Dx 9 yrs plus ago with Gleason 9, PSA in the 40s and 4-5 bone mets and 1 lymph node in stomach area (which was removed). Been on Lupron and Zytiga since dx (with 3 vacations yrs ago. )
Had prostate removed shortly after dx and radiation of largest tumor 8 yrs ago. Based upon last 2 labs which showed minimal increases in PSA from .06 to .07 to . 10 , the treatment MIGHT be starting to fail.
Curious what might follow Lupron and Zytiga and what my options would be: Chemo- or some other med?
Many thx for your input
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jfoesq
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Your numbers are still low,, but I understand your concern with the steady increase. It is typical for doctors to prescribe Xtandi (enzalutamide) after zytiga stops working. It is another second generation androgen blocker, but works differently. It interrupts the metabolism of testosterone within the cancer cell.
An easy thing that is worth a try and sometimes extends the effects of Zytiga is to switch from prednisone to dexamethasone.If a no go then the switch to Xtandi is common.
My dad has stage-4 prostate. I also had my prostate removed for stage 3b, 7 years ago...had biochemical recurrence, and had radiation 4.5 years ago. My dad is getting radiation now. Talking to his radiation oncologist, he mentioned that should my cancer come back, there is a new scan called PSMA they can do and then zap the individual tumors with radiation prior to hormonal therapy...i guess maybe this might be too late for you to consider, but I'm not sure. You might want to ask your dr about it. Good luck.
Agree with above comment about PSMA PET/CT. I think more and more it is being accepted the next step in the instance of rising PSA is PET imaging not just jumping from drug to drug.
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quick drop on zytiga ... what next 
