Moving along

[Dastardly]

I have now had 4 straight increases in PSA during the past year, but it is still only 0.52. My latest bone scan shows increased activity in the lower spine and new activity in my right leg. My consultant has talked about adding either Xtandi or Zytiga. Having read about the PEACE1 trial, I am favouring Zytiga. Is this the right choice? Should one always be taken before the other and which has the worst side effects?

My consultant also wants me to start taking Zometa intravenously every 8-12 weeks. Anything I should be aware of concerning this?

The only treatment I am on currently on is 3 monthly implants of Zoladex.

As always, I am very grateful to those who respond to my questions. I know we are not alone and all that, but sometimes, it feels that way.

Many thanks

[Magnus1964]

Everyone responds differently to medications. For me zytiga had less side effects than xtandi.

You might consider Xofigo for bone metastasis.

[tango65]

The results of the PEACE 1 trial only apply to de novo castration sensitive metastatic cancer.

Zytiga or enzalutamide are both effective in controlling the cancer for a while. I do not know of any study comparing zytiga against enzalutamide.

Zytiga may be better tolerated than enzalutamide,

If you cancer were castration resistant and have bone metastases, denosumab could be indicated, If that is not the situation, then you should have a DEXA scan and if there is osteoporosis or severe osteopenia, denosumab should be indicated.

[Dastardly in reply to tango65]

Thanks Tango. I know that PEACE1 was designed for those who are newly diagnosed, but the success of this trial gives me hope that Abi will work well for me as well. We all need hope.

[Hidden]

Your bone scan showed increased activity with a PSA at 0.52? I need to rethink my treatment plan. thank you.

[Shooter1 in reply to Hidden]

I have a large increase in my mets at PSA of 0.51 from 0.24 thirty days earlier... Now going in for RT to hit those mets and hope to get rid of the pain.... Only showing 2 mets in my entire body. One is new, one was treated last year when it popped up.

[Hidden in reply to Shooter1]

Mr. Shooter1, What type of scan showed the mets increase? All this time I have been led to believe that a ct and/or bone scan doesn't show anything until a PSA reaches 2.0.

[Shooter1 in reply to Hidden]

Last year the 2 mets I had at that time did not appear on standard CT or bone scan...NaF-18 showed them nicely... This latest scan, normal CT and Bone scan, showed large recurrence on previously treated 'sitz' bone and nice bright rib met. All at only 0.51 PSA. Regular scans are required by my insurance before new scans will be covered.... This time the cheaper regular scans showed mets thus saving insurance company money...

[Hidden in reply to Shooter1]

Thanks, now I have to rethink a heck of a lot of things.

[Tall_Allen]

It is way too late for a PEACE1 kind of treatment - that is only for newly diagnosed men.

Zytiga -> Xtandi seems to last longer then Xtandi ->Zytiga:

thelancet.com/action/showPd...

Zometa should be taken every 3 weeks, not 3 months. But I think you should get a DEXA scan before deciding.

[Dastardly]

Thanks for the Lancet link TA - very interesting. I may have misunderstood the frequency of Zometa but will, of course check it out. I had a Dexa scan on Dec 24 2020 and was diagnosed with Osteopenia at the lumbar spine.

[SteveTheJ]

IMHO, get a bone density test before you start Zometa or anything similar. I've heard the side effects are very unpleasant. Why take it if you don't need to?

[CAMPSOUPS in reply to SteveTheJ]

He should ask his Dr. for reason Zometa is being recommended. If you look at his bio he had widespread bone mets at diagnosis and he is 77 years old. Could be bone damage and risk of fracture could be higher than risk of side effects. Zometa can also slow bone met progression.Side effects vary greatly from person to person.

Anyway best to ask his Dr. why the Zometa recommendation IMHO.

[sgtmac52d]

What was your initial Treatment, Radiation, Surgery ? .. I was diagnosed in May 2019. I have been <0.1 last 2.5+ years. Lowest was 0.008 in 2020. in Dec and recently went up to 0.016. Jan 2022. I had Clear Margins No Invasion of Lymph Nodes or Seminal Vessel. I had a Gleason of 4+3=7 with a Tertiary Gleason 5 less than 5% that isn`t good. my PSA at Surgery was 4.5. Dr said it did not Spread .. but do not know now so time will tell. Good luck Sir.