Should I continue Abiraterone for 12 months, or switch to chemotherapy now?

[happycamperguy]

I'm wondering if I should continue my Abiraterone for 12 months (to Nov. 2021) even though PSA has not dropped to undetectable. I've done 8 months now. Or should I roll over to chemo sooner than that?

My MO says I am ADT/hormone-resistant. I started Abiraterone (Zytiga) in Nov 2020. My PSA did not go to undetectable. My PSAs from Feb 2021-June 2021 have been bouncing up and down in 0.26 to 0.36 range, with the only bright spot a drop in PSA in May 2021 to 0.26. MO and I then decided to continue Abiraterone for 6 more months rather than original plan to switch to Apalutamide in May 2021 if PSA got undetectable (it didn't). See my profile.

So I'm currently on track to finish Abiraterone for 12 months in Nov 2021, then reassess. MO said likely chemo with Abraxane and Carboplatin in Nov 2021 if my PSAs don't improve. I see him on 27 July for lab tests and discussion.

I'm Gleason 9 with micrometastatic PC. MO confirmed previously that STATISTICALLY I'd likely live only another couple years at this rate. Of course I'm thinking I can beat those odds.

Your perspectives? Should I stay on Abiraterone and hope for a PSA drop? Or start chemo sooner? Other treatment ideas for this ADT-resistant patient?

[Tall_Allen]

Consider staying on abiraterone, as it is doing something at least - maybe switch to dexamethasone - and add chemo. What is Araxane?

[happycamperguy in reply to Tall_Allen]

Oops. Abraxane. I fixed original text.

[Dett in reply to Tall_Allen]

TA, I thought that the determination of ADT/hormone/castration resistant PC required a lot more than a low but not undetectable PSA. I recognize that recent studies show a benefit to early chemo, so that is probably advisable in any case, but isn’t the MO’s assessment of two years without it overly pessimistic?

[Tall_Allen in reply to Dett]

Read his profile.

[Hidden]

I don't know much but I know that if my PSA was less than 1.0, I sure as hell wouldn't drop Zytiga unless scans show Radiographic progression. I would milk Zytiga for every single day possible.

[Hidden in reply to Hidden]

Agreed - ride the horse s long as possible if scans show no progression.....

[tango65]

You should continue on abiraterone until clinical or radiographic progression of the disease. The PSA seems stable oscillating between 0.3 and 0.4. You could try dexamethasone and see if helps to get the PSA lower.

[RyderLake2]

Hello, I agree with previous writers. If the Zytiga is working don't mess with it. Are you on an ADT drug? If not, perhaps you should be. Has the cancer metastasized to your bones? That is usually the first place it goes after it escapes the prostate. Your bones are usually the first to throw out for PCa the "welcome mat". If so, you need to get on a bone strengthening drug like Prolia (denosumab) to prevent a skeletal related event (SRE). Good luck!

[DarkEnergy]

I was on Lupron quarterly injections and Zytiga, kept going for 2 years even when PSA <0.02 was holding. Heck, even after the first year added 6 cycles of Docetaxel.

Been on treatment vacation since 11/06/20, current PSA 0.18, my next blood draw is on 07/22/21. If PSA uptick, then repeat above.

[Poowater]

Your MO appears to be doing a great job. My MO says I should be on Zytiga for life.

[Muffin2019]

I would stay on Zytiga , on quartely lupron shots and my psa is .8 as of last month, my oncologist is happy and may never go to undectible or my take longer, scans show no progression and if it does show progression I will do chemo again.

[Danish-patient]

I took Arbirateron for five years before it stopped working - so why the 12 month limit?

[DrRobin]

Happy camper, abiraterone is sited as the standard of care in our metastatic condition. A person I know is doing well with it and whack a mole radiation. He was high volume far worse than me and lymph nodes when diagnosed. I have no nodes but could not take abi after 4 months cause my liver would not break it down! Wikipedia says seems to say Gilbert’s which I have may be why. But it lowered my PSA lower than it ever was. Stay the course if you can!

[Spyder54]

HappyCamperGuy,I presented w PSA 47. in Oct 2020. Turp for biopsy. PCa inoperable. 8 months of Firmagon, started Xtandi Nov 2020. Switched to Zytiga (Abi) in Jan 2021 as my T started rising on Xtandi. T & PSA continued to drop slowly zigging and zagging down to only 2.26 now. I would love to be down below 1. Enjoy the moments. Now told should not start Docetaxel because Hormone Sensitive with PCa cells in sennescence Doxy would do nothing. Needs cells to be multiplying rapidly to work. So Im only on the ADT Train almost 9 months since Dx. Enjoy your success to this point. 🍀

[Anatalya]

Idk, my husband's PSA has never dropped lower than .54, and at latest test had jumped from .56 to .68 in two months. He is on Zytiga as well. He's going in June to get another PSA to see if it continues to go up. Doc won't take him off Zytiga to do anything else until it's certain the Zytiga is failing.