Xtandi after Zytiga

[alperk]

MO refusing to substitute dexa for prednisone with Abiraterone since it's not FDA approved. Convinced (?) him to wait 3 weeks (4/5) for blood test after radiation of only active met to check PSA which was 0.253 on 1/21 and 0.309 on 2/21. Hoping result lets me stay on Aba as long as possible. He wants me on Xtandi but agreed to wait for blood test. I feel they are humoring me but am I at any risk in waiting or should I give up and go Ztandi right now?

[rsgdmd]

Abi may be starting to fail for me & I asked my MO about trying dexamethasone and she agreed it was worth a try. Will see when do labs in 2 weeks. What if you gave him studies? bjui-journals.onlinelibrary...

link.springer.com/article/1...

[Gearhead in reply to rsgdmd]

Please keep us posted.

[Tall_Allen]

email this to him:

bjui-journals.onlinelibrary...

[alperk]

Thanks for your quick response. I sent my MO this message: "I want to follow Dr Lipman's recommendation. If he does not believe abiraterone plus dexamethasone is a viable interim step then I should proceed with Xtandi. There has been some significant success with dexamethasone. See pubmed.ncbi.nlm.nih.gov/300... but that may not be the right choice for me. I want to keep Xtandi in my quiver as long as possible and I look to Dr. Lipman to make that determination. It is not a question of what I want but what the team decides."

The nurse responded with the FDA requirement. Given that, I expect to go to Xtandi as advised by MO unless the blood test 4 weeks after radiation shows improvement. Do you think that is a prudent plan.

[Fightinghard]

xtandi is generally well tolerated and can knock down the pca for several years. I would go for it right away.

[alperk in reply to Fightinghard]

thanks for your reply. I am awaiting PSA results but considering switch from abiraterone plus prednisone to abi plus dexa so I can save xtandi for later. Can't understand my MO's reluctance to try dexa. Might need a different MO

[MateoBeach in reply to alperk]

Agree. That MO has too narrow thinking and not considering available evidence. Would not be acceptable to me. What other useful possibilities might he/she miss?

[Fightinghard]

your MO should be able to explain “why” they do not think the change to dexa would help you. Sounds like you should at least get a 2nd opinion from a different MO.

[alperk in reply to Fightinghard]

Agree. He says it's because it's not FDA approved. Will contact my summer MO who started the Aba plus P 19 months ago and is the logical choice to modify it to Aba plus dexa.

[alperk in reply to alperk]

Second opinion disagrees with dexa and presents detail defending that opinion. Xtandi it is. Thanks to all for your responses.

[Hidden in reply to alperk]

Hello sir,

May I ask what your second opinion presented in detail? I'm heading in the same direction, trying to decide on the Dexa switch protocol.

[alperk in reply to Hidden]

I provided all the study info I could find from our website and requested the switch. Here is his answer to "would you prescribe dexa" : No that would actually be a mistake, the indication for the prednisone is to make up for sensed mineralocorticoid deficiency. This is operating outside of the standard of care and this is not something I am willing to do nor what I suggested nor what I advocated. If you are having issues with abiraterone and you going to switch to enzalutamide you must come off all steroids as this preclinical and clinical data to show that glucocorticoids interfere with a novel antiandrogen such as enzalutamide that is really the only change I would recommend. The prednisone itself is not the anticancer element of the treatment nor is the dexamethasone in fact there are many downsides to that I strongly discourage it. These studies are weak data, in fact there is evidence to suggest prostate cancer cells can use the glucocorticoid pathway to grow. None of the international consensus treatment guidelines based on high level strong evidence would endorse that.

I hope this is helpful. Keep me posted on your progress. Good luck my friend.

[Hidden in reply to alperk]

I just can't thank you enough for your time sir. I have spent quite some time researching the " Anti Dexa " protocol. I never as much scratched the surface until now. I will most defiantly stay in contact, I'm very interested in the results that Xtandi produces after Zytiga runs it's course. Thanks once more sir.

Wyatt.