Zytiga failure after cassodex failure?

[peterjoe]

I was diagnosed with stage 4 in 2015. I had chemo, lupron, and cassodex, until PSA suddenly spiked last year. I understood it to mean cassodex was having reverse effect. After scans showed tumors growing in prostate, started on Zytiga, with lupron. PSA already started dropping soon as I quit cassodex, and everything was stable; until, after over a year, now spike in PSA. Just had scans, and awaiting results and recommendations. Anyone with this experience and/or advice?

[Tall_Allen]

You may be able to get more time out of Zytiga by switching from prednisone to dexamethasone. After that, Xofigo (if in bones) or Jevtana or both.

[GeorgeGlass in reply to Tall_Allen]

what about those other 2nd line hormonals like: xtandi, erleada and nubeqa? Are they ineffective after zytiga fails?

[Tall_Allen in reply to GeorgeGlass]

There is cross resistance between Zytiga and Xtandi. It's too early to know about the others. Since there is some synergy between Zytiga and Erleada, there may be less cross resistance.

[Engraver68]

Are you oligometastic if so what about SABR treatment to nets?

[GeorgeGlass in reply to Engraver68]

I think I will find that out tomorrow when I get results of an Axumin scan. I'm on a Lupron break right now and allowed the PSA to rise higher than I normally do so they should show cancer locations. The PSMA PET I did in 2016 showed, "probable" cancer in the abdominal aortic lymph node and two retroperitoneal nodes but not conclusive. That leads me and docs to believe it has been metastatic since the beginning so I dont know why this well known local doctor I started seeing this year (due to covid) wants to do these scans. I presume he wants confirmation and a current look and will then do what he thinks is best based on the scan results. If those presumptions from the 2016 PSMA PET scans are confirmed, then SABR would probably be a waste of time, right?...like melting the tip of an iceberg?

[j-o-h-n]

Greetings pj,

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j-o-h-n Sunday 02/14/2021 12:31 PM EST