Update :Dad's psa started to rising really fast doubling time is around less then three months and reached to 1.0 from 0.7 in 20 days.(doubling confirmed started rising almost one year ago.I have more than three readings) Seems like abiratarone stopped working, He has not taken anything other than abiratarone 1000 mg plus 5 mg Prednisone and pamorelin injection when he was diagnosed stage 4 metastatic Gleason 4+4 = 8, with several mets hree and half years ago. Right now he is in perfect shape. Recently consulted medical oncologist and he suggested
(1) Inj.Elligard 22.5 mg S/C Every 3 monthly
(2)Tab.Enzaluatamide 40 mg 4 Tabs Daily
(3)Tab.Dexa 1 mg Daily
(4)Tab.Shelcal 1 Daily (calcium supplement)
(5)Inj.X-GIVA 120 mg S/C
Dear friends my question is he suggested to change pamorelin hormone therapy injection (triptorelin) to Eligard(leuprolide) ? I don't know which one is better please suggest me.
Should I change abiratarone to enzaluatamide or should I just change Prednisone to dexamethasone and not changing abiratarone?
What dosage of dexamethasone should he take as he used to have 5 mg Prednisone so should he take 0.5 mg dexamethasone or 1 mg.?
Any other options available ?
Would also like to know about relugolix.
Sorry for too many questions
Written by
Nirman
To view profiles and participate in discussions please or .
The change to dexamethasone 0.5 mg may work for a while. If it does not work, continuing treatment with chemo is considered better than using enza or apalutamide.
If PSA continues to go up, the cancer is castration resistant. Chemo with docetaxel or cabazitaxel should be the next step. At the same time he could ask for Provenge if it is available or a similar vaccine which are available in India.
If he doesn't want to have chemo, he could get of the SOC and try Lu 177 PSMA treatment which is available in India and it may be more effective in patients without previous chemo.
Following this way after Lu 177 PSMA , chemo and the other anti androgens, enza and apalutamide could be used.
If there are many bone metastases, discuss having denosumab or zoledronic acid.
Why isn't he doing docetaxel next. It may be a good idea to alternate chemo and hormonals. Good idea to add Neulasta, especially during the pandemic.
• His testosterone level should dictate whether switch to Eligard is called for. What is it? Relugolix is not available anywhere as far as I know. Was he offered that?
• A DEXA scan should indicate whether XGEVA is needed. What is his bone mineral density?
• His serum calcium and serum Vitamin D should dictate whether supplementation is needed. What are his levels?
• Dexamethasone is not required with enzalutamide, but it is a good idea with docetaxel and Neulasta.
Hello Allen thank you for your precious advice(1)here in India right now situation is not so under control and going to some hospital is bit risky with danger of getting infected of covid so we are not planning docataxel right now. (2)His recent visit total testostoren is less than 10 so should we switch to Eligard what's your advice on that? (3)Haven't done dexa scan because going to clinic is risky but his serum vitamin D and calcium are good and in the range. However he takes calcium 2-3 times in a week daily 40 minutes of sun with body exposed properly to sun. And 60000 iu every month with K2 mk-7, and walking 15000 steps everyday to take care of bones.
(4) relugolix wasn't offered by him(5) he even didn't have much idea about that but I guess it's in process of fast process fda approval so maybe available by December or January perhaps.
(5) right now we are planning to continue abiratarone and switching Prednisone to dexamethasone and let's see what happens and then we will try enzaluatamide alone. I wish we could use docataxel but even doctor suggests it's better not to take chemo to prevent getting infected.
Once again thank you Allen you are so knowledgeable, Updated with latest and accurate research, you almost reply promptly and almost every confused pc patients like my dad and others I appreciate and wish very good health and fitness to you and everyone handling PCa.
As I said, why switch from pamorelin if it is working so well? I wouldn't count on FDA approval of relugolix until next year. India sometimes gets drugs early though.
Makes sense to try switching from prednisone to dexamethasone with his abiraterone.
He should not be supplementing calcium or vitamin D if he doesn't need them. They do nothing for bone health and if his levels are already adequate. Extra calcium is associated with increasing prostate cancer. High intake of Vitamin D draws calcium out of bones and weakens them.
First step should be switching from prednisone to dexamethasone . Continue rest of other meds and monitor PSA more closely. Even if you get a few more months, its good.
As far as Androgen deprivation meds such as Lupron, goserelin ,Eligard...they are almost same. Whatever is being used, ,the real effectiveness of their T lowering can only be estimated by level of Total and free testosterone.
Relugolix is just the tablet form of Leuprolide and is expected to come in market only by end of 2021. This is NOT a new medicine...just a different way of giving Leuprolide.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Medical Oncologist in Denver
When is Medical Oncologist Appropriate?
medical oncologist in Atlanta?
Medical Oncologist in Southern New England 
Medical Oncologist recommendation: Mayo Clinic
