Recap, fast heartbeats 120/130 per min, oncologist stops aberaterone. Angiogram heart - mild artery disease, sinus arrhythmia atrial flutter. Cardiologist adds digoxin and apixaban. Not bad for 76 year old smoker also enjoys social drink.
19 days later oncologist restarts Aberaterone. 4days later heartbeats start to rise after total 7 days I stopped taking Aberaterone!
4 days after stopping heart seems to have gone back to normal again.
Spoke to oncologist yesterday he will review and suggest possible change of meds to enzalutemide, to confirm next week. Having read side effects of enz, that also includes high heartbeats !!
Any other alternatives or is my choice to risk heart attacks or not take cancer meds (other than prostap which I continue) ??
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Dondodoc
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Agree with Magnus. Bicalutamide is a great medicine which is so under utilized. It has least side effects of all LUTAMIDES....yes It can cause some breast enlargement which can be prevented and controlled by Tamoxiphen 10 mg a day or radiation to Breast area. The great thing about Bicalutamide is that some people go in remission for months or even years after stopping Bicalutamide (Anti Androgen Withdrawal effect) Hope you are that lucky man in Japan who had a remission of 8 years after stopping bicalutamide
Just last month a recent research showed that Bicalutamide prevents clinical infection from Coronavirus and reduces intensity of Covid-19 symptoms.
Bicalutamide would be not be appropriate in your case. Now that we have better anti-androgens, there is little use for it other than to prevent the effects of testosterone flare when starting Lupron. Yes, docetaxel remains effective after abiraterone (but you had very little anyway).
Thanks Allen, in all 30 months on aberaterone before problems. Oncologist is also Fellow Royal college radiology, equally cardiologist is a lead interventional guy. Fortunately I have good private insurance. Put you on the spot! Where would you go ? Aberaterone/ enzalutemide high heart beats possible serious heart problems or chemotherapy? Perhaps very unfair question and I do aplogise Don
I think there is a logistical advantage to doing chemo early. It is usually 6 treatments, 3 weeks apart, so you are able to move onto the next therapy (enzalutamide or apalutamide) in just 15 weeks. On the other hand, if you start with enzalutaimide, it can be years before the next treatment. I believe that the more treatment you get, and the sooner you get them, the better off you will be. All of these treatments have lower side effects when used earlier, and increase lifespan and QOL if used earlier.
Your heart symptoms may or may not be tightly related to some of the prostate cancer treatment drugs you may be taking or about to take. You might want to consider whether you are seeing a Cardiologist who is a "Plumber" vs. an "Electrician".
Conditions like atrial fibrillation can come and go, sometimes with or without many symptoms. Certain types of atrial fibrillation called "paroxysmal atrial fibrillation" or "a-fib with rapid ventricular response" can cause symptoms of high or irregular pulse rates to come and go. An "electrical" cardiac specialist can evaluate such things by EKG examination while such episodes are in progress, and/or have a patient wear an 24/7 heart monitoring device for up to 14 days. This might be done using the older, bulkier Holter monitor or something like the smaller, newer electronic Zio Patch Heart Monitoring System.
Anecdotally, I started having occasional A-fib with RVR after about 3 years on ADT with Lupron in my late 60s, before I went onto Xtandi. While it was happening, especially at first, it scared the crap out of me. Fortunately, my heart rhythms either converted to normal on their own after a while, or responded to specific heart drugs which could be administered "as needed" or on a low-dose regular basis. These drugs might include various "beta blockers" or "calcium channel blockers", such as versions of Metoprolol or Diltiazem, and/or perhaps other oral drugs that influence heart rhythms.
When A-fib does not respond in due time or in response to drugs, a patient and his doctor may have to decide if an electrical shock "cardioversion" is needed. There is also a "cardiac ablation" procedure where they go inside the heart via a catheter to try to disable those criss-crossing and misfiring nerves. (I've never had to have either of those done.)
There might also be an added blood thinner of some type if persistent A-fib has increased the likelihood of pooling blood in the heart forming blood clots that may be thrown off into a lung or causing a stroke.
Again, anecdotally, I happened to notice certain come-and-go "triggers" that seemed to be associated with some of my symptoms. Not every time, and not all the time, but enough for me to notice. Alcohol consumption was one. I no longer have large glasses of wine, but every once in a while will take a few very tiny sips with some nice Italian food, just enough to remember/experience the flavor and aroma. I also switched over to an occasional non-alcoholic beer. For a while I also seemed to be triggered by things associated with a vasovagal type reaction, starting in my stomach. Certain super spicy foods without something to temper them, or too much all at once. Sometimes the shock of really cold things eaten or rapidly drunk. I made mental notes of such things, and toned them down in relatively easy ways. Over time with some baseline meds, I seem to be having fewer "triggers" and less frequent episodes.
Anyway, in my experience, my A-fib is better now and managed pretty well with some daily medications and the occasional "as needed" pill when I feel symptoms. My occasional A-fib does not seem to be tightly related to any of the prostate cancer medications I've been taking regularly for almost 7 years now.
Good Luck! with your prostate cancer drugs, and with your heart rate issues.
When our treatments work, it is wonderful.
You should see an electrophysiologist heart doctor for an opinion. Perhaps flutter ablation might be something to think about.
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Abiraterone 500mg Daily
Another updat, this time from the hospital bed. 
Advice on dosage for Abiraterone
Lupron + Aberaterone or Aberaterone alone for mcrpc?
