zytiga reduced to 1 pill a day

[benninger]

My husband has been undetectable for over 4 years. His gleason score was 10. Stage 4 ductal cancer. His DR. wants him to reduce Zytiga to 1 pill with a low-fat breakfast he was on 4 tablets a day. Has anyone here reduced their medication and what has your outcome been.

[noahware]

The outcome should be okay, but I wonder why the doc wants to do this... the only rationale is to save money, so far as I know. (Some men may actually absorb MORE of the med doing 1 pill with food than doing 4 pills without.)

[benninger in reply to noahware]

I believe that is the reason the Dr. knows that we pay out of pocket for his prescriptions. We have never complained about the cost. He said there is enough studies out that confirms one pill with a low-fat diet is effective. I just want to be sure that this works. If anyone has tried this please give me your results.

[noahware in reply to benninger]

Well, I did some both ways and my results were that my T stayed low, but I was also on ADT. Eventually my PSA started rising, and the Zytiga failed. The problem is, how would I truly know how effective the med was when I was doing 4 w/o food vs doing 1 w/ food?

I have no way of knowing which, if either, of those two regimes was the better. If I had done only one or the other, would the med have failed even sooner? Or would I have gotten a few more months?

That's why it is probably better to go with a study that compares results for MANY men. And I think that is what your doc is doing. These studies showed it worked, its just that the EXACT amount of absorption is less predictable with the lower dose. But the fact is, even that higher dose on an empty stomach will have variable rates of absorption from man to man.

I am quite sure you can be confidant in those studies, and go with the lower dose.

[benninger in reply to noahware]

Thank you.,

[Concerned-wife in reply to benninger]

it is now included in the NCCN guidelines and you can find info on what kind of breakfast . You can find info from U of Chicago study.

[benninger in reply to Concerned-wife]

Thank you and I will be looking at the NCCN guidelines.

[DMohr011]

Gleason 9/10 with Ductal form, stage 4 here. Undetectable for over a year and have been removed from everything. DX 11/2020. I only did 6 months zytiga. Was taken off zytiga when the cancer spread before they could radiate.

MO feels my Ductal is just not normal prostate cancer and is treating differently. Hoping he is right!

[benninger in reply to DMohr011]

DX 4/2017 ductal form, stage 4 . Prostate removed 7/2017 PSA continued to rise Casodex and Lupron started 12/2017 followed with 6 chemo (Taxotere) along with Lupron . Zytiga along with Lupron started in 06/2018 . PSA has been undetectable since. Just afraid to change the course. Good luck and God bless

[Tall_Allen]

The only reason is to save money, but with abiraterone costing $187/mo through GoodRx, there may be no reason to risk uneven absorption:

goodrx.com/abiraterone

[Soumen79 in reply to Tall_Allen]

Please dont change what is working nicely

[benninger in reply to Soumen79]

We were really surprised by what the Dr. suggested. Thank you

[benninger in reply to Tall_Allen]

GoodRx is where we do buy it. Our Medicare supp. is thru a trust at the plant where he worked for 42years. It had a cap of 400,000 that we have almost depleted from paying over 8,000 a mo. for the zytiga. GoodRx has been a blessing. I know the studies state that one a day with the low fat died is ok, but I would really like to hear from someone who is on this. DR. ordered blood work in 6weeks. Going from 4 to 1 seems extreme to me.

[jptss in reply to benninger]

Im paying in Canada 3,500 out of pocket they say its the generic see if you could move to the cheaper but take the 4 pills a day like I'm doing, any savings is better than nothing I know its not about the money but maybe this will help.

[Huzzah1 in reply to jptss]

Wow, is there not a GoodRX type option in Canada? If not, head down to states and stock up on the price of $187!

[jptss in reply to Huzzah1]

id pay alot less but I had to get off the company ins plan as it would drive up the cost to my fellow workers so it was better to pay cash and try to write it off at end of year.

[pineman in reply to Tall_Allen]

Just a quick note. I've been purchasing my Abiraterone at Costco Warehouse for 119/mo. 120 250mg tablets. Cheapest that I've found anywhere. Hope this helps.

[cesces]

You will almost certainly get less accurate dosing.

The reason for the low fat dosing is that it's more accurate.

But there could be compliance benefits. Will the new regime make it easier to fit the dosing into his regular eating or preferred eating and dosing habits?

That might make it a worthwhile tradeoff. It could even be a discussion with the Doc about such matters may have prompted the change?

[Si52]

Hi, I also started with 4 Zytiga pills a day 3.5 years ago. After about 6 months, I reduced it to 3 per day. Then I further reduced it to 2 a day with low fat yoghurt, and finally to 1 a day. Then the manufacturer stopped producing 250 mg pills and only sold 500mg ones. So I am now on one 500mg pill every alternate day. For the last 2 years my PSA has fortunately remained at less than 0.01. Apart from Zytiga, I am on a quarterly Zoladex and Xgeva injections. My best wishes to you and your husband.

[benninger in reply to Si52]

Thank you for your input.

[Lettuce231]

Hello, I hope this may be of some help to you and your husband.

I have been taking 500 mg of Zytiga everyday over a period of 2 years plus. I have prednisone about an hour before the I take the Zytiga. I take the Zytiga with a fried egg on toast, followed by a yogurt, my theory is absorption.

Initially I was on 1000 mg per day taken with water.

My psa at diagnosis in 2014 was 150, it rose for a while, I had different treatments, but Zytiga, prednisone and the 3 monthly injection is working well.

Today my psa 0.045, undetectable.

If I might make a suggestion, I wonder if it might be better to gradually reduce the dose and monitor the psa, it’s working well for your husband, perhaps a tweak is better than a full stop.

I wish you both well and hope your husband enjoys his breakfast.

[benninger in reply to Lettuce231]

I am thinking the same way . Going from 4 pills to 1 seems too drastic of a change.

[Docker53 in reply to Lettuce231]

May I ask which treatmentsyou were on before. My husband had his prostate removed in 2017 for PC at a Gleason 8. His PSA after 6 weeks was 0.45 Urologist prescribed Eligard injections every 6 months. Due to the Urologist being a 4 hr drive we changed to a local Urologist and he didn't believe in Hormone therapy so he stopped the Eligard injections. So no treatment whatsoever for 3 years even though his PSA was creeping up in March 2020 my husband's PSA started rising, doubled in a few months. After Bone Scan and MRI Prostate cancer had moved to the bones, femur, hip and chest. His PSA at highest was 48. We felt our Urologist wasn't helping at all. His comments were "You know your cancer is incurable right and how long do you want to live anyway?" My husband at that time was a young 74. Needless to say we fired him and now have a new Urologist and Oncologist team. Hubby was put on 4 pills a day, Xtandi along with Xgeva injections monthly. PSA dropped to 16 over a 15 month period and then started to rise again over 5 months ago to 28. Oncologist put him on Chemotherapy for 10 sessions 1 every 3 weeks along awith Prednisone. He just finished his 6th session and his PSA rose a bit the first 3 sessions which she said was normal. It is going down slowly 🐌. However after his 4th treatment it dropped by 5 to 21.4, after his 5th it went up 0.8. Oncologist said she wasn't concerned that may happen. His next session is October 25th. He gets his blood work done day before Chemo to make sure he can proceed with next treatment. Just 4 more to go. We pray PSA keeps going in the right direction. If Chemo fails what is the next best option. Thank you for any insight that will help ease my mind. I would be lost without him. Signed Worried Wife. 😔

[Lettuce231 in reply to Docker53]

Hello, I'm so sorry to hear of your dilemma, " no treatment whatsoever for 3 years " that's disgraceful, plus " how long do you want to live anyway " I feel very upset for you.

I can certainly tell you what treatments I had before the current one's, but I can't advise you. I think what I would do is re-post on this sight again, I'm sure you will receive the help you need to the question " if chemo fails ", also you might hear from people who it has worked for.

I was eventually diagnosed in 2014, after seeing a quack who did nothing in 2013 when I had a PSA of 130. My Gleason was 7. I have had Lupron continuously all the way through, but reduced the time period to 3 monthly shots as opposed to 6 monthly, I found the secondary effects difficult to cope with, it worked for me.

I began with casodex 50 mg + 30 mg of Lupron.

Then it was switched to 50 mg of Androcur + 30 mg Lupron.

The PSA came down, but rapidly rose again. In September of 2018 I was switched to Zytiga and prednisone along with Lupron, the PSA at that time was 9.58 about a year later it was down to 0.527.

My situation is very different to the one that you are facing, my treatment process would not be the same for your husband. Please re-post pretty much what you have written to me, I'll watch for it and will be interested in the response.

In the meantime my heart goes out to you " worried wife " my worried wife and I send you and your husband a huge hug.

[Docker53 in reply to Lettuce231]

Thank you for your feedback. Greatly appreciated

[Lettuce231 in reply to Docker53]

you are welcome 🙏

[benninger in reply to Lettuce231]

Many prayers for you and your husband we have been married for 58 years and he is my life too

[Lettuce231 in reply to benninger]

did you mean to send this to Docker53 ?

[winkoliu]

Reduce dose mainly for reducing side effects. I support what Lettuce231 said it might be better to gradually reduce the dose and monitor the psa.

[NRH_Beach]

After being on - and responsive - to Zytega for -3 years, I would welcome a recommendation to get a therapeutic dose more efficiently. The insight on Zytiga efficacy being dependent on fat content is emerging as it is used more widely.

I am on a Zytiga/ADT vacation right now. Based on my history (BRCA2-fueled aggressive APC). Although Zytiga was wearing me down, it is difficult to keep a positive outlook now that I am off therapy.

[benninger in reply to NRH_Beach]

My husband also has the ATM gene.

[benninger]

Will be doing a lot of reading, thank you

[Foldem]

I took this alternative. 1 pill rather than 4. It works just as well. Make sure to understand what the breakfast should be. You want some thing with fat in it.

[benninger in reply to Foldem]

I thought it was to be a low-fat breakfast. Could you tell me what you usually have for breakfast

[reb77]

I've been taking one Zytiga pill a day with food for about a year now. As before, PSA continues <.1.

[benninger in reply to reb77]

thank you

[benninger in reply to benninger]

thank you

[earstohear]

I started to split my Zytiga pills when J&J cancelled my free shipments. After 15 weeks of 250mg Zytiga with a low fat breakfast (cup of corn flakes with one cup whole milk) my PSA and T remain undetectable (been so for years). I fast two hours before and one hour after.

My MO is unhappy with me and refuses to change my medicine list from (2) 500mg tablets daily. Deep sigh.