Hubby dx in Jan. 2020 and began ADT right away; had 8 weeks proton full pelvic and all scans and tests have been good until now. His T and PSA were declining with every test; he started Zytiga on Sept 10 AFTER his tests; yesterday his PSA and T were more than double 2 months ago; Zytiga SHOULD have made T go down so big worry. Does anyone know any reason why Zytiga would make PSA jump from 0.54 to 0.93 and T jump from 41.3 to 86?
thanks for any suggestions
The PSA increase could be explained by the elevation of testosterone above castration levels..
If he is in ADT with Lupron or similar and he is taking Zytiga as instructed it seems impossible that the testosterone will increase from 41 to 86. Zytiga is supposed to block all production of testosterone in the body. Since this is very unlikely, you could request to repeat the tests and be sure you are dealing with a real situation.
Thanks--we thought exactly what you have also said; he takes (2) 500mg tabs in middle of night so he hasn't eaten and will not eat for several hours; he takes the (1) 10mg prednisone with dinner so he has food in stomach. He has been on Eligard every 3 mo. after his 1st Degarelix injection; as mentioned, PSA and T were going down steadily through Sept and only change is adding the Zytiga and prednisone--he has said those 2 pills make him feel better, so very puzzled. thanks again
> he takes (2) 500mg tabs
Curious. Is there a reason for non standard dosage ?
1000mg IS standard dosage, along with 10mg prednisone--either 4-250mg or 2-500mg pills
Oh sorry you are right. I read it as 2 *250 = 500. Thank you
no problem--always good to check 
PSA can jump at the start of any new therapy because of dying prostate cancer cells, but in this case, it is because his T increased. Adding Zytiga to whatever kind of ADT he is using (Lupron?) should not make his T go up. Keep the Zytiga, but try switching to another kind of ADT (Degarelix, Orgovyx, etc.)
Also, retest T - it could be a lab error.
Thanks, TA--we're hoping it IS a lab error and plan to retest in 6 weeks. He had Degarelix as 1st shot to avoid any T flare; next injections have all been the 3 mo. Eligard which has worked well for him with no side effects--or maybe no side effects means it isn't working?? But T and PSA were dropping--hoping this is some kind of fluke. I assume if his T continues to rise that his MO will switch his Eligard to something else--at least we will know to ask. Scans after Proton finished looked really good with "suspicious iliac nodes no longer seen. Prostate was a little smaller but RO said it would take a year to shrink it...especially since it was SO largethanks again for your opinion--always find it reassuring!
As mentioned earlier, husband’s PSA and T increased 2 months after starting Zytiga and Prednisone. He also started taking Ionic Zinc and Quercetin at same time as Zytiga. PSA and T had been steadily going down for the 9 months he’d been on ADT (Eligard). SO, the ONLY change between steady reduction on ADT and the PSA & T increase, is adding Zytiga, Ionic Zinc and Quercetin.
1st article indicates quercetin should interfere with PSA activity and that it acts like an antiandrogen too—blocking AR.
Another article indicates how good Quercetin is at fighting prostate cancer but then 2nd article says it might increase production of testosterone; this makes me wonder if he should stop Quercetin????
Seems as if the ADT + Zytiga+ quercetin would be a triple whammy, stopping testes from producing T, stopping production of T in other organs and preventing T from binding to cancer cells--sounds great until you think about it also preventing T from being excreted, and that it might be protecting the testes, thus increasing the levels of circulating T…the good news/bad news scenario.
pubmed.ncbi.nlm.nih.gov/343... 2021 Jun
“Therapeutic effects of quercetin have been assessed in diverse cancers including prostate cancer through the establishment of in vitro and in vivo experiments. Moreover, this agent might prevent the initiation of this type of cancer as it indirectly blocks the activity of promoters of two important genes in the pathogenesis of prostate cancer i.e. androgen receptor (AR) and prostate specific antigen (PSA).”
Then why has PSA increased since starting quercetin + Ionic Zinc+ Zytiga? Answer may be in next article??
supplementsinreview.com/tes... October 15, 2017
“Decreasing T excretion: Early research suggests that quercetin reduces the activity of an enzyme needed to remove testosterone from the body through urine. UGT2B17 is an enzyme that converts testosterone into testosterone glucuronide – the form in which it can be excreted out of the body through urine. This has the effect of lowering your circulating testosterone levels. Quercetin has been shown to inhibit this enzyme’s activity by as much as 72% in isolated cell culture, meaning that the excretion of testosterone is slowed down, and its circulating levels are increased.
In addition, there is early research evidence that quercetin can protect the prostate and testes and even boost testosterone levels, especially in the context of health disorders such as diabetes. Because of this, it is sometimes included as an ingredient in testosterone booster formulas.”
IS it possible quercetin has caused T level increase?
I am guessing this would mean Quercetin is working opposite of what Zytiga and ADT are trying to do. IF SO, we need to take him off Quercetin.
any thoughts? Comments? Corrections to my theories?
While hoping the blood work from 11/11 was a fluke, Hubby had another test 11/29 and both levels still elevated—done by different lab, so both can’t be lab error.
Everything works in mice.
do you think the Quercetin "could be" the problem? I hate to think Eligard could be failing after only 10 months. just too much of coincidence that numbers go up when Zytiga+ Quercetin + Ionic zinc started and NO other changes. guess it might be a good idea if he stopped the Q and zinc?? sort of a test to see if things go back to normal??
another question since you are SO knowledgeable: I have been begging MO for genome test for hubby since March and FINALLY they are ordering kit. I have done lots of research on genome sequencing, etc, but not sure I understand it all--my main takeaway is that cell mutations in cancer cells can show which "available" drugs might work or won't work on certain people.
IS IT POSSIBLE that results might show Zytiga isn't a drug that will work on him?
I really appreciate anything you might be able to tell me--we are so nervous about this increase, even though small compared to other men, and we're grasping at anything
Sorry to see your anxiety. It's one of the worst aspects of this I think.I'm not a research scientist and I guess you aren't either so yea. Stop the Q and zinc NOW.
If you believe that strongly in Q then eat instead:
Organic Kale
Organic red onions
Organic Rainbow chard.
Organic mushrooms.
Etc.
Rough cut them up and simmer in a bowl of MIso soup. (minus the onions --and if available add seaweed, abragi, sesame seeds, shrimp some days, my personal taste)
I really have no idea - I haven't seen any studies of it in men with PCa. Does it interfere with ROS formation (needed to kill cancer cells)? Does it increase the speed of liver clearance of other medicines?
No, the genome tests won't rule out Zytiga. They usually don't suggest any new therapy - but why not try? There is a test for AR-V7 that can predict a shorter effective life for Zytiga, but I never understood why do it - just take the Zytiga and find out. I find IHC tests more useful than genomic tests, usually.
I found an article, but cannot access it: "Abiraterone acetate: a potential source of interference in testosterone assays." Might be worth checking out.
It is probably the PSA bounce. Starting any ADT drug causes an initial PSA increase due to dying cancer cells.
“Zytiga SHOULD have made T go down so big worry.”
OK I’m a little confused as usual. I thought Zytiga, along with Xtandi and Casodex were anti-androgens. They keep the cancer from using the testosterone not lower it?
No, abiraterone acts on the CYP17A1 enzyme activity to reduce the production of androgens.
It is unlike an antiandrogen such as casodex, which acts on the androgen receptor (and by blocking the receptor, allows for an INCREASE in circulating testosterone... mine went up to 1500 when on casodex, but T is now around 5 on Zytiga).
PSA can get erratic during and after treatment.
Start doing monthly PSA tests. Don't think to worry unless you see a pattern over 3 consecutive monthly PSA tests.
It's the trajectory, not the absolute number, you must worry about.
I had my PSA under control for 22 years. After RP. When my PSA reached 15 I started new medication. I had Lupron, Casodex,Radiation.In 2019 when PSA went back up to 15 I started on Zytiga and one month later it went to 50 and three months later was 126. I then opted for Chemo(Taxotere) but that did not work. I started Lynparza in September 2021 and PSA is now 146.
Zytiga and PSA
Slow rising PSA. Wait and watch?
Low T Levels or Low PSA-which is more important ?
Stopping Zytiga d/t side effects
PSA increase .08 to .15
