Alternative to Zytiga/Abiraterone?

[Adendino]

My husband Jeff is 62 and was dx in Oct/22 with PSA=12, Gleason 9 (4+5), cancer in all cores, with SVI and ECE, but thankfully, the PSMA pet didn’t show any spread to nodes or bones/organs. He started Lupron in Nov/22, Abiraterone in Dec/22, and will start 8 weeks of IGRT next week.

Recent blood work is showing highly elevated liver values and it’s looking like he’s one of the few men who won’t be able to tolerate the Abiraterone because of liver toxicity. Would the appropriate alternative be to substitute Enzalutamide or Docetaxel for the Abiraterone? Or, maybe just drop the Abiraterone, not replace it, and just do Lupron with radiation??? Other than aggressive prostate cancer, he’s slim, fit, active, an athlete, and healthy.

Thanks,

Adrienne and Jeff

[Tall_Allen]

Sometimes the liver can get used to abiraterone, if you stop it and then slowly increase the dose.

[OzzieJ]

My liver readings were elevated (AST and ALT) and I had to delay a chemo session by a week. I put it down to two weight training sessions (CrossFit) the week before as these enzymes can also be generated by muscle. Once I made the connection I stopped training and they came down within 5 days. So to be safe hold off on any heavy training 4-5 days before a blood draw for liver enzymes. I note your husband is athletic which is why I make this comment, and of course, it could be the abiraterone. Best wishes.

[Chrisbaird]

Started on Zytiga jan 2021 1000 gms daily after 2 months liver enzymes @ 12 PSA laid off the tablets for a month started again 500 gms daily April 2021 my PSA continued to lower since Aug 2021 PSA 0..01 > with Zytiga 500 gms 3 monthly H T injection only down fall hot flushes day time summer Nightly throughout the year

[icanwintwice]

i was put on Lupron May21. Started Zytiga in August. Psa went to <.02. In November 22 Liver numbers blew up. Had to get off. Got back on in Dec when liver numbers receded then the liver numbers blew up again. Got off and started Erleada January 5. So far so good. Hopefully the results will be as good as they could have been w the Zytiga.

[Magnus1964]

Casodex may be a good alternative.

[Fash01]

Have you considered or studied supplementing with Tudca or milk thistle? I’ve read some interesting studies of both. Tudca in particular.

[wilcoxsaw]

Same thing happened to me. Liver numbers went up to 10 times the upper normal limit. Stopped the drug and after a month or so liver numbers went back to normal. Tried one half dose liver numbers immediately went up.

You could try the drug under your doctor's care at a lower dose and see what happens.