Is facial swelling of concern

[Life5]

Hello,

Wanted your help for my dad. He was diagnosed with metastatic pca with psa 114 and started on zytiga and prednisone. He is currently on zytiga 750 mg (due to higher liver Enzymes the mo lowered the dose from 1000 mg) and 5 mg of prednisone since the past couple of months, his last psa was undetectable in August and is due for another check in October. His August bloodwork indicated high sugar levels and the doc has him on metformin. His ldl was also High but statin with aspirin did not suit him. He did his ecg which was normal- so the doc suggested to start on the metformin and to decide on the statin+aspirin during the next visit. We have been noticing his protruding belly and swollen face recently - while moon face is a known side effect of prednisone - does it happen with low doses of 5 mg or should we be worried and contact the doctor before our mid October appointment?

[tango65]

Does he have pitting edema in the legs? Did his weight increase during the last few days?

healthline.com/health/pitti...

When taking Zytiga and 5 mg of prednisone it could be an increase in ACTH which could lead to more aldosterone secretion with an increase in sodium retention, edema and higher elimination of potassium which could lead to hypokalemia and possible heart arrhythmias.

The solution is to increase prednisone to 5 mg twice a day. If there were problems with the prednisone discuss with the doctor to use eplerenone which is an aldosterone receptor blocker.

[Life5 in reply to tango65]

Hi- does not seem like pitting Edema - overall post his diagnosis in July 2019, his weight lowered initially but then has been stable but his belly has gradually increased ... he was initially on 5mg prednisone twice a day but that caused an increase in sugar levels in the first month of its usage so the MO lowered it to 5 mg which worked well till now .... we are noticing his swelling - facial swelling is more prominent but seems like overall bloating , there is no pitting though when you press on it...his blood protein has been low since quite some time - the doctor has never shown any concern regarding the same... due to high LDL cholesterol in August he got anECG done which was normal, his blood sugar levels were also high so he has been on metformin for the past 2 months so maybe can try with 10 mg of prednisone- will discuss with the MO during his next appointment. He is to get blood work done for his appointment , any other tests we should get done for checking the same ?

[tango65 in reply to Life5]

Discuss having an urinalasys to see if he is loosing proteins in the urine. Look for pitting edema in his legs.

[Life5 in reply to tango65]

He is - during the last test in August there was protein present in his urine but the doctor said + was okay if it was ++ it becomes a matter of concern... the lab test used marks it as negative if it is <10 mg/dl, trace if it is 10, + if it is 25, ++ if it is 75, apart from protein it showed 4 each squamous cells and epithelial cells and 2 cast with no hyaline cast. The blood creatinine level was normal. There is no pitting Edema in the legs.

[GAdrummer in reply to Life5]

If the weight remains stable, but swelling occurs, he is losing muscle mass. In my husband's case, swelling was because of calcium deposits on heart valve that allowed less than 10% normal flow.

[Life5 in reply to GAdrummer]

Thanks will get it checked

[Hidden]

5mg Prednisone is too low of a dose to cause moon face. You need to be at 20mg and up to see that side effect.

[j-o-h-n]

Don't wait until your Dad's appt with his M O in mid October.....call M O TODAY!!!

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 09/28/2020 1:40 PM DST

[Life5 in reply to j-o-h-n]

Thanks John. Will call the MO today itself