Thanks all for tour contributions when I was experiencing Provenge side effects. My fever broke early Sunday morning! On to my new question, when I saw my MO last week, we discussed me going on Taxotere/Docetaxel. Later that afternoon my MO called me and said I did well on Erleada/apalutamide until it started making me dizzy all the time. With that in mind, my MO wants to put me on Zytiga instead. I have mets on my spine, ribs and pelvis. I’m in fairly good health. Any ideas which way I should go?
Thanks
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MJCA
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If you stopped apalutamide because of side effects and not because it was failing and the cancer progressing, you could take abiraterone instead of doing chemo.
You could take Zytiga without steroids, if the increase in aldosterone caused by zytiga is blocked by a medicine called Inspra.
The main reason to take prednisone with zytiga is to avoid the increased production of ACTH and in consequence the increase in aldosterone caused by the ACTH stimulation of the adrenal glands.
The metabolic pathway to produce aldosterone in the suprarrenals is not blocked by Zytiga, in consequence there is an icrease production of aldosterone which will cause sodium retention, water retension, hypertension and increase elimination of potassium resulting in hypokalemia and heart arrithmias.
Zytiga has been used without prednisone when using Inspra instead. Inspra is a specific aldosterone receptor blocker, an increase in aldosterone does not do too much because the receptors are blocked by inspra. It is not the SOC but it may work.
the side effects of taking steroids a very dose dependent. You body makes about 4 mg a day normally. It produces most of this early in the day. Taking 5 mg does have effects on glucose levels, cataract formation and has negative effects on bone but they are subtle. Abiraterone can give you years of life while chemo is not as likely to prolong life as much.
The amount of Prednisone is very small. Normally 5-10MG. I am taking more because my cortisol level dropped a lot and I was tired all the time. I feel fine now. No SE's from it.
The combination of Taxotere and enzalutamide was recently shown to be beneficial. Curiously, there was no benefit in combining Taxotere + abiraterone. You can also discuss combining olaparib + abiraterone, which worked in men even without BRCA mutations in the PROpel trial:
I completed Provenge with little side effects in mid October; I knew beforehand that Provenge will not lower my psa. Infact, my psa shot up from 1.1 to 4.3 between July and October; this included the time when I was Provenge. My onc put me on Xtandi on November 11; I am having very minor side effect from Xtandi. As at today my psa has dropped from 4.3 to 0.2. Let me add that, I have been on Lupron for two years. I have been drinking Japanese green tea since last week. Best to each and every one of us , Brothers.
not sure what direction you should take. It’s my understanding that each individual is different. I’ve been doing Lupron and added Xtandi about 7 months ago. My PSA is climbing slightly- up to 3.5 so my Oncologist is having me do all the Tests to see if any new tumors have formed…hopefully not, but if there is then his next plan is to forward with Taxotere/Docetaxel. I should know know next Monday. All in all I feel more comfortable with whatever treatments are in my future because it seems that better treatments are coming out all the time. Sorry for rambling on.
I would recommend the Taxotere! My dad did it for six rounds and had a ton of cancer kill! It is derived from tree bark and much more natural than Zytiga.
Zytiga just didn't work for me at all, I felt sick and weak all the time. MO took me odd it after 4 months and moved me to Docetaxel. I just finished my 2nd dose on Nov. 29th, mostly have stomach cramps and diarrhea for the first week. Not any worse than Zytiga for me, it's annoying but bearable. Hair loss started a couple weeks after the dose, but hair means nothing to if I can put the brakes on my advanced cancer.
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