What to expect after Xtandi?

[Lynsi13]

Hello!

It's been a while since I have posted.. fortunately, my daddy has been doing fantastic and with 2020 giving me mental whiplash every 2 seconds, I stepped away from reading about all of the current research, news, and available treatments for advanced PC for the sake of my mental health! 😜

However, I've been wanting to touch points to see if I can be caught back up on the status of treatment plans and particularly what I should expect for my dad's path forward.

A quick recap, dad was diagnosed in June 2015 with stage 4 PC that had caused his tumor to become so enlarged that he was in kidney failure and needed double nephrostomy tubes directly to his kidneys for several months. His PSA was 257 and the cancer had spread to a single nearby lymph node.

He started Lupron, bicalumatide, and chemo immediately. He was able to stay on Lupron and bicalumatide for 4.5 years before his PSA began to move upward. At that point we started provenge, but unfortunately due to covid, he was only able to get 2 of the 3 infusions. He then started on Xtandi and has been seeing a low and steady number since (.31).

A few years back we tested my dad for genetic markers and found nothing significant. We're currently testing his tumor samples to see if we can find and markers within them.. but we haven't received any results.

Dad will be 80 this June and he's in great shape.. walks daily, keeps up his property, hauls firewood, and preaches at a small town church every Sunday.

My question is, what should we expect if we start to see an increase in his PSA? Zytiga? Radiation? Additional chemo? Some new treatment I'm unaware of? I like to have a sense of what's up the road, so if anyone can give me some insight, I would appreciate it!

Lynsi

[Boywonder56]

Imo.....he's 80....and qol comes into play. Have you enquired into adding erleada?

[timotur]

Your Dad is amazing for being active at 80yo while going through ADT, and you are too for taking such care of him. It seems he became CR after his response to Lupron ended. Further systemic treatment would likely include second-line hormonal tx, Zytiga, but not sure of the timing of that with Xtandi. If further ADT fails, possibly he may try further chemo to sensitize the PCa to a re-challenge of Zytiga (see Dockam's posts). Keep an eye on the trials looking at Lu-177 as early treatment (see the posts from Patrick in Australia, who had several rounds and responded well). All the best for continued success!

[Jif1]

I was on Zytiga, Prednisone and Lupron for two years, ending last year. So far, my psa is undetectable! That combination worked for me and perhaps, Zytiga/Prednisone could do the same for your dad. Of course, check with your oncologist.

[j-o-h-n]

"Dad will be 80 this June and he's in great shape.. walks daily, keeps up his property, hauls firewood, and preaches at a small town church every Sunday."

At 80 your Dad can do that for me anyday.... except for the preaching, my wife does that to me everyday including Sundays....

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 04/18/2021 2:27 PM DST

[topofthemountain]

I am 71 years old, had my prostrate removed in early 2018, I was on Eligard for approx 12 months before my PSA started rising, moved to Xtandi (enzalutamide) for 12 months before it stopped working. My prostrate cancer is very aggressive and my oncologist suggested LU-177. I am an ealier adopter and I had my first injection in February 2021 and my PSA reduced from 50 to 3.5. I had my second injection in April 2021 but do not have the results. I am being treated in Brisbane Australia. I had minimal side effects except a lighter wallet as the treatment is not cheap and there is no support from government as it is not an approved treatment but based on my results it is an effective treatment. Best of luck for your father.

[Spyder54]

Xtandi failed me, and verdict still out on Zytiga. I started on Xtandi at month #3 from Dx, after being on Firmagon (only)for first 2 mos (started within 1 week of Dx-diagnosis). Once Xtandi was added to Firmagon my Testosterone rose from 0% to 15% 1st month on both, and 16.2, 2nd month on both. My URO/Onc was afraid of a PSA failure as its downward momentum had flattened, so we switched at month #4 to Firmagon + Zytiga + 10mg Prednisone. T dropped that month from 16.2 to 3.2%, but PSA rose from my low Nadir of 4.2 (from 47 at Dx) to 4.7, and 2 weeks later up again to 5.2. Last week T went to new high of 26, but PSA to a new low of 3.7. So now-at 6-1/2 months since diagnosis, I am struggling to get to undetectable. KEY: I have now been turned down by 6 different Surgeons for Prostetectomy (citing NCI Guidelines). Not giving up. Believe it is hard to get to undetectable with the “Mother Ship” still in place. Hoping that PSA will not follow recent rise in T, but rather T will settle back down toward 0%.

Summary for Lynsi13: Both of these 2nd gen drugs work for many, but not all. Side effects are tolerable for some, but not others (age doesnt seem to be biggest factor). When they work, they work well. Zytiga is cheaper as it is finally available as a generic. Xtandi very expensive without some type of a National Financial Support system ( think the company will pay for first month).

All our best to you and your family. Research like this is helpful, but nothing like actual useage by your Father. Good Luck for a long and continued healthy life❤️

Mike K (Spyder 54)