really hard to know which treatment is contributing to good effect and how much if you are on 20 supplementary herbs, spices and other substances...because it gets complex and confusing. But, the good news is that you are truly doing well based on behavior of your PSA.

[dhccpa in reply to LearnAll]

Yes, I'm just plugging away and reporting as I go along. I make no spectacular claims at this point.

[TJGuy in reply to LearnAll]

Learn all

Question about Nadirs.

PSA

Testosterone

Time to Nadir

Perhaps you can confirm or correct my following statements.

My recollection when I first started to read about all this several years ago is it is better to reach a Nadir SLOWLY. That aggressive PC shuts down quickly to ADT to protect itself, but less aggressive has a slow PSA drop actually succumbing to it. So quick drops are worse than slow drops.

My speculation is that Zytiga etc will likely allow a lower PSA to be reached than Lupon, given the situation is the same.

So we might be talking about Nadir on first level ADT vs Nadir on second level ADT, etc.etc.

Testosterone, help me with this.

<=50 is castrate.

<20 is ideal.

What does reaching a testosterone Nadir of say for example 10 vs reaching say 3 mean if anything. Assuming both get you a low PSA say 0.03

You might reach a Nadir in Lupron and then reach a even lower Nadir when things get worse, and you add Zytiga.

What goes wrong with the process of shutting off testosterone from the testis when testosterone begins rising let's say on Lupron itself. Is this inevitable?

I'm thinking the problem of rising PSA is more likely in the PC overcoming low T as opposed to T rising causing PSA to rise.

So these are thoughts I'm putting out here to be confirmed or corrected.

Thanks

[LearnAll in reply to TJGuy]

TJ...Your questions are very important and relevant and I myself had similar questions 6 months ago. But now, I have read a lot of info about this issue so I can try to say what I think about this issue of Nadir T and/or Nadir PSA.

First...Nadir PSA and how long does it take and what it means.... Nadir PSA is a point which is achieved after being on Lupron or any other ADT. So, if initial PSA was 200 and it kept going down and reached ...say..0.2. And then either it was hovering at 0.2 or increased to 0.3 or more. In this case , your Nadir PSA will be 0.2. Requirement for Nadir PSA is that it should be a continuous fall and the lowest level is Nadir.

Second important thing is how many months it took to reach that lowest point(Nadir) Say it took 3 months or it took 10 months. This time period is called TTN (Time to Nadir)

A lot of research has concluded that the longest progression free and overall survival depends on how low PSA went....lower the better. So 0.2 or lower ..which is called "undetectable" is the best for survival. Now, Time to Nadir (TTN) also predicts survival. Longer TTN means longer survival. And you are correct in saying that a very rapid fall means PSA fell because of receptor transcription and not due to gradual death of cancer cells. Slower and Longer TTN means longer PFS and overall survival.

T level : Castrate T definitions are arbitrary points agreed by researchers for convenience. In reality, lower the T goes, better is outcome. Like My T went all the way down to 1.5 from 710. There is research to prove that if T goes to 5 or lower, it is the best for survival. Why? They do not know but this is what they saw in patients.

Dr Laurence Klotz explains it beautifully saying " Hit the prostate cancer cells hard to knock them down to as low as you can......But do not keep hitting it...Stop ." He is a big proponent of Intermittent ADT and believes that constant hammering of T and keeping it low continuously leads to faster androgen resistance and even worse NE change. . Cancer cells become desperate for survival and find ways to use other things than T as fuel. With my own experience I can say that when I had very low T, my body and mind became so weak and tired that I was functioning at half of my capacity. Now, I am on Off period of IADT and my T has recovered to 300+ , I am feeling much better, more energetic, more motivated and much less tired.

Example: If you achieved Nadir PSA of 0.2 or less and you achieve it in over 9 months time...then , you can expect to live about 8 to 10 years easily if you do not have other serious comorbid medical conditions. And that is what I am expecting for myself due to my Nadir PSA of 0.2 and Time to Nadir 12 months.

[j-o-h-n]

Greetings cmgork,

Would you be kind enough to give your bio info which you can add to your home page. Age? Location? Scores Psa/Gleason? Treatment center(s)? Treatment(s) to date? Doctor's name(s)? Thank you!!! All info is voluntary but it helps us help you and helps us too. Keep posting here for good info....

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 09/26/2020 10:55 PM DST