Zytiga and Atrial Fibrillation

[Dastardly]

I have been taking 1000mg Zytiga and 5mg Prednisolone daily since March 2022, and have been poodling along quite happily until October. This is when my blood pressure began to rise noticeably with quite a number of Systolic readings over 150. On Thursday October 20th, I suffered quite severe palpitations and got in touch with my Oncologist who told me to stop taking Zytiga with immediate effect, but to carry on with the Prednisolone. The palpitations continued and I ended up at my local hospital in A&E, who then referred me to the Cardiology department. I live in the UK and. although health care is free, it is not quick, so I could be waiting for some time before getting that Cardiology appointment.

In the meantime, I had a clinic meeting (by telephone) with my Oncologist who told me the policy is to withdraw Zytiga until I have been seen by Cardiology and my Atrial Fibrillation has been fully investigated. I have now come off Prednisolone as well. My Oncologist is due to call back in 4 weeks to check on any progress.

As I see it, The AF could be down to the Zytiga, or maybe even the Prednisolone if Cortisol levels have got too low.

Now this situation is not as clear cut as you might think. My palpitations started around 08:30 on October 20th. The previous day, at 09:00, I had a 4mg infusion of Zometa.

Now, my Oncologist doesn't think the AF is down to the Zometa................ but I can't help wondering.

I would appreciate any opinions or advice as to where I might go from here.

Thanks guys. Much appreciated.

[TylexGP]

Sorry to hear about the Afib. I actually was diagnosed with Afib a year before my PCA DX. I had a semi-successful ablation but am still on Afib meds and a blood thinner. I have been on Lupron and Zytiga for almost 18 months with the Afib being well controlled. Maybe this was a new onset Afib that was not caused by the Zytiga unfortunately you will not know for sure, but wanted to share it is possible to manage Afib and take Zytiga.

[Dastardly in reply to TylexGP]

Hi TylexGP I don't think much is going to happen in the short term until I have seen the cardiologist. After that, who knows. Good to know that you can deal with both Zytiga and AF though.

Many thanks.

[tango65]

If the blood pressure started to go up it may be an indication that despite of the prednisone zytiga was causing an elevated production of Aldosterone.

This hormone causes an increase in sodium reabsorption, water retention and potassium elimination. Consequently there is hypertension , edema and hypokalemia which could cause arrhythmias.

To control this situation the doctors may increase the dose of prednisone or they could add eplerenone (Inspra) which is a specific aldosterone receptor blocker.

Consider to talk with your doctor to see if you can get the electrolytes checked.

[Dastardly in reply to tango65]

Thanks Tango,I had never even considered Aldesterone and will certainly follow through on your suggestion. I have had an irregular heartbeat for years in the firm of atrial ectopics and had got used to how it feels. What seems to have happened here is that my ectopics have suddenly been given a huge dose of speed (or whatever) and have gone berserk. It was literally that sudden. That is why I suspected the Zometa. I am due another infusion in January, but I think I can live without it.

Cheers.

[Chrisbaird]

Hi Dastardly I’m uk too stage 3. on zytiga n prednisone started on 1000gm zytiga Nov 2020 5 gm prednisone with monthly protrap injections after 2 months had to come off Zytiga with liver enzymes increased BP. But carried on with prednisone daily Tested a month later and liver was fine so have since been on 500 gm zytiga and PSA has remained low last 17 months 0.01 > hope your dosages help with improvements

[Dastardly in reply to Chrisbaird]

Hi Chris,Thanks for your response. My onco talked about the possibility of going back on Zytiga at a lower dose, much as you have. I feel a bit like Forrest Gump at the moment. Stage 4 PC is like a box of chocolates, you never know what you're going to get.

Good film though

[hg115pb]

I would agree with tango. Increasing blood pressure may indicate the need for more prednisone As they treat the a fib talk to your oncologist re increasing your prednisolone

[Dastardly in reply to hg115pb]

Thanks hg115pb

I am certainly going to take this further.

All the best

[Kcski]

Sorry about your trouble. My Dad started with Chemo, Taxare, and had awesome results. It killed a ton of cancer. Maybe you could switch to that?

[Dastardly in reply to Kcski]

I had 6 cycles of Taxane (Docetaxel) in 2019 and ended with PSA undetectable. Since then, Bone and CT scans showed additional metastases, hence the addition of Zytiga and Prednisolone.Glad to hear that chemo worked well for your dad and I wish him well. And you of course.