I have stage 4 +4 Gleeson Psa which got out of the prostrate into the blood stream into some of the bones and some spots on the lungs .Very lucky to have one on one with the professor .Had a zap of radiation originally 10 months ago to stop pressure on the neck and this released pain in the neck arm and right leg.Had tests on the prostate which we already knew the result as the horse Had "bolted".Started Firmagon in January and now inject my self monthly,Had 6 rounds of Doxetaxel finished that around 8 weeks ago .PSA down from 370 originally to last week of 0.08.The professor says i have had a great result,He mentioned it probably will not come down any further .Question i ask is in December i probably go onto Zytiga .I have a a fairly fit and healthy lifestyle but was diagnosed with pagets disease around 20 years ago but does not affect me .Wondering if it may increase the bone weakness on Zytiga and is there an alternative ? I have also slightly high BP and that worries me a little.I am 73. I do realise i am very lucky compared to some of the stories i read here
Regards Brian
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Brianne07
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no i am not on Zometia but did indicate to to the professor a few month ago should i go onto something which would make sense but at the time he did not seemed to be to worried about it .But have read a few answers here now that maybe i should be on something?
Why would you like to start Zytiga plus Prednisone?
I am more than 4 years on Firmagon injections alone and my PSA started to rise a year ago from 0.2 to 1.5 and a drop to 1.4 in the middle of my Degarelix injection cycle.
I have a similar concern like you with Abiraterone plus Prednisone.
I am also afraid of the high blood pressure.
The problem (change) is to balance the apsorbed Abiraterone dose with the appropriate Prednisone.
If you don't match the absorbed Abiraterone dose with the appropriate Prednisone that could cause high blood pressure.
I am talking about this not from my own experience (I am not using Abiraterone plus Prednisone) but more from what I read here about the varying absorbed dose.
The most constant absorbed dose of the Abiraterone is achieved when taken on an empty stomach.
If you take a reduced Abiraterone dose (in order to save money) with the light meals than you could run into a problem with the absorbed dose not being the same all the time during your treatment with Zytiga.
Therefore you would have a problem to match it with the appropriate amount of Prednisone in order to avoid high blood pressure.
Again, maybe I am overly cautious about this. Maybe everything will work out fine for you?
My bone mineral density is dropping and I am not really sure would taking Prednisone help with that? Probably not. Or maybe i am just overthinking this issue.
The last but not least is the liver effects of the Zytiga.
I can see here that people usually stop Zytiga after 5 years of use as the liver starts to present toxic effects of the Abiraterone plus Prednisone.
I am going to radiate my prostate now as I am castrate resistant (the PSA is rising) and don't want that the CRPC strains live the prostate and invade the rectum and the bladder etc.
Apperantly the radiation of my prostate will not extend my life but save me lots of potential trouble down the road by avoiding (minimizing) invasion of the rectum and surroundings by the CRPC.
Was Zytiga your idea? I am asking this as your PSA is really low.
I believe the newest data indicates that earlier adoption of drugs like abiraterone prolongs life better than doing ADT waiting for PSA to rise and adding Abiraterone. The difference is significant. I am on abiraterone and do take medications for hypertension that I never had but it is controlled. The dose of prednisone is so small in my case (5mg) that it should not have a major impact on bone density but lack of testosterone will. The liver toxicity is easily detectable. Many do not have it. It is usually early and often goes away with time. I do not think serious liver damage has been detected very often just elevated liver tests.
I asked the medical oncologist registra about estrogen patches but it looks that they don't know or that they don't want to give it to you once you are on ADT.
I know that it is good for the bones.
I will see soon the endocrinologist regarding my bone density and should ask him for estrogen patches. I just hope that I will remember that question...
I did ask the endocrinologist about low dose estrogen patches but he said no. We didn't go into deep discussion about why not.
I am osteoporotic after 5 years on firmagon injections with the t score of -2.5. I am still hspc. my last PSA was 0.23 6 months after sbrt of my prostate with Electa Unity MRI guided linear accelerator made in Sweden. My PSA was 1.4 before the radiation.
Discuss having Denosumab or zoledronic acid. Castration and zytiga will reduce the bone density. These drugs reduce reabsorption of the bone and may increase or maintain the bone density. Talk about having a DEXA scan done, to have a basal bone density value.
I am on Denusomab as well. Some of my mets are in my hip socket. Unfortunately I need a hip replacement but can't get it as the bone is weak and could fracture badly. Then they would cut off my hip ball and it's wheelchair/crutches time.
It was already there when I got my DX. I guess it wouldn't have helped as I was told. My Uro at the time was not a lot of help as far as what to do. He just did SOC and out the door.
I have been on zytiga and some form of steroid since June 2018. Had a baseline bone densitometry and one a year later where I had lost a little density. Have been getting annual zoledronic acid infusion since and bones seem to be holding their own.
What is your t score now? My was -2.5 and they want me on yearly zoledronic acid infusion as well but I am hesitant. It is a difficult decision for me as I feel fine now. I am also afraid about the immune system effect of the zoledronic acid infusion (only my crazy idea, but I don't want to change anything until my PSA is only 0.23 on Degarelix alone and I don't have any on the psma pat scan visible Mets yet.
I asked hubby's MO at beginning to do DEXA because he was going to be on these meds. "not necessary; we all lose bone mass as we age." His primary care said I'll order one asap. Results showed osteopenia in 1 hip and osteoporosis in other hip--this was before treatments. Primary put him on Boniva; finally had a 2nd DEXA after 18 months on Boniva--apparently guideline is to wait 18 mo, between???
Anyhow, after 18 mo. on Boniva he now has osteoporosis in BOTH hips--BMD worsened while on Boniva! 18 months wasted. Boniva, Prolia and most of those drugs mentioned here just try to slow down bone breakdown//loss. There are new drugs out that actually reduce bone loss AND build bones/increase BMD--they require injection daily for 2 years, and Jeff says he won't do that. The best one is the newest but only FDA approved for menopausal women--primary care is trying to get Jeff on that one--there have been some trials/studies on men and looked good. This one requires monthly injection in dr. office for 1 year--then put on Denusomab for a year or more (?) but apparently the bone building of new drug continues.
It isn't going to do hubby a lot of good just to stop bone loss--he needs his bones built up.
So, my 2 cents: insist on DEXA before starting any of these meds and get follow ups to assess BMD. also, bisphosphonates can cause eye problems...conjunctivitis, blurred vision, eye pain, and inflammation--we think this might be why Hubby's eyesight is deteriorating after being great for 4 years after cataract surgery--he needs oof of the bisphosphonates
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