I’m a lucky man thanks to Zytiga and prednisone

[Histbuff]

I’ve been taking Zytiga +2 doses of prednisone daily for five years. They’ve worked wonders for me although effectiveness has started to wear off.

[Magnus1964]

You respond well to treatment. If zytiga is your first ADT drug, there are others that hopefully you respond to also. keep up the good fight.

[Tall_Allen]

Try switching from prednisone to dexamethasone- it may give the Zytiga some extra life. Send this link to your MO:

bjui-journals.onlinelibrary...

[SeosamhM in reply to Tall_Allen]

RLR (real life result) based on TA's suggestion:

I switched from pred to dex in fall of 2020 based on rising PSA. This was +4 years post mPCa diagnosis and +1.5 years post mCRPCa. So far I am +1.5 years additional on Zytiga + Dex + ADT alone.

Note that the study reference (sort of classic, by now) that TA gives for the steroid switch was based on "biochemical recurrence" (i.e., PSA rise) and not confirmed "clinical" or "radiological" progression. I do now think that the study's 56.25% of study participants (93) responding positively to the pred to dex switch (based on stabilization/lowering of PSA) may be a bit optimistic in a larger population (e.g., I am the only one in five current patients of my MO that has had a positive response to Zytiga + Dex).

However, all things considered the switch is a no brainer to try! - Joe M.

[Tall_Allen in reply to SeosamhM]

I'm glad the results were so good. I agree-- it's a no brainer to give it a try.

[SeosamhM in reply to Tall_Allen]

...even though, maddeningly, the exact reason why the switch works still seems to be elusive. There are a few resources in addition to the study discussed here:

From 2015: ncbi.nlm.nih.gov/pmc/articl...

From 2019: urotoday.com/recent-abstrac... NOTE that abstract this gives the vague hint that "Abiraterone acetate in combination with dexamethasone appeared to be especially active.."

From 2021: bmccancer.biomedcentral.com...

Still - it seems that a P to D switch should be, in the proper circumstances, part of the SOC narrative.

[Histbuff in reply to SeosamhM]

Thanks, SeosamhM. I appreciate having my eyes open to this possibility and I'm going to be discussing it with one of my oncologists this Friday. This bmc... reference that you give is extremely helpful.

[Chrisbaird]

That combination zytiga and prednisone works well for me. 500gm and 5gm daily for the past year PSA stable @ 0.01 reading monthly tests

[dhccpa in reply to Chrisbaird]

How long have you been on that combo?

[DenDoc]

Would be nice to know more about your history, your diagnostic numbers, your other treatments in the past, etc. Consider adding to your profile. Then when you post like you just did we can all understand more about what you are reporting.

[Histbuff in reply to DenDoc]

Good suggestion. I added detailed to my profile.

[Chrisbaird]

Been on that combination since Dec 20. Firstly 1000gm zytiga with 5 gm prednisone but reduced to 500gm March 21 as slight liver toxicity … added prostrap hormone injection 3 monthly hot flushes only sideline effects more so I’m summer months

[slpdvmmd]

I have been on Zytiga since June 2018. In 2020 PSA went up slightly and had an Axumin scan that really was not helpful as read at a prominent cancer center. Switched to decadron and PSA went back down for a year. When it began to go up again I got a PSMA scan in Florida before CMS approval. Demonstrated three lymph node mets in my left neck and I went to Heidelberg for radioligand therapy which as of this moment I have had a positive response to. You cannot over image in your situation and definitely need some type of PET scan. IMO probably some type of metabolic based PET (remember commonly available FDG has low sensitivity in prostate cancer) as well as a tumor marker targeted PET like a PSMA PET. If I had to do over again I would have gotten a PSMA PET in 2020.

[Histbuff in reply to slpdvmmd]

I had a PET scan in May and I was found to be free of cancer masses but now I need to have another one (because of a rising PSA) and my insurance company/Medicare won't approve it. At least not so far (as we have appealed).

[slpdvmmd in reply to Histbuff]

Insurance in any form is corrupt. I am sorry. I spend at a minimum two days a month on the phone (most on hold) with my insurance.

[Histbuff in reply to slpdvmmd]

Well... My insurance has been pretty good up til now. A couple of years ago the generic for Zytiga came out so we consulted with them and they said they would keep paying the steep costs for the Zytiga if that was my choice (which it was).

[j-o-h-n]

That's History............. time for something new..........

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 02/03/2022 11:47 PM EST

[Radtech40]

My father was diagnosed 6 years ago stage 4. He is a young 88 years old. He has been on Lupron and on and off casodex as well as xgeva for bone Mets. Onc took him off casodex 2 years ago for rising psa, he’s only had Lupron for two years and xgeva. His psa was 80 about 5 months ago, scans showed no progression. His psa now is 140 so we go Monday to talk about Zytiga or Xtandi. Does he have to try chemo before getting Xtandi because he won’t, also he has Medicare replacement, how much out of pocket are we talking about?

Thanks for any help.

[Histbuff in reply to Radtech40]

I'm no expert on these matters, Radtech, but I can respond to some of your questions. I don't see why a man would have to try chemo before switching to X-Tandi. I know that some researchers do recommend it though. Actually, I'm hoping that I'll be able to make that switch as well, but it's something of a long shot. The research that I saw indicated that an average man only gets 2-3 months out of switching from Zytiga to X-Tandi. My sense that going from Z to A only works well for about 1 in 5 patients. As for the costs, I know that there are two generics for Zytiga on the market and at least one for X-Tandi. I turned down a chance to switch to a Zytiga-generic because Zytiga has worked so well for me. I wish you and your father the best.

[Radtech40 in reply to Histbuff]

Thank you so much for your response. Monday we meet with the oncologist to go over everything. I wish you the best as well!

[Histbuff in reply to Radtech40]

What was your father's experience with Xgeva? Were the side effects okay? Did it work on his bone mets (at least for awhile)?

[Radtech40]

My dad started right at diagnosis with Xgeva, zero side effects, he is still on it 6 years in. He's never had any issues from it and it has been a miracle worker! The first 6 months he was on it, he went in for a bone scan and all of his mets were decreasing in size with 3 to 4 of them disappearing altogether! Those ones have not returned since. Now fast forward 6 years in and still on Xgeva, all of the old mets are still in remission except for one pesky one in his back that wants to grow, so he had it radiated, which radiation doesnt always get rid of them because they are stubborn, so now were starting Xtandi. He gets Xgeva every 4 weeks, he gets labs before the injection to check calcium levels. Xgeva prevents the overgrowth of the bones. If your dad has not tried it, I would definitely do it. Its not harsh and it has really done wonders for him.

[Histbuff]

Wow! That sounds like a miracle drug to me. I'm glad that it has been so effective for your dad and hope that it works that well for others (and for me if and when I get bone METS). Thanks for this detailed response.