AST and ALT elevated

[Simonapo]

Hi, this is my first post, but I have been reading many posts on this site for the past few months and I thank you all for the great info provided. I am here concerned about my Dad that was diagnosed back in July with stage 4 PC, PSA 8,75, Gleason 4+5, 3 lymph nodes and 2 very small ribs mets. He was started on Lupron every 3 months, 30 days Bicalutamide, and now Zytiga 1000 mg plus Prednisone 10 mg. He just completed 2 weeks ago 55gy RT to prostate and lymph nodes plus 45gy to ribs mets, total 100 gy. Today he had his blood work and AST is elevated to 81, ALT to 241, the MO at COH recommended to repeat it in one week. Before radiation and start of Zytiga all blood counts were normal. Not sure if the AST/ALT elevation is due to radiation or Zytiga or both? Could anyone recommend any supplements that would help liver during this treatment or recommend a holistic doctor in Orange County California? Any advice is greatly appreciated. Thank you so much. I forgot to mention that Germline and Somatic test don’t show anything concerning. His PSA today was 0.185 and T<7. Thank you again.

[GoBucks]

My ALT & AST skyrocketed in month 7 of taking Zytiga. The numbers can go 5 times normal so he has a way to go. I stopped Zytiga for 7 weeks to allow numbers to go down. Then restarted at half dose. ALT & AST were still good so I went to 3/4 dose. Been there for 3+ years. PSA still <0.01.

[Simonapo in reply to GoBucks]

Thank you so much, so glad to hear that you are doing great with this treatment now and you were able to fix the ALT and AST issue. Thank you fir your reply.

[TylexGP]

When I started Zytiga, I saw an increase in ALT and AST( which had been on at the lower limit of normal) and eventually went slightly above the upper limit of normal. They continue to be at the upper limit of normal after 6 month of treatment but MO isn't concerned since it has been stable. Your Dad ALT and AST is high but like another poster said if he stays under 5x the ULN they will likely keep him on it. Hopefully it will come down some

[Simonapo in reply to TylexGP]

Thank you so much

[Hidden]

Take a hard look before you stop Zytiga. I'm sure the MO will come up with something, dose reduction, etc. This isn't a hit the panic button moment. Good luck.

[Simonapo in reply to Hidden]

Thank you

[Tall_Allen]

Very common for Zytiga to cause elevation in AST/ALP. It usually goes back down with a reduced dose or stopping. Then it can be reintroduced. Don't take any supplements when there is liver toxicity.

[Simonapo in reply to Tall_Allen]

Thank you Allen

[Gearhead]

As a less-important side item, ask his Dr. about the prednisone dose. Zytiga guidelines for prednisone are 5 mg per day if castration sensitive and 10 mg per day if castration resistant. And your Dad seems to be castration sensitive based on his PSA decrease. But there are various reasons for varying from the prednisone dose guideline, so perhaps his Dr. has prescribed this dose purposefully.

[Simonapo in reply to Gearhead]

Thank you, I will definitely ask this question. Two months ago I knew nothing about prostate; ever since the diagnosis I read a lot and gather so much useful information from this site, thank you all SO MUCH.

[Canoehead]

Despite other comments about supplements, European Milk Thistle and dandelion root helped some of us reduce liver enzymes. These are otherwise innocuous supplements that are commonly recognized as benefitting liver health.

[Simonapo in reply to Canoehead]

Thank you so much, could you please recommend where should I purchase them from? There are so many sites …Thank you for your help

[Canoehead in reply to Simonapo]

With supplements you are really looking for a company that has been around for a while and whose quality and consistency you can trust. You can buy milk thistle from life extension. For dandelion root, Nature’s Way seems to be a reasonable choice, although I don’t have the experience with them that I have with life extension.

[Simonapo in reply to Canoehead]

Awesome thank you so much

[MateoBeach]

He was metastatic at diagnosis in July, called de novo metastatic. He’s done all of the right treatments so far. Good! But should now consider possible prompt use of docetaxel chemo if he is well enough to do that early rather than waiting for more advanced progression. PEACE-1 trial showed much improved outcomes for the intensive regimen in this setting. Should be discussed with his MO. Welcome.

[Simonapo in reply to MateoBeach]

Thank you so much I will discuss it with the MO

[ctflatlander]

I've had to stop the 1000mg and restart at 750mg. Still high alt/ast. Stopped again until recovered and restarted at 500 where I'm at now. That was 4 yrs ago.

[Simonapo in reply to ctflatlander]

Thank you so much, we will try that as well. Thank you again.