Short update on my fathers health and hoping to get some advise. My father started on Zytiga in October 2020. His PSA at the time was around 750 ng/mL. His lowest PSA was around March 2022, around 49 ng/mL. After that PSA started to fluctuate little bit going higher to 90 ng/ml and then next month dropping to 50 ng/mL, and again going over 100 ng/mL and dropping to around 70 ng/mL. He has multiple bone metastasis over his enteire body but the MRI and other CT scanns showed little acumulation but every report has been no significant difference or steady disease.
Over the past 3 months my father has pain mostly in his legs and hip. Another issue is having the swollen legs from the knee down. We tried to use Lasix (furosemid) to take care of the water retention ( or Edema i think it is called ) but not much sucess in that regards. His shugar level is also lower this past 1 month and he is no diabetic. It is around 3.9 mmol/L. We are unable to find good doctor who can give us some advice or which specialist to see. ( We live in Serbia by the way). My father also has low mobility past 2 months because of swollen legs and pain.
One doctor recomended to stop taking Prednisone for 7 days, not sure if that is ok to do.
Has anyone else have similar issues and any advice will be helpful.
Thank you to anyone taking the time to read this post or give the advice.
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pozitronij
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Zytiga may cause an increase in aldosterone and this is associated with edema, hypertension and low potassium.
He needs to increase Prednisone to 10 mg if he is taking only 5 mg and he needs to have the electrolytes measured to see if he has hypokalemia which may cause heart arrhythmias.
If increasing prednisone doe not improve the edema he could be treated with eplerenone (inspra) which is an specific aldosterone receptor blocker. If inspra is not available he could be treated with spironolactone.
Zytiga does not block the production of Aldosterone in the suprarrenal glands. When cortisol goes down because of Zytiga there is an increase in ACTH which eventually leads to hypertrophy of the suprarenal glands and increased production of Aldosterone.
Prednisone is given with Zytiga to avoid the increase in ACTH. Enough corticosteroids should be given to avoid this increase. This is variable person to person.
If he is taking 10 mg of prednisone or 1 mg of dexamethasone and his potassium and blood pressure were normal , the cause of the edema most probable is not related to zytiga. He needs to be seen by an internal medicine doctor sooner than later.
Any of the doctors just don't pay attention on the monthly analysis he does, so nobody told him to try and measure potassium. Tomorrow he will do analysis of all what you mentioned so we can see what is the next step. Thank you for the advices
My father just got some results back. And looks like everything is in the normal ranges. Potassium is 4.7 mmol/L.
Na 142 mmol/L
Cl 99 mmol/L
Mg 0.9 mmol/L
His Insulin is 13.96 uU/mL.
Probably will have to look for the answer somewhere else, not sure if trying eplerenone could help him to try it and how long could take if it is working to see the results. Since he does't have DVT most likely then is the issue with Heart ?.. Thank you for the info you provided lastnight.
I would suggest that he is not taking enough prednisone. Edema, high blood pressure, and low serum potassium are symptoms of not taking enough prednisone with Zytiga. He should never stop taking prednisone suddenly - it causes a rebound effect which will make symptoms worse. Increment up to a higher dose instead - try an extra 2.5 mg (total 7.5 mg). If that's not enough, try an extra 5 mg (total 10 mg). If that doesn't do the trick, try 0.5 mg dexamethasone instead. Take it in the morning - he will have trouble sleeping if he takes it at night.
Thank you for the replay Allen. My father is taking 10mg of prednisone for almost a year, and he had been taking 0.5 mg of dexamethasone last 2 months. But he has trouble with Edema. I guess it is not advisable to go with higher doses. We will try to find the doctor and present the things mentioned here. On the last EKG he also had something little different on the test compared with previous EKG. I will have to get back on that as well
My guess is stopping Prednisone will make it worse. As others have said, increase Prednisone to 10mg. I've been through this exercise so I have experience.
As was discussed above, Zytiga can increase the amount of Aldosterone, a mineralocortocoid. This happens because Zytiga doesn't shut the production down of Aldosterone and without the feedback from the corticosteroids (cortisol), the adrenal gland cranks out more. Taking Prednisone tells the adrenal gland that there is enough Aldosterone.
Thank you for the replay. Did you solved the issue by taking Prednisone of 10mg. Unfortunately my father has been taking prednisone of 10mg and he has this issue. Also he just told me that past few days he has low blood pressure, not sure if low potassium can cause that. He will do some analysis tomorrow and i will update this post
I was taking Dexamethasone, another steroid that is stronger than Prednisone but taken in lower doses to be equivalent. I was taking .5mg of Dexamethasone which is roughly equivalent to 5mg of Prednisone. I had to go up to 1mg (equivalent to 10mg Prednsione) to stop the feet and leg swelling. I tried going back down again but immediately had the feet and leg swelling come back and then resolve again at the higher dose.
I know that Zytiga can cause low potassium (hypokalemia), but from what I know that increases blood pressure. Best to talk to a doctor.
Too much Aldosterone will cause low potassium, but also raises blood pressure. Again, I'm not a doctor but I would think that increasing the amount of steroids to see if things improve should be safe to try. Based on my experience things improve quickly, beginning within a few hours.
Thank you so much for the reply and advises. My father will do more lab tests tomorrow so we can present to the doctor if we can find good one. Since most of the doctors that we have access too are really bad. And I am saying that after years of trouble, most of the advices they are giving are completely wrong, and it takes so much effort to find the answer. And it usually came from this form after we present to the doctors. My father lives in Kosovo and there is very low quality of doctors.
I would also try Dexamethasone. It's another steroid like Prednisone, only it's stronger so the dose is less. So 1mg per day of Dexamethasone would substitute for 10mg per day of Prednisone.
Possibly yes, since he was taki g just 0.5 dexamethasone past 1 month, but he had on 10mg of prednisone swollen legs to then he made switch to dexamethasone of 0.5mg but that was mistake he should have taken 1mg. Probably that made things little bit worse. Thank yoi
My father just got some results back. And looks like everything is in the normal ranges.
Potassium is 4.7 mmol/L.
Na 142 mmol/L
Cl 99 mmol/L
Mg 0.9 mmol/L
His Insulin is 13.96 uU/mL.
Not sure if having low dosage of dexamethasone caused the issue of having legs swollen more. He will continue with 1mg of dexamethasone but not sure how long could take to see the results if it is working.
I'm off Zytiga now and still having this problem with feet and lower legs swelling/fluid retention.
I'm trying to get off the steroids, but this takes time after being on them for years. I have found that 1 mg of dexamathasone works for me, but not .5mg daily. As soon as it wears off, my feet start swelling again. If it's going to work for him, he should know right away, that's how it's been for me. I've been trying to get off this steroid so I keep trying to drop the level and every time I get the swelling. I've done this many times now.
Yes, he did the test today, and the legs get very swollen. When he presses with finger on the leg it looks as it put a mark on the leg that stays for some time
Unfortunately no, he took 1mg around 8 AM today of Dexamethasone, and he took again Lasix 1h ago, around 5PM, ( Serbian time) and his legs are very swollen.
It did take me several days to get them back down, that's also with trying to elevate my feet above my heart whenever possible. Of course, it might also be something else so best to talk to the doctors, they know more than we do here.
Of course, but thanks for the conversation and ideas. Since it certainly helps to talk with doctors and either understand them better or point out important stuff that otherwise we could missed to mention
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