My dad took PSA test today (12 Apr 2021) and the result's 5.55 and T: 0,0868 nmol/L. (His doctor said the test would be done after 3 month after taking Zytiga and taking PSA test after 1 month is my dad's decision). Previously, my dad took 8 rounds of chemo which finished in Nov 2020 with PSA: 0.29. Then it increased to 2.66 at 25 Feb 2021 and 3.52 in 4 Mar 2021, T: 0.466 nmol/L. He started taking a half dose of Zytiga from 10 Mar 2021 (PSA's estimated at around 4.5 based on the growth rate).
Could you, who have experience, share with me your view on the following points?
- Does a half dose of Zytiga (500mg/day) work or not since T level reduced from 0.466 tyo 0.0868?
- Should my dad take full dose of Zytiga or not because PSA still increases (from 4.5 to 5.55, nearly 24%)? I heard of PSA flare with Zytiga (even though it's not normal) and heard that Zytiga treatment should be monitored for at least 3 months before making a decision of effectiveness. Is it correct?
Zytiga works for a lot of people, some after 18 months are still stable. It didn't work out for me, my PSA climbed to 360 and Oncologist stopped the Zytiga and put me on another round of Chemo, the Zytiga didn't even last 3 months. Chemo has got PSA down to 70 at moment.
Everyone is different what works for one person doesn't for the next, keep talking with your Oncologist.
I've been on Zytiga for over three years now. I have been 0.1 PSA since first month treatment. We all share the same disease but our bodies react differently to treatment. What works for me may not for you. Staying positive is a good start there are many other options for you and more on the horizon. Never give up Never surrender. Leo
I have my 4th round on Thursday, so far it's working and I'm feeling better (apart from Chemo side effects), Xmas, Jan and Feb I was quite poorly and struggled just getting up and down the stairs, I was starting to feel this might go past the point of no return. I certainly wasn't keen on having to go through Chemo again and was worried that feeling so weak it might add to health complications during Chemo. I do have age on my side (57) and was pretty fit before diagnosis 2 years ago.
Oncologist seems to think my options are becoming limited, the cancer seems pretty aggressive and is finding it's way around everything he throws at it. My first round of Chemo lasted me 11 months before PSA started climbing (PSA was 1386 at diagnosis) it went up to 360 Xmas and blood counts were very low.
I don't know how much Chemo drugs my body can tolerate but I think I have to start factoring in QOL as well, being mobile and not being in pain is the most important factor.
It looks like you'll be done with chemo just in time for the height of the swimsuit season! Good to hear that you are responding and feeling better, but I hear you clearly: Treatment tolerance versus QOL is the mental struggle we really face, but so often gets lost in the daily fight against our cancer.
As a fellow 50-something (53) with "age on his side", I'll be pulling for you, Z.
Thank Tall_Allen for advice. He had taken 500mg without food (2 hour after breakfast) for 2 first weeks and 2 weeks latter right after breakfast (after reading information from Heathlunlocked)
I was on Lupron and 1000 mg Zytiga at the same time for 1 year. I had good results. My PSA went to undetectable at about 6 months. Initially I had monthly checks on my PSA but after about 3 months with things trending downwards it went to 3 month PSA checks.
"Testosterone flair" is common with luteinizing hormone agonist therapy (Lupron, Zoladex, Trelstar, and others) which in turn causes PSA to flare. The reason is that the drugs work by stimulating the pituitary gland to produce luteinizing hormone which, in turn stimulates the testes to produce MORE testosterone until they finally overload in one or two weeks and shut down.
Zytiga works by an entirely different method. It shuts down the biochemical pathway that converts other chemicals into testosterone. As I understand it, if the Zytiga is working, there should be no testosterone flair and no increase in PSA caused by testosterone flair.
Alan
P.S. I'll leave the above posting alone but add that my understanding that there should be no PSA flare with Zytiga is wrong. See the posts by Dawn80 and myself below.
Thank you for response. Hier is Search Results from google search with keyword “Psa flare with zytiga”:
“The PSA flare after abiraterone treatment occurred in 9 of 103 (8.7%) patients who received abiraterone after docetaxel. The median PFS of the patients who experienced the PSA flare was similar to that of patients achieving an immediate PSA response but was higher than that in those who did not have a PSA surge”
Well, that surprised me. I saw an article recently that said that Zytiga is sometimes offered with Lupron or similar ADT drugs to prevent testosterone flare - which I assumed is the cause of a sudden temporary rise in PSA.
However, the article you found certainly does show that a PSA flare can occur with Abiraterone.
I found that the full text of the article is available for free here:
You might want to download it so that you can send it to your Dad's oncologist if he didn't know this could happen. However the doc may have known that this can happen and that's why he wanted to test after 3 months.
I read the full article, looking for an explanation of what causes this phenomenon but the authors didn't know. The main conclusion of their research was that an early rise in PSA after starting Zytiga should not be assumed to mean that the treatment failed. It should be continued for several months in case the Zytiga really is working and the PSA rise is only temporary.
I have been on 1000 mg Zytiga + Prednisione since Jan 2015 . Urologist also prescribed 1000 IU D3 and 1000 mg Calcium. PSA is presently undetectable. Have also been told Zytiga does not work for everyone. All the best.
I have been on the Lupron shot every three months since last November and 1000mg Zytiga since January. My last two monthly PSA tests have been undetectable. The next test is next week and hoping for the same. Two more undetectable tests in a row and I will go to quarterly testing instead of monthly. Good luck to your dad!
Zytiga worked very well for me , PSA from 78 to about 3 , but it only worked for just over a year , now I am on good old chemo........
I would follow the Doctors recommendations. I'm on a full dose of Zytiga a d PSA has dropped from 629 to .5, which is my "Nadir". It took 18 months to reach nadir, but I'm holding steady.
In 2017 took Zytiga right after Cosadex failed after I had salvation IMRT to my PG in 2016 when ADT failed. But the extra RT to PG did almost nothing, and Cosadex did nothing either, and when on full dose of Zytiga that is free here in Australia on our Medicare, Psa went down from about 5 to 2 for a couple of months then slowly rose and was declared useless at Psa about 8 after 8 months, and then I quit Zytiga and did 5 doses of Docetaxel which quadrupled Psa 12 to about 46, where it stayed, so chemo failed, and I got referred to Lu177, and 6 doses over 18months got rid of all soft mets, and many bone mets. I began Xtandi during Lu177 which boosted the Psa reduction from 25 before to 0.32 after 1 year, and 4 doses, then Xtandi failed, which is about what all these ad-on drugs to ADT manage to do, but they don't kill much Pca.
The two last doses of Lu177 in 2020 were less successful with Psa moved from 30 to 7m but PsMa scans showed a pile of mutated new small bone mets which generated much more Psa a lot faster than older mets. So after October 2020, Psa is now about 350, and it was doubling 2.7 times in a month. Xtandi became completely useless.
So without soft tissue mets ( that anyone knows are there ) I was able to start on Ra223 ( Xofigo ) on 26 Feb this year, and next dose is Friday 23 April, soon, but nobody really knows if Ra223 may work; IT SHOULD work as they say, but putting up with Pca means witnessing a great succession of potions in yourself and your friends and all they do is buy you a little extra time before you are forced to accept palliative care.
One friend found he died less than 3 years after diagnosis early enough, but RP, IMRT, ADT, Cosadex, Zytiga, 10 doses Docetaxel, PARP inhibitors all did very little to allow long survival after his diagnosis at 58, with beautiful young family.
I was diagnosed 5 years too late in 2009, Gleason 9, age 62, Psa 6, inoperable and probably with hundreds of small mets that did not show up until my first PsMa Ga68 scan in 2016.
I've had 10 such scans now because its completely useless to try to treat Pca without seeing where many of the mets are.
I have another PsMa scan on about 24 May to see what might be going on and doc says that they might give a third dose, but if scans and blood tests show my bones and marrow are wrecked, the doc will send me for more chemo with Cabazataxel, and that is very likely to fail, and using other more vicious types of chemo might wreck me so much its time to hoist a white flag, and go for palliative care.
But I also could be real lucky and find Ra223 zaps all bone mets without completely wrecking bone marrow, so until I know what's going on, I am always going to .........
Thanks for your feelings about the battle I face and that which so many here also face. None of us really like dying from cancer; we all would prefer old age taking a long time to end us. I've got No 2 dose Ra223 next Friday, day after tomorrow. I hope it reduces the miscellaneous coming and going of pains in spine which I do not know are caused by Pca, or arthritis or old age. But over last 6 months, my BP has gone up doc tried Tritace pills which did nothing, and Valsartan pills over last 2 weeks are doing nothing. I am getting BP readings of 200 for systolic, 90 for diastolic, pulse 55, and its all a lot higher than last year. I should have low BP and no occasional headaches. The cycling I was doing was supposed to keep heart and vascular system working just fine, and all the docs were happy I cycled, and didn't have a big fat pot belly and lots of other problems, but here I am with a heart-vascular problem despite living the right lifestyle. Perhaps I may have been far worse if I had never cycled.
I feel that many medics just don't have a clue how bodies work.
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Good to hear that you are responding and feeling better, but I hear you clearly: Treatment tolerance versus QOL is the mental struggle we really face, but so often gets lost in the daily fight against our cancer. 
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