DRAMATIC PSA RISE W/ZYTIGA

[TomsWife]

Can anyone out there explain why my husband’s PSA rose from 96 on 01-28-22 to 539 on 03-24-22? I read the test result last night, have been up most of the night researching and came up with nothing. He did well on Xtandi for about 3-1/2 years until 03-07-22, when he was switched to Zytiga/Prednisone because his PSA had risen to 27 by 11-10-21. He has also not tolerated the Zytiga well (especially extreme fatigue), should that be relevant. We won’t be seeing his oncologist for two weeks and he is impossible to reach by phone so I am reaching out to you experts for help. I need (1) an explanation of why there’s been a 443 point PSA jump in less than two months and (2) hope for the future. Please reply so I can help my husband (and myself) cope with this devastating news. Thank you.

[GP24]

There is a cross-resistance between Xtandi and Zytiga. If you get resistant to one of them the other will work just for a couple of months or not at all. If Zytiga does not work in your case, the PSA value can rise quickly. The MO will recommend a chemo with Docetaxel when you see him.

[TomsWife in reply to GP24]

Thank you for replying. I guess we’ll find out in a couple weeks.

[Justfor_]

It is always prudent to double check labs as errors are not unknown. You need not wait for a re-test as with the two latest PSA values his doubling time is less than one month.

[TomsWife in reply to Justfor_]

I did double check the results after reading your suggestion but, alas, no change. Thank you for your post.

[Tall_Allen]

Zytiga often doesn't work for very long (if at all) after Xtandi fails. It is best to alternate chemo and hormonal therapies.

prostatecancer.news/2019/12...

[TomsWife in reply to Tall_Allen]

Thanks for responding.

[diamondrn]

Zytiga took my PSA from 140 down to around 5 for several months; then it quit working and my PSA is now up over 200. It has been discontinued while we figure out where to go next.

[TomsWife in reply to diamondrn]

I wish you the best as you figure out where to go next.

[Costarica1961]

I cannot say why, but I had the same experience just the opposite combo xtandi stopped working in two months. Chemo Was sucessful for a year plus afterwards, the side effects were there but not horrble like a lot of people believe. Individual results will vary. Get some sleep more options beyond chemo.

[TomsWife in reply to Costarica1961]

Thanks for the encouraging words. Looks like chemo will probably be next for us.

[Hidden]

We just went thru this. His oncologist put him on Jevtana with a half dose of Xtandi. I couldn’t figure out why he kept him on the Xtandi but after extensive research found that there are some stage two trials during this exact thing. It has worked but the chemo has been rough. At one point his white blood cell count dropped to 1.6. But they got it back up. He has two more sessions and we are hoping that the chemo has reactivated Xtandi so it will work longer. He was on Zytiga for 2 1/2 years before it failed. Xtandi only worked a couple months after that and he didn’t tolerate a full dose. Fine at the half dose. Don’t give up. There are still plenty of options out there.

[TomsWife in reply to Hidden]

Thank you, thank you for the encouraging words. Hope is essential in order to cope with all this.

[Foldem]

Your husband has become castrate resistant. Drugs to reduce testosterone won’t help anymore. My PSA is also over 500. To me this just a number. Ask your doctor about Xofigo (Radium 223) before doing chemo. The radium has almost no side effects, so quality of life is pretty high. Best wishes.

[TomsWife in reply to Foldem]

Good to hear you did well with Xofigo. Thanks for your input. All the best to you as you bring down that 500.

[TomsWife]

I have followed your writings on this forum for several years now and have always been impressed with the depth of your knowledge of the subject matter and your generous willingness to share it with others. I was hoping you’d reply to my post - and you did! You gave me alternatives to consider and research before our next appointment and I thank you. On question, though, what is BAT?

[Hidden]

Hope is so very important. Pat was diagnosed six years ago the first week of June. He was highly metastasized and his PSA was over 1500. Research! Ask questions! Be part of the planning for his treatment. I have fired doctors and taken issues to the Vice President of a hospital to get what I felt we needed. Don’t be shy about asking why and what options you have. I had a dr early on tell us he’d never make 10 years. I plan to send her flowers when we prove her wrong!

[whwalker1]

I had a similar experience when my PSA increased to 126 from 25 after starting on Zytiga. I had a RP in 1999 after a diagnosis with Gleason of7.My PSA was under control for 20 years with Lupron, Casodex and Radiation. My scans showed some Mets in Lymph Nodes and minor lesions in the spine over the last 5 years. Did 6 months of Taxotere infusion in 2020-2021 and PSA briefly went down to 26 but went back up to 126 3 months after Chemo.

Started Chemo pillls( Lynparza) in 2021 until March 2022 when my PSA increased from 126 to 180.

I will be starting LU-177 next week.

Thankfully I have no bone pain.

I had a difficult time with Taxotere and upon reflection I should have looked at other options.

The beat goes on!!

[j-o-h-n]

Dear Tom is 88 years old......The Chinese would consider that age to be very luck since it represents infinity twice. May his Psa drop to a level that is a sign he will be around till he's 98. God Bless!

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 03/27/2022 10:34 PM DST

[ishitasen]

Your husband's PSA level has risen significantly within a span of two months suggestive of disease progression. Most probably the Zytiga / prednisone combination is not working for him at this time and needs to change the treatment. The treatment options remaining with him are quite limited. You can try Lu-177 labelled PSMA therapy which had been approved recently by the FDA in metastatic prostate cancer.