Update on "Zytiga failed, Xtandi next" from 8 days ago

[alperk]

My "winter" MO (Fl vs Mass) says the active hip lesion means the Zytiga is failing, at least at that one area only but recommends Xtandi and I am now hormone resistant after 19 months on ADT plus Zytiga/prednisone.

I asked my "summer" MO the following.

"Is it possible that the hip lesion is the location where Zytiga failed causing PSA rise and if treated all others are responding OK ? If so, can I therefore postpone Xtandi or should I stop grasping for straws and just start Xtandi. I have a PSA test scheduled for April 5, 3 weeks after radiation completion. Thanks."

His response

"You are describing is what we call oligo progression and the few lesions that might show growth may be what I call Rogue clones and usually what I do is not stop or change the current treatment and just add stereotactic radiation to the areas that showed progression usually 3 lesions or less".

I forwarded that to my RO and he responded:

"I agree… Usually if it’s just a site or two that looks like it’s active we would use a more dominant modality like radiation and just knock it out and then watch the PSA… If it does not continue to rise after xrt you leave them on the same treatment."

This is fantastic news if PSA responds as hoped and means, I believe, that I am still hormone sensitive and a treatment change is unwarranted.

I will look for comments and provide updates for anyone in a similar situation.

[Tall_Allen]

That is exactly what we are doing with my friend - zapping the single active hip lesion and sticking with ADT+Zytiga.

[David1567 in reply to Tall_Allen]

Same with my husband. We thought abiraterone had failed after just 3 months but progression was only on 2 liver Mets. He just finished 3 sbrt sessions to his liver and we will see if the abiraterone and dexamethasone can work for him now. Hopefully he can stay on abi for awhile! 🙏 Still worried why abi didn’t work on the liver Mets though.

[Tall_Allen in reply to David1567]

Unfortunately, metastases will always become resistant to whatever one throws at them, and there will always be new metastases. It is the nature of cancer.

[j-o-h-n in reply to Tall_Allen]

Just like the IRS and taxes..........

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 03/14/2023 5:22 PM DST

[tango65]

I did the same with 2 retroperitoneal mets and I continued with ADT and darolutamide. The mets are gone.

[Toth]

Thank you for this post. I didn’t realize treatment could be so nuanced. When my Zytiga stopped working I was put on Xtandi, which failed to work for me and also had many side effects for me. But we all have different DNA and different cancers. Zytiga may work wonders for some individuals, I suppose.

Yin-Yin

[alperk]

Update on last post. PSA .253 on 1/23,.309 on 2/21 prompted Plarify scan which showed hip lesion (only one active). PSA on 4/4 was encouraging dropping to .24, BUT on 5/23 PSA increased to .343. So, am I hormone resistant now and should switch from Zytiga to Xtandi or wait a few months for another PSA check ? Very disappointed.