Zytiga failing

[Roches]

My husband has reached the end of treatment with zytiga.

Psa rising and cancer is spreading, only option now is chemotherapy.

He’s 80 and doc is worried he might not be able to tolerate it.

Has anybody had experience of chemo at that age?

Thanks

[Magnus1964]

Has he been on xtandi? At his age that might be a better option than chemotherapy.

[Hidden]

Age alone isn't a determining factor whether he could tolerate chemotherapy. How fit he is and any underlying conditions, etc. would be the most important.

I tolerated chemo quite well, but I am signficantly younger. The important thing to remember is he only has to commit to doing one cycle at a time and can make a decsion to stop at any time. The commitment is basically feeling lousy for a week. The second 2 weeks of the cycle are usually more or less back to normal. He can also go with a lower dose or more frequent infusions with a lower dose.

Based on recent trials, chemo is a better option than switching to another anti-androgen such as Xtandi, but only if he is fit enough.

nejm.org/doi/full/10.1056/N...

[arete1105 in reply to Hidden]

Just curious when you said he could go with a lower dose. I thought all chemo was at full dose state side.

[Hidden in reply to arete1105]

There are people I know in the US that have had reduced dose so it is done here. It's best to have the full dose if you can. Another option is 1/3 the dose every week. This is sometimes done with older patients.

[Back2future in reply to Hidden]

Just wondering if you had any chemo mouth sores during chemo and what if any did you do to mitigate or prevent it. I can't find much but ice chips and expensive mouth washes.

[Hidden in reply to Back2future]

Never had the problem, most do not.

[Chdh in reply to Back2future]

My husband had mouth sores with proton radiation. I made him lemon balm tea to resolve.

[Shooter1 in reply to Back2future]

Expensive mouth washes are usually formulated at the pharmacy, Mine told me how to make my own with just a prescription to the active ingredient . Twice as much for 1/3 the price.

[Tall_Allen]

80 is certainly NOT too old for docetaxel. Only comorbidities, like bad blood work, are contraindications, not age. That said, close monitoring of side effects and blood work is essential. And use of Neulasta with it is important, particularly during the pandemic:

ncbi.nlm.nih.gov/pmc/articl...

[Roches in reply to Tall_Allen]

Thank you.That’s a great help.

[tango65]

He could be treated with Lu 177 PSMA instead of chemo. It is a systemic treatment, treats mets everywhere and it has shown to prolong life. Side effects may be well tolerated and there are not severe unless there is extensive bone marrow infiltration by the cancer.

The treatment can be obtained abroad, ( Europe, mainly Germany but also Austria, Switzerland, Finland, Netherlands etc. ) or in India, if financially possible.. There are clinical trials in the USA.

clinicaltrials.gov/ct2/resu...

[Roches in reply to tango65]

Thank you for your reply, unfortunately we wouldn’t be able to afford it.

[tango65 in reply to Roches]

You could see if one of the clinical trials may be possible.

[DaughterAR]

My father is 82. His cancer has metastasized into various bones all over his body. They are always stunned he has no pain. All the meds (xytiga, xtandi, etc) are not stopping it. The doctors said he could try chemo but he has chosen to stop treatment totally and focus on quality of life.

It’s not the right choice for everyone but he’s happy with it. He’s right at two weeks off now and feeling good. His color is improved, his mood is high and he’s doing things like leaving his walker across the house as he does chores and sings to himself. He wasn’t doing that a month ago.

We all know this will not last, but he just could not stand the idea of chemo and it’s effects when it was only buying him time- which was possibly time where he’d be sick and miserable a lot anyway.

I hope you find the answers you are looking for.

[addicted2cycling in reply to DaughterAR]

DaughterAR wrote -- " ...he has chosen to stop treatment totally and focus on quality of life.... "

Quality of Life has been my mantra from diagnosis and I applaud those who have chosen that path AND the family members who while possibly in disagreement ACCEPT the choice being made.

Just wondering if your father had given any thought to trying some form of testosterone? Sounds totally contrary but the results could be overwhelmingly energetic.

Good luck to y'all.

[DaughterAR in reply to addicted2cycling]

I don’t think so but it’s something to look into.

[Qbtdan in reply to DaughterAR]

I am 76 yrs old. I am on Eligard and Zytiga for 2 1/2 years.

I started with prostate cancer that metastasis to bones throughout my body.

So far PSA at .04

How long was it before your dad’s PSA Rose?

[DaughterAR in reply to Qbtdan]

He was diagnosed five years ago and up until two years ago it stayed under 2.0, usually under 1.0. In his case the psa doesn’t necessarily move if the cancer grows. They found he had it all over and I believe his PSA was around 6.

In the past five months he’s gone from 6 to 22 and that’s still on all his treatments.

[Kcski]

My dad did Docetaxel at age 72 and tolerated it very well! He is active mowing his lawn, playing golf, tennis, and soccer. So I think it is important to not sit around and instead move. During his six rounds of chemo he did not feel great after the chemo for two to three days. Like Dr. Nordquist said, it is like a hang over. The last two doses were the most uncomfortable, BUT the Docetaxel killed a ton of the cancer! He has just been on ADT for two years now. I just watched Fantastic Fungi, and it said Turkey Tail mushrooms paired with chemo put a 80+ breast cancer patient in remission! There is a high upside trying the chemo and maybe look into Turkey Tail mushrooms! Good luck!

[Hidden in reply to Kcski]

It looks to me like a lot of people seem to think that all chemo is the same. It's not. The chemotherapies for prostate cancer are on the more tolerable end of the spectrum. My quality of life improved on chemotherapy and it really looks like it's helped me to live longer.

I was opposed at first, but decided to try it anyway. Turned out it was no where near as difficult as I thought it would be. I do understand the reluctance, but unfortunately chemotherapy is the most under-used treatment for prostate cancer.

[Spyder54]

Also watched Fantastic Fungi. Excellent. There is Ancient healing power with Fungi. Something like 12,000 species of Fungi. Cannot ignore. Mike

[Sheba215]

Dear, Roaches: I have been on Zytiga for many years. My PSA as been rising as well. My OC doc has transitioned me to Nubeqa. No side effects thus far. I am 76. He wants to delay chemo as long as possible. Good Luck. I forgot to mention that in February, 2020, with my PSA at 10.4, my OC sent me to receive 6 doses of Xofigo/Radium-223 ( one injection every 4 weeks. I was still on Zytiga at the time. Medicare covered. I had a PET SCAN a few months after the treatment ended and OC mention ed the my Met spots were "less bright" then on the previous scan. I am having a PCMSA scan in October. Depending on what that shows, my doc would like to send me for another round of Xofigo. The good news is that the PSMA will show everything. The bad news is that the PSMA will show everything.

[Roches in reply to Sheba215]

Thank you for your reply.Had your cancer metastised?

[Sheba215 in reply to Roches]

Yes, I was diagnosed as stage four in Oct. 2013. Original PC diagnoses was Sep. 1999, Gleason 6 (3+3) I've been battling this for a long time. Oct. 2013 as scan showed mets in iliac nodes, left pelvis and neck of left femor. Started Zytiga at that time. Also continued with Lupron, Prednisone and Xgeva. Stopped Xgeva in May of this year due to Jaw bone problems. Subsequent scans have shown a few new spots. I haven't had any pain from mets.

[squidlicious]

Is your dad on Lupron as well? I will assume so. I was on Lupron plus Xtandi the Lupron plus zytiga. Both failed. However I’m now on Lupron plus Erleada (apalutamide) and this has worked well for 3 years! By the way I failed chemo (docetaxel).

[Roches in reply to squidlicious]

Thanks for that.

I gather your cancer had spread?

[squidlicious in reply to Roches]

It has not spread but I got it young (46) and it’s high-grade Gleason 8/9. I’m 62. Did not have surgery. ADT was/is my primary treatment. I also had RT and in 2018 cryo-ablation.

[j-o-h-n]

They say 80 is the new 80..........

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 09/24/2021 8:16 PM DST

[lincolnj8 in reply to j-o-h-n]

A nice bowl of ice cream makes everything better you know...

[Roches in reply to j-o-h-n]

Well said and thanks.😊

[j-o-h-n]

now ya talking.............. Chocolate chip (two scoops)...

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 09/24/2021 9:56 PM DST

[TeleGuy]

Have you tried switching from prednisone to dexamethasone? Just search for this on the forum if you haven’t.

[Leader4077]

I am a cheerleader for the “earliest” chemo you can get when PSA doubling time is dropping below 6 months. Firmagon alone for me had failed by December 2020……I asked for Docataxel and started the next month…….6 cycles later, 7 PSA drops in a row by June 2021 down to 2.98 from 22.

My whole story is in the September 2021 issue of Prostapedia newsletter……….go Chemo!

Mike Brown

[Roches in reply to Leader4077]

Thanks for your reply, we are going To give it a try.